Dr. Philip McMillan, John McMillan
In early December 2024, alarm bells rang through the global health community as reports emerged from the Democratic Republic of Congo (DRC) about a mysterious illness exploding through a densely populated urban area. The disease, temporarily dubbed “Disease X,” had infected 376 people in the impoverished Panzi district of Kwango Province, with children under five accounting for 52% of cases and nearly 100 lives lost. In the crowded streets of the district, where narrow pathways wind between tightly packed buildings, mothers rushed their feverish children to a local hospital.
“What makes this situation particularly heartbreaking is that 52% of the 376 infected are children,” Dr. Philip McMillan, who has been closely monitoring the outbreak, explains in a recent Substack video. “What we’re seeing here is characterized by fever, headaches, cough, and sometimes difficulty breathing.”
But this wasn’t just any ordinary outbreak; it emerged alongside another health crisis – an unprecedented spread of monkeypox that had taken an unusual urban turn. “This isn’t the rural Congo of common imagination,” Dr. McMillan explains. “These are communities living in dense urban conditions, where diseases can spread rapidly from household to household.”
The story becomes intriguing when we learn how this crisis began. A single traveler from Belgium, visiting underground clubs in March, introduced a new form of monkeypox to the Kinshasa region – the first documented case of sexual transmission on the continent. What began in social venues soon spread through communities, eventually affecting families and children in unprecedented ways.
Understanding the Perfect Storm: How Multiple Diseases Interact
When international aid arrived, it potentially came with unintended consequences. Well-meaning healthcare workers from highly vaccinated regions may have brought their own invisible passengers – COVID-19 variants, RSV, and mycoplasma. For families already struggling with malnutrition and poor sanitation, this created a perfect storm of health challenges.
The human immune system functions like a private army protecting a building: monocytes serve as tanks, neutrophils as foot soldiers, T cells as the Air Force, B cells launching antibodies as missiles, and natural killer cells as the Navy. When a threat appears, the soldiers sound an alarm by releasing a signalling protein called interferon to alert other soldiers and enhance security everywhere.
COVID-19 is unique because it can disable these chemical alarms. It’s like a thief cutting the power to a building’s security system. The soldiers are still there, but they can’t communicate or respond effectively.
Many people in regions like the Congo carry diseases like sub-clinical malaria in their bodies all the time, but the soldiers of the immune system are strong enough to keep these diseases under control. When COVID-19 disrupts the immune system by blocking interferon, it’s like distracting or weakening those soldiers. Even if someone doesn’t feel sick from COVID-19, their immune system is not functioning at full strength and, dormant diseases like malaria see an opportunity.
In places with high malnutrition (like the 40% rate in Panzi), people’s immune systems are already weaker. When you add COVID-19’s disruption with interferon, plus other infections like monkeypox that do the same thing, the immune system becomes overwhelmed. It’s like having a demoralized and exhausted military trying to handle multiple prison breaks at once.
“Think of interferon as a prison alarm system,” Dr. McMillan explains. “When a threat appears, it alerts all neighboring cells to enhance their defenses.” With the alarm system disabled, the viruses can spread without triggering our body’s natural defenses. This is why asymptomatic COVID-19 can be dangerous even when people don’t feel sick—it secretly weakens their immune system’s ability to control other diseases.
Global Implications and the Battle for Universal Health Access
When WHO investigators finally identified the underlying cause of “Disease X” in December 2024, it wasn’t a new pathogen at all – it was malaria. Yet this wasn’t a typical malaria outbreak. In many cases, malaria can exist subclinically, kept in check by a healthy immune system. The combination of immune suppression from COVID-19 and monkeypox, coupled with severe malnutrition, allowed previously controlled infections to explode into full-blown crises.
The implications reach far beyond the Congo. Health experts anticipate the resurgence of dormant diseases worldwide. Tuberculosis, syphilis, and other conditions long controlled by human immune systems might break free as our collective defenses weaken.
This crisis has exposed critical vulnerabilities in our global health systems. While medications like hydroxychloroquine and ivermectin have helped some populations manage COVID-19, they cannot address the underlying problems of malnutrition or prevent the spread of multiple pathogens simultaneously. The experiences of communities like Panzi remind us that effective healthcare must address not just individual diseases, but the entire ecosystem of human health and well-being.
For the families of Panzi, this crisis may no longer be a medical mystery, but it is nowhere close to being resolved. People are still dying. This is a disturbing reminder of how global health challenges disproportionately affect the world’s most vulnerable populations. As one local health worker observed, “We’re not just fighting diseases here; we’re fighting poverty, malnutrition, and the unintended consequences of global health inequity.”
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