With no vaccine or treatment available for a strain of Ebola that is circulating in Uganda, the country's latest outbreak is shaping up to be the third largest on record.
Fred Balongo, a teacher and farmer from the village of Madudu in the Mubende district of Uganda, had a close call with Ebola earlier this fall (2022).
When his son's friend and neighbor tested positive for Ebola, Balongo and the rest of his family were instructed to quarantine for 21 days.
While everyone in Balongo's immediate family turned out okay, their neighbors suffered a different fate. In a matter of weeks, the 14-year-old son and his mother died with the virus.
"That is the challenge we are going through now," Balongo told DW. "They were my neighbors, like 100 meters from my home."
Ebola in Uganda caused by Sudan virus
Madudu, a village of about 480 households, lies 150 km (93 miles) from the Ugandan capital Kampala. It has emerged as an Ebola hotspot, having seen the country's first case in the current outbreak in September. Over the past month, cases of the deadly virus have been identified in eight districts across the country, including Kampala.
Official government figures indicate that at least 51 people have died and 132 people have been infected at time of writing.
The particular strain of Ebola that is spreading across Uganda is caused by the Sudan virus, which has a mortality rate of between 41-100%. Before the current outbreak of Ebola, Sudan virus was last detected in Uganda in 2012, says the World Health Organization.
A 'worrying' trend of Ebola infections through April
The Ugandan Ministry of Health, which is in charge of coordinating efforts to fight the outbreak, has made somber projections for the next six months. Its officials estimate about 1,200 cases and 500 fatalities by late April 2023. That's according to a government report leaked to the Telegraph newspaper in the UK. The leaked report suggested there had been a general mismanagement of the crisis, a lack of healthcare workers on the ground and shortages of proper personal protective equipment (PPE) for doctors in clinics.
"We did see a very worrying trend of case numbers going up over the last three weeks," said Sam Taylor, a Medecins Sans Frontieres (Doctors Without Borders) spokesperson on the ground in Uganda. "This last week, the case numbers have been less than the previous week, but [it's] not necessarily a small number."
The ministry's projections would make this outbreak the third largest on record since Ebola was first identified in 1976, Taylor said. He spoke with DW from Uganda's capital, where he said life was generally continuing as normal, "which from our perspective is slightly worrying because we do have cases that we've identified [in Kampala]."
Lockdowns have been declared in other regions, however. The people of the country's Mubende and Kassanda districts entered a government-issued 21-day lockdown late last month in an attempt to slow the spread of cases.
"It is very tiresome," said Balongo, reflecting on his own quarantine. "You don't eat. You are just thinking about what is happening tomorrow."
Balongo said business in Madudu has come to a standstill, and some people don't have enough food to eat.
The exhaustion Balongo describes is understandable: Ugandan schools were closed for two years over the course of the COVID-19 pandemic, marking the longest pandemic-related school closure in the world.
Julius Mugambwa, a DW reporter on the ground, said he worries the resulting fatigue could be causing complacency in the population.
"Many people seem unbothered by the spreading Ebola," said Mugambwa. "Emerging out of the COVID-19 pandemic, many have the attitude that if we survived COVID, we can survive Ebola."
Vaccine for Ebola Zaire ineffective against Sudan strain
Although Sudan virus presents with most of the same symptoms as the Zaire strain, the order in which they present can be different. While Zaire presents first with general body weakness and muscle stiffness, then fever, Sudan virus presents first with fever and exhaustion.
Initial warning signs of an infection with the Sudan virus can be largely indistinguishable from other illnesses common in Uganda, such as malaria. Taylor said this has kept some patients from attending clinics until they have experienced symptoms for multiple days. And that is a problem, because the longer a person has been infected with the illness, the harder it is to treat.
Once someone is infected with Ebola, symptoms can start to appear between two to 21 days after exposure to the virus, but the average incubation period is eight to 10 days.
The course of the Ebola virus generally moves from "dry" symptoms, such as fever and fatigue, to "wet" symptoms, including diarrhea, vomiting and unexplained bleeding.
"There's not a lot we can do for patients once they come in and the medical people describe them as 'wet,' which means their viral load is already very high and they're already transmitting the virus, which is problematic," said Taylor.
How COVID helps in the fight against Ebola
This problem is amplified by the lack of a vaccine or treatment.
Jimmy Whitworth, a professor of international public health at the London School of Hygiene & Tropical Medicine, said there was only about 55% genetic similarity between Ebola Zaire and Ebola Sudan viruses.
That means there is no cross-protection between the two infections, making the Ebola Zaire vaccine unlikely to protect against the Sudan strain. This, experts say, makes the current outbreak in Uganda especially worrisome.