Congo Ebola crisis reaches grim milestone with more than 1000 dead as highly contagious virus outruns response

More than 1000 people have died in the Ebola outbreak in Congo, according to Africa’s top health body, a grim toll in the fastest Ebola outbreak in history, as conflict, community resistance and an uneven response fuel its spread.

Speaking at a health summit in Ghana on Wednesday, Dr Jean Kaseya, director-general of the Africa Centres for Disease Control and Prevention, said 1031 deaths have been confirmed.

“These are people dying. They are dying because we don’t have vaccines, we don’t have medicine, we don’t have funding,” he added.

The latest update from Congo’s Ministry of Health showed that as of Monday, 2473 cases had been recorded in the latest outbreak. At least 737 patients were in isolation or hospitalised, it said.

This outbreak is unlike most previous Eones because the Bundibugyo virus responsible for it has no approved vaccines or treatments. It has also killed more people at a faster rate than any outbreak on record, including the the worst on record, which killed 11,000 in 2013 to 2016, which took eight months to reach 1000 deaths.

Conflict and community resistance are complicating the response

The World Health Organisation has said the true scale of the outbreak could be ⁠two to four times larger than official figures indicate. Some communities at its epicentre also remain difficult to reach, mainly because of fighting involving rebel groups.

Ebola is rare, but highly contagious and can be contracted through contact with bodily fluids such as vomit, blood or semen.

Officials have warned that 80 per cent of new cases have emerged outside known chains of transmission, a sign the outbreak is spreading faster than health officials can track it even as they step up their response in Ituri province, the epicentre of the outbreak, and four other provinces where cases