C1 · Advanced
13 min
global healthinfectious diseasehumanitarian crisisconflict zones
The Virus That Returns: Ebola in the Congo
El Virus que Regresa: Ébola en el Congo
A new Ebola outbreak has been confirmed in Ituri Province, in the Democratic Republic of the Congo, with at least 65 dead. Fletcher and Octavio dig into the history of the virus, why Congo keeps bearing the brunt, and what this tells us about the fragility of health systems in conflict zones.
Un nuevo brote de ébola ha sido confirmado en la provincia de Ituri, en la República Democrática del Congo, con al menos 65 muertos. Fletcher y Octavio exploran la historia del virus, por qué el Congo sigue siendo el epicentro, y qué dice esto sobre la fragilidad de los sistemas de salud en zonas de conflicto.
7 essential C1-level terms from this episode, with translations and example sentences in Spanish.
| Spanish | English | Example |
|---|---|---|
| brote | outbreak | El África CDC confirmó un nuevo brote de ébola en la provincia de Ituri. |
| rastreo de contactos | contact tracing | El rastreo de contactos es fundamental para contener la propagación de una enfermedad infecciosa. |
| hacer frente a | to confront, to face, to tackle | La región lleva décadas haciendo frente a brotes sucesivos sin los recursos necesarios. |
| subregistro | undercounting, underreporting | El subregistro de muertes en zonas de conflicto dificulta enormemente la evaluación real del brote. |
| reservorio | reservoir (biological host) | Los murciélagos de la fruta son probablemente el reservorio natural del virus del ébola. |
| vacunación en anillo | ring vaccination | La estrategia de vacunación en anillo consiste en inmunizar a todos los contactos cercanos de un caso confirmado. |
| fragilidad del Estado | state fragility | La fragilidad del Estado en zonas de conflicto complica enormemente cualquier respuesta sanitaria efectiva. |
Sixty-five people dead and almost nobody is talking about it.
The Africa CDC has confirmed a new Ebola outbreak in Ituri Province, in the Democratic Republic of the Congo, and it's barely making the front page anywhere.
Y eso ya lo dice todo, ¿no?
And that says it all, doesn't it?
Que un brote de ébola con decenas de muertos en el Congo se haya convertido en algo casi rutinario para los medios occidentales es una de las cosas más perturbadoras que puedo imaginar.
That an Ebola outbreak with dozens of dead in the Congo has become almost routine for Western media is one of the most disturbing things I can imagine.
Ituri specifically.
And that name will ring a bell for anyone who followed central Africa in the early 2000s.
This province has been at the center of some of the worst violence the continent has seen in decades.
Exacto.
Exactly.
Ituri no es solo una coordenada geográfica;
Ituri isn't just a geographic coordinate;
es un lugar con una historia de conflicto armado casi ininterrumpida desde los años noventa, con milicias, grupos rebeldes, y una presencia del Estado congoleño que ha sido, en el mejor de los casos, intermitente.
it's a place with a history of almost uninterrupted armed conflict since the nineties, with militias, rebel groups, and a Congolese state presence that has been, at best, intermittent.
Which is exactly the kind of environment where a hemorrhagic fever can spread before anyone even knows what they're dealing with.
You can't do contact tracing when there's no functioning health infrastructure and people are fleeing violence.
Claro, y eso no es teoría;
Right, and that's not theory;
es lo que pasó en el brote de 2018 a 2020, que también comenzó en Ituri y en las provincias del Kivu.
that's what happened in the 2018 to 2020 outbreak, which also started in Ituri and the Kivu provinces.
Fue el segundo brote más grave de la historia, con más de dos mil muertos, precisamente porque la respuesta sanitaria tenía que operar en medio de un conflicto activo.
It was the second deadliest outbreak in history, with more than two thousand dead, precisely because the health response had to operate in the middle of an active conflict.
I covered the tail end of that one from Nairobi.
The thing that stuck with me was how often health workers themselves became targets.
Vaccination teams being attacked, treatment centers burned.
The distrust ran that deep.
Esa desconfianza tiene raíces históricas muy profundas, Fletcher.
That distrust has very deep historical roots, Fletcher.
El Congo fue objeto de algunas de las prácticas médicas más crueles de la época colonial, experimentos sin consentimiento, explotación de comunidades bajo la excusa de programas de salud pública.
