Ebola Outbreak 2026: A Q&A with Direct Relief’s Dr. Jeffrey Samuel

When the first cases of Ebola virus were announced in the Democratic Republic of the Congo this month, Dr. Jeffrey Samuel, traveling in East Africa, read about it on the Direct Relief website.

Dr. Samuel, a clinical pharmacist and Direct Relief's regional director for Africa, was visiting hospital partners in Uganda at the time the country's first cases were being identified and contained.

"We were already engaging with and supporting partners in Uganda through routine medical shipments and other ongoing support," he explained. "That work was not Ebola-specific, but it reflects the kind of sustained support health systems need before, during, and after an emergency."

Direct Relief also dispatched $2.5 million in emergency medical support to the DRC, the epicenter of the outbreak, to support Ebola containment and treatment.

But Dr. Samuel stressed that routine support can't be disentangled from emergency response. Both are vital to containing an Ebola outbreak or similar public health emergency, and to helping affected communities respond and recover.

"Ebola response is about much more than Ebola alone," he said. "Stronger health systems allow countries to continue delivering essential healthcare services even while responding to an emergency."

Direct Relief: So many people are unfamiliar with Ebola, and it's frightening. Can you give us some background? How does Ebola spread, what are the symptoms, and how do people stay safe?

Jeffrey Samuel: Yeah, absolutely. Ebola is a severe viral disease: It primarily spreads through direct contact with body fluids from someone who is either sick with the disease or has died from it. That includes blood, vomit, diarrhea, urine, saliva, sweat, and other types of bodily fluids like that. It can also spread through contaminated medical equipment, unsafe burial practices, or direct contact with the body of someone who has died from the disease.

One important thing I always emphasize with Ebola is that it's not airborne, like measles or Covid-19. You can't get Ebola simply by walking past someone. That's why healthcare workers, the families that take care of these patients, and the people involved in different burial practices are often at the highest risk.

Ebola typically starts with non-specific symptoms: stuff like fever, fatigue, muscle aches, headaches, and weakness. It can look like malaria, typhoid and other infectious diseases common in the region, so it's hard to distinguish at the outset. It's not until the disease starts to progress that many patients start developing vomiting, diarrhea, and dehydration. Their organs start to fail, and in some cases, patients can experience hemorrhaging in the later stages of illness.

The incubation period, which means the time between when a person is exposed to when the symptoms begin, is usually between 2 and 21 days. That's a very large range, which does not help [with diagnosis and containment] either.

Direct Relief: How dangerous is this outbreak?

Jeffrey Samuel: Historically, Ebola has been extremely deadly. Fatality rates typically depend on the strain involved, how quickly the outbreak is detected, and the strength of the healthcare system responding to it. Most people are familiar with the Zaire virus, which caused the large Ebola outbreaks from 2014 to 2016 in West Africa. Those outbreaks often had fatality rates around 50 to 70 percent, which is extremely high.

The Bundibugyo virus, which is the one that's causing the current outbreak, has historically had somewhat lower fatality rates - generally around 25 to 50 percent. But that's still a very serious and potentially fatal disease.

Direct Relief: How is Ebola prevented and treated?

Jeffrey Samuel: In terms of prevention, the most important measures are early identification of cases, isolation of those suspected cases, infection prevention and control - in other words, good hand hygiene and personal protective equipment - contact tracing of people those patients have been in contact with recently, and safe burial procedures.

You need strong community engagement and trust. That's a big [issue] specifically with this outbreak. There have been reports of Ebola treatment units being attacked and set on fire, which shows how difficult containment becomes when fear, grief, and mistrust are present.

Right now, the treatment is supportive care. That includes IV fluids, electrolyte replacement, oxygen support, treatment of secondary infections, management of blood pressure, providing the right nutritional support, and very careful monitoring.

These supportive care measures can really improve survival in a massive way. For us at Direct Relief, focusing on supporting these areas is top priority.

Direct Relief: Can you talk about the difference between treating the Zaire and Bundibugyo strains?

Jeffrey Samuel: Absolutely. The biggest practical difference is that this current outbreak is being caused by the Bundibugyo virus, while the 2014 to 2016 West Africa outbreak was caused by the Zaire Ebola virus. That distinction matters because all of the approved vaccines and monoclonal antibody treatments that were developed over the past decade were specifically designed for the Zaire Ebola virus.

But it's important to remember that during that outbreak, these tools were not widely available. In fact, that outbreak is what accelerated [Ebola] vaccine and therapeutic development globally. Researchers are now working on similar tools for the Bundibugyo virus as well.

