The latest figures suggest there are nearly 1,000 suspected cases connected to the outbreak and more than 200 suspected deaths.
A growing number of cases have also been detected in neighboring Uganda and South Sudan, and patients are under observation in Italy and Brazil. An American who tested positive for the virus was evacuated for treatment to Germany where he was in critical but stable condition.
He has since been discharged from the hospital and is continuing to recover.
Last week, New York-based aid group the International Rescue Committee (IRC) warned that response efforts in the DRC are struggling due to delayed detection and low levels of contact tracing.
The first Ebola cases of the current outbreak were confirmed in late April, but the IRC suspects the disease may have been spreading undetected since before March and potentially as long as three months before the epidemic was declared in mid-May.
Rachel Howard, senior technical emergency health advisor at the IRC, estimated only about 20 percent of contacts are currently being traced, which means health authorities are struggling to find new sources of transmission.
‘IRC teams warn that shortages of diagnostic cartridges and testing backlogs are slowing confirmation of cases, further obscuring the true spread of the outbreak,’ Howard said in a statement.
Symptoms of Ebola can begin between two and 21 days after infection, initially resembling flu with fever, fatigue, muscle pain and headache, before progressing to vomiting, diarrhea and, in severe cases, bleeding.
The virus spreads through direct contact with infected bodily fluids, including blood, vomit and saliva. It is not airborne, meaning transmission requires close physical contact.
Evaluating the actual likelihood of a tournament outbreak, Varga said: ‘It’s real. There’s no question.’ He called the DRC team ‘the most concrete example of it.’
‘The DRC team is sensitive enough to this that they’re self-isolating until they come, which basically means they are making sure they have no contact with anybody,’ Varga continued.
The DRC, making their first ever World Cup appearance, will be based primarily in Houston upon arrival, where similar isolation protocols are expected to remain in place throughout the group stages.
However, if those front-line containment nets fail, a worst-case scenario would trigger major disruptions to the tournament’s competitive integrity and global health safety.
Workers line up to disinfect their protective equipment at Mongbwalu General Referral Hospital
Physicians with Doctors Without Borders provide medical care to a patient in the DRC, where officials have warned the outbreak is ‘likely far worse’ than current estimates state
If a player or team official exhibits symptoms mid-tournament, public health mandates would immediately overwrite sporting logistics, plunging the competition into chaos.
‘I have no idea what FIFA would do dynamically, but I know what the CDC and every public health person in America would recommend: strict quarantine,’ Varga said.
‘They would go into quarantine, they wouldn’t come out, and we would need to contact trace anybody they had been in contact with.’
The CDC said last month that it was working closely with FIFA on safety and screening measures ahead of the World Cup.
Officials did not provide specifics surrounding screening and procedures ahead of the competition, but reiterated that it is ‘actively working with FIFA to ensure safe traveling and passage’ and to ensure the ‘American public remains safe throughout’ the tournament.
There is currently a level 3 travel warning to the DRC, advising Americans to reconsider travel there, and the US is requiring Americans arriving from the DRC, Uganda or South Sudan to reroute their travel.
They now must arrive in one of four airports for enhanced screening: John F Kennedy International Airport in New York City, Washington Dulles International Airport outside of Washington, DC, Hartsfield-Jackson Atlanta International Airport and George Bush Intercontinental Airport in Houston.
Because the virus features a prolonged 21-day incubation period, a single positive test would spark a domino effect across the tournament brackets.
Entire squads would have to be removed from contention, rendering scheduled matches unplayable and destroying the competitive structure of the group stages.
‘For example, if a player for the DRC develops a fever after match one and tests positive for Ebola, I would assume you lock down the entire DRC team for the rest of the tournament,’ Varga said.
‘They would not be allowed to play in that setting because of the long incubation period and the risk involved. While I can’t speak for FIFA, the public health recommendation would be immediate quarantine.’
Opposing squads who shared the pitch with an infected individual could find their own tournament dreams crushed by a public health quarantine, even if the actual risk of transmission remains low.
DRC players celebrate after qualifying for this year’s tournament, which could be rocked by a domino effect of quarantines if a single person tests positive for Ebola
The FIFA World Cup trophy on display during the Official Draw in December
‘I don’t know what FIFA’s exact protocols would be for that,’ Varga said. ‘But I would argue that there could be a potential scenario where one of DRC’s opponents is also removed from the tournament.’
The fears are not purely hypothetical. Just days ago, mayor Juan Franco of La Línea de la Concepción, a small Spanish town near the border with Gibraltar, signed a decree banning a scheduled June 9 friendly between the DRC and Chile, citing health risks from the Ebola outbreak.
The decision left the DRC without a final friendly before flying across the Atlantic for the tournament.
The team had already been forced to cancel a training camp and planned farewell events for fans in capital city Kinshasa due to the outbreak, and has since relocated its base to Belgium.
If a single friendly in a town of 65,000 people was deemed too great a risk, the question of what happens inside a stadium holding 82,500 becomes considerably harder to answer.
Ultimately, while complex biological threats dominate emergency playbooks, frontline medical teams must remain anchored to the high-probability cases that routinely fill emergency departments during massive summer heatwaves.
‘In terms of our FIFA preparedness, we are also concerned about the things that are highly likely to happen,’ Varga pointed out. ‘What happens if it’s 95 degrees out and you’ve got thousands of people at a stadium passing out from dehydration?’
Axel Tuanzebe and DRC teammates celebrate his goal during their match against Jamaica in March
Even so, the extreme preparation required for catastrophic biological outbreaks ensures that the local healthcare infrastructure remains entirely adaptable.
‘That said, we are actively drilling on Ebola right now,’ Varga said. ‘Drilling on Ebola is the same as drilling on Hantavirus or any other novel disease.
‘We have dedicated personnel who practice putting on hazmat suits, conducting point-of-care testing and executing specific protocols… Since a lot of it is going to happen in New Jersey, we’ve just been refining that to be Ebola-specific.
‘Hackensack University Medical Center is our flagship hospital… closest to MetLife Stadium where the big events are going to happen, so they’ll be key in that.’
As the official hospital partner of the FIFA World Cup in New York and New Jersey, Hackensack University Medical Center sits closer to MetLife Stadium than any other major medical center in the region.
If the worst case arrives, they will be the first to know and the first to respond.