The Congo was subjected to some of the cruelest medical practices of the colonial era, experiments without consent, exploitation of communities under the guise of public health programs.
No es irracional que la gente desconfíe cuando llegan forasteros con jeringas.
It's not irrational for people to distrust strangers arriving with syringes.
No, it's completely rational given the history.
And yet that same distrust costs lives when the thing you're running from is the one thing that could save you.
Es una trampa terrible.
It's a terrible trap.
Pero sigamos un poco más atrás, porque el ébola como enfermedad no es algo que la gente entiende bien fuera de sus momentos de pánico mediático.
But let's go back a little further, because Ebola as a disease is something people don't understand well outside of their moments of media panic.
El virus fue identificado por primera vez en 1976, a orillas del río Ébola, en el norte del Congo, que entonces era el Zaire de Mobutu.
The virus was first identified in 1976, on the banks of the Ebola River, in northern Congo, which was then Mobutu's Zaire.
Two simultaneous outbreaks in 1976, right?
Sudan and what was then Zaire.
Different strains, it turned out.
Correcto.
Correct.
Hay cinco especies del virus del Ébola, y la más letal, la especie Zaire, es precisamente la que ha protagonizado los grandes brotes en el Congo.
There are five species of the Ebola virus, and the deadliest, the Zaire species, is precisely the one behind the major outbreaks in the Congo.
Tiene tasas de mortalidad que pueden superar el noventa por ciento en casos sin tratamiento, aunque en contextos con atención médica adecuada la cifra baja considerablemente.
It has mortality rates that can exceed ninety percent in untreated cases, though in settings with adequate medical care that figure drops considerably.
Ninety percent.
That number lands differently every time I hear it.
And yet, here's the thing that doesn't get communicated well: we actually have a vaccine now.
A real one.
It's been around since 2019.
Sí, la rVSV-ZEBOV, comercializada como Ervebo.
Yes, rVSV-ZEBOV, marketed as Ervebo.
Y fue aprobada en parte gracias a los datos obtenidos durante el brote de 2018 en el Kivu, donde se administró bajo protocolo de uso compasivo.
And it was approved in part thanks to data obtained during the 2018 Kivu outbreak, where it was administered under compassionate use protocol.
Eso es lo paradójico: el Congo sufrió lo suficiente como para generar la evidencia científica que produjo la vacuna que ahora se supone que lo protege.
That's the paradox: the Congo suffered enough to generate the scientific evidence that produced the vaccine now supposed to protect it.
That sentence deserves a moment of silence.
The country paid for its own cure in deaths.
Y la vacuna existe, sí, pero llegar con ella a una provincia donde hay grupos armados que atacan a los trabajadores humanitarios es otro problema completamente distinto.
And the vaccine exists, yes, but getting it to a province where armed groups attack humanitarian workers is a completely different problem.
El acceso logístico en Ituri sigue siendo un obstáculo enorme, no solo por la geografía sino por la inseguridad.
Logistical access in Ituri remains an enormous obstacle, not just because of geography but because of insecurity.
Let me ask you about the Africa CDC specifically, because that's the body that confirmed this outbreak.
It's a relatively young institution.
How much weight does it actually carry?
Fue fundada en 2017 por la Unión Africana, y la pandemia de COVID le dio un impulso enorme, tanto en visibilidad como en recursos.
It was founded in 2017 by the African Union, and the COVID pandemic gave it enormous momentum, both in visibility and resources.
Jean Kaseya, su director actual, ha sido muy activo en reclamar que África desarrolle su propia capacidad de fabricación de vacunas en lugar de depender eternamente de suministros externos.
Jean Kaseya, its current director, has been very active in demanding that Africa develop its own vaccine manufacturing capacity instead of eternally depending on external supplies.
Which COVID made painfully obvious.
The vaccine hoarding by wealthy nations in 2021 was, depending on your perspective, either a case study in rational self-interest or a moral catastrophe.
Probably both.
Fue las dos cosas.
It was both.
Y lo que puso de manifiesto es que la arquitectura global de salud pública sigue siendo profundamente asimétrica: los países que más sufren las enfermedades infecciosas son los que menos poder tienen para determinar cómo se distribuyen los recursos para combatirlas.