In the meantime, the public health response principles remain largely the same. It's really surveillance, monitoring, contact tracing, infection prevention and control, supportive care, and community engagement.

Direct Relief: Why did this outbreak take so long to surface?

Jeffrey Samuel: One of the biggest challenges is that early symptoms of Ebola look very similar to many other diseases common in the region. A patient with fever, vomiting, fatigue, or diarrhea may initially be suspected of having malaria, cholera, typhoid, or another common illness. In many outbreaks, the alarm bells only begin once healthcare workers become infected, or if there's a cluster of unexplained deaths that appear, or if the laboratory testing confirms something unusual.

This outbreak is also occurring in an incredibly complex environment. The eastern DRC has faced years of conflict, displacement, insecurity, and strain on the healthcare system. Insecurity can delay surveillance teams from reaching the affected areas. It can limit testing capacity, disrupt transport, and make it harder to trace contacts effectively.

There are also trust issues that can emerge during outbreaks. In some communities, people may fear isolation centers or avoid seeking care because they worry about stigma or separation from family members.

And because the Bundibugyo virus is relatively uncommon compared to the Zaire Ebola virus, it may not have been the first thing clinicians initially suspected when they were seeing these cases.

Direct Relief: Is this going to spread much further? What happens if it does?

Jeffrey Samuel: Yes, there's certainly a risk of further regional spread, which is why neighboring countries have implemented stricter border controls, enhanced surveillance, and other preparedness measures. Rwanda, for example, temporarily closed key border crossings with the DRC. And in the U.S., travelers who have recently visited the DRC, Uganda, or South Sudan are being routed through designated airports for enhanced public health screening.

The biggest danger is that outbreaks can overwhelm fragile health systems and healthcare facilities. They can reduce routine care access. They can increase infections in healthcare workers, and interrupt normal services like maternal and child health or vaccination programs.

Ebola really creates broader humanitarian impacts, and in settings already affected by conflict or displacement, the response becomes even more difficult. A lot of measures have been put in place to try to prevent it from spreading further regionally. But that doesn't negate the impact that's happening on the ground right now.

Direct Relief: During the West Africa outbreak, Americans were diagnosed with Ebola - it's happened during this event too - and they had much better survival rates than the West African people who got sick. Why is that?

Jeffrey Samuel: It's important to state clearly that the differences in outcomes were not biological. They were largely about access to care and the strength of the surrounding healthcare system.

Patients treated in highly resourced settings like the U.S. often received earlier diagnosis, intensive monitoring around the clock, aggressive fluid and electrolyte replacement. That's a real key. They also had access to oxygen support, advanced laboratory testing, PPE, and intensive care when needed. [Note: the federal administration has announced that Americans diagnosed with Ebola during this outbreak are being routed to Kenya, not the U.S., for treatment.]

In many outbreak settings, especially in places affected by conflict or displacement, it can be much harder to provide that same level of care consistently because the infrastructure and resources are often much more limited. And that can have a real impact on patient outcomes.

Honestly, this is one of the broader lessons Ebola keeps exposing globally: Outbreak preparedness and health system strengthening are deeply connected.

Direct Relief: Direct Relief has shipped a significant range of medical support, including PPE, cardiovascular drugs, and IV fluids, to the DRC in response to this Ebola outbreak. How did the organization decide what to send, and what role will that support play?

Jeffrey Samuel: All these items play a very practical and important role in the outbreak response.

PPE helps protect healthcare workers and prevent transmission inside of healthcare facilities. During Ebola outbreaks, protecting healthcare workers is critical because health worker infections can quickly weaken the overall response capacity.

IV fluids are absolutely key to supportive care. Ebola patients often experience severe vomiting, diarrhea, dehydration, and electrolyte loss. So a key part of treatment is being able to replace those fluids and electrolytes.

Beyond Ebola-specific supplies, essential medicines like cardiovascular drugs, antibiotics, and other critical treatments help keep the broader health system functioning during an outbreak. Ebola response does not pause the rest of healthcare - patients still need care for chronic diseases, infections, pregnancy complications, and other urgent health needs.

And our approach is very much partner-driven. We work directly with local partner organizations, hospitals, and in-country ministries of health to understand the actual operational and clinical needs on the ground. We also look at storage capacity, cold chain requirements, logistics, and feasibility for what we send.

The strongest responses happen when that emergency support is layered onto resilient local systems. Emergency response plus long-term system strengthening go hand in hand.

The goal is to support countries not only in responding to the current outbreak, but also to build stronger systems for whatever comes next.