And what it revealed is that the global public health architecture remains profoundly asymmetric: the countries that suffer most from infectious diseases are the ones with the least power to determine how resources to fight them are distributed.
Walk me through what a response operation looks like on the ground in a place like Ituri.
Because it's not just sending vaccines.
It's a whole architecture of containment.
Es enormemente complejo.
It's enormously complex.
Primero tienes que identificar el foco del brote, lo que requiere laboratorios con capacidad de diagnóstico rápido.
First you have to identify the outbreak's origin, which requires laboratories with rapid diagnostic capacity.
Luego viene el rastreo de contactos, que consiste en localizar a todas las personas que han estado en contacto con alguien infectado y vacunarlas, una estrategia llamada vacunación en anillo.
Then comes contact tracing, which means locating everyone who has been in contact with an infected person and vaccinating them, a strategy called ring vaccination.
Ring vaccination.
The same basic concept they used to eradicate smallpox.
You don't try to vaccinate everyone;
you build a firewall around the cases you know about.
Exactamente.
Exactly.
Pero eso requiere que la gente te diga quiénes son sus contactos, que confíen en ti lo suficiente como para hacerlo, y que esas personas se dejen vacunar.
But that requires people to tell you who their contacts are, to trust you enough to do that, and for those people to accept vaccination.
En un contexto de desconfianza institucional y conflicto armado, cada uno de esos pasos puede romperse.
In a context of institutional distrust and armed conflict, each of those steps can break down.
Sixty-five dead is the confirmed figure.
But in a province with that level of instability and that kind of health infrastructure, confirmed is doing a lot of work in that sentence.
Estás en lo correcto, y los epidemiólogos lo saben bien.
You're right, and epidemiologists know it well.
El subregistro en zonas de conflicto puede ser dramático.
Undercounting in conflict zones can be dramatic.
Las personas mueren en casa, sin haber sido vistas por ningún trabajador sanitario, y esas muertes simplemente no entran en las estadísticas oficiales.
People die at home, never seen by any health worker, and those deaths simply don't enter the official statistics.
El número real podría ser bastante mayor.
The real number could be considerably higher.
And we should say, because it matters: Ituri is not isolated from the rest of the country or the region.
There are displaced populations moving, there are trade routes, there are porous borders with Uganda, Rwanda, South Sudan.
Y eso es lo que hace que la contención sea tan urgente.
And that's what makes containment so urgent.
Uganda ya ha vivido brotes de ébola importados desde el Congo, el más reciente en 2022.
Uganda has already experienced Ebola outbreaks imported from the Congo, the most recent in 2022.
Cada vez que hay un foco activo en Ituri, los países vecinos activan sus propios protocolos de vigilancia epidemiológica en las fronteras, porque saben lo que puede pasar.
Every time there's an active focus in Ituri, neighboring countries activate their own epidemiological surveillance protocols at borders, because they know what can happen.
The 2022 Uganda outbreak.
That one scared me, because it was a different strain, the Sudan strain, and the existing vaccine doesn't work against it.
There was a real scramble to develop and deploy something fast.
Y eso ilustra otro problema estructural: tenemos una vacuna eficaz para la especie Zaire, pero el virus tiene cinco variantes y no disponemos de soluciones igualmente maduras para todas ellas.
And that illustrates another structural problem: we have an effective vaccine for the Zaire species, but the virus has five variants and we don't have equally developed solutions for all of them.
La investigación avanza, pero avanza impulsada por las crisis, no de forma sistemática y anticipatoria, que es como debería funcionar.
Research advances, but it advances driven by crises, not in a systematic and anticipatory way, which is how it should work.
Reactive rather than proactive.
The story of global health, honestly.
We fund research when we're scared and cut budgets when things calm down.
Es exactamente así.
That's exactly it.
Y la ironía cruel es que prevenir un brote cuesta una fracción de lo que cuesta contenerlo una vez que ha comenzado.
And the cruel irony is that preventing an outbreak costs a fraction of what it costs to contain one once it has started.
Pero el dinero de la prevención es invisible: nadie sabe qué pandemia no ocurrió porque hubo inversión en sistemas de vigilancia.
But prevention money is invisible: nobody knows which pandemic didn't happen because there was investment in surveillance systems.
Politicians don't get credit for things that don't happen.
That's as old as politics itself.
Exacto.
Exactly.
Y mientras tanto, en Ituri, hay familias que están enterrando a sus muertos.
And meanwhile, in Ituri, there are families burying their dead.
El ébola también cambia los rituales funerarios, porque el cuerpo de alguien que muere por ébola es altamente infeccioso, y eso choca directamente con prácticas culturales de duelo que implican contacto físico con el fallecido.
Ebola also disrupts funeral rituals, because the body of someone who dies from Ebola is highly infectious, and that directly clashes with cultural mourning practices that involve physical contact with the deceased.
That's one of the underreported dimensions of how these outbreaks spread.
The funerals.
The 2014 West Africa outbreak, the big one, was partly amplified by funeral practices in Sierra Leone and Guinea.
It's not carelessness;
it's grief.
Y ahí es donde la respuesta sanitaria tiene que ser culturalmente inteligente, no simplemente técnicamente correcta.
And that's where the health response has to be culturally intelligent, not just technically correct.
Equipos que trabajan con líderes comunitarios, con líderes religiosos, para encontrar formas de honrar a los muertos que no pongan en peligro a los vivos.
Teams working with community leaders, with religious leaders, to find ways to honor the dead that don't endanger the living.
En los brotes donde eso se ha hecho bien, ha marcado una diferencia enorme.
In outbreaks where that has been done well, it has made an enormous difference.
The question I keep coming back to is: what would it actually take to end this cycle?
The Congo has had more Ebola outbreaks than anywhere else on Earth.
Fourteen, I think, since 1976.
At some point you have to ask whether this is a disease problem or a governance and infrastructure problem wearing a disease mask.
Las dos cosas están completamente entrelazadas.
Both things are completely intertwined.
El reservorio animal del virus, que probablemente son los murciélagos de la fruta, existe independientemente de la política.
The animal reservoir of the virus, which is probably fruit bats, exists independently of politics.
Pero que cada salto del virus al ser humano se convierta en un brote grave es una función directa de la debilidad del sistema sanitario y de la fragilidad del Estado.
But that every jump of the virus to humans becomes a serious outbreak is a direct function of the weakness of the health system and state fragility.
Un brote en Suiza no llegaría a diez casos.
An outbreak in Switzerland would not reach ten cases.
And there's something worth sitting with in that comparison.
The same virus.
Completely different outcomes depending on where it lands.
That's not virology;
that's political science.
Oye, hay algo que dijiste antes que quiero retomar, porque usaste una expresión en inglés que tiene su equivalente en español y merece la pena explicarla.
Hey, there's something you said earlier that I want to come back to, because you used an expression in English that has its Spanish equivalent and it's worth explaining.
Dijiste que la vacuna 'no funciona contra' la cepa Sudan.
You said the vaccine 'doesn't work against' the Sudan strain.
En español eso se dice 'no es eficaz frente a', o 'no actúa contra', pero también se usa mucho 'hacer frente a', que es un modismo muy natural.
In Spanish we say 'no es eficaz frente a', or 'no actúa contra', but 'hacer frente a' is also very commonly used, which is a very natural idiom.
Hacer frente a.
That's interesting.
It's literally 'to make a front against,' like a military formation.
You're facing something head-on.
Exactamente, y se usa en contextos muy variados: puedes hacer frente a una crisis sanitaria, puedes hacer frente a una deuda, puedes hacer frente a un adversario en un debate.
Exactly, and it's used in very varied contexts: you can 'hacer frente a' a health crisis, you can 'hacer frente a' a debt, you can 'hacer frente a' an adversary in a debate.
La clave es que siempre implica una confrontación activa, no pasiva.
The key is that it always implies an active confrontation, not a passive one.
No es simplemente 'aguantar';
It's not simply 'to endure';
es 'plantar cara'.
it's 'to stand up to.'
So if I wanted to say 'the Congo has been fighting this virus for fifty years,' I could say...
'el Congo lleva cincuenta años haciendo frente a este virus'?
Perfectamente dicho.
Perfectly said.
Guárdalo, Fletcher, porque la próxima vez que intentes algo parecido y salga mal, voy a necesitar ese clip de audio como contraste.
Hang on to that one, Fletcher, because the next time you try something similar and it goes wrong, I'm going to need that audio clip for contrast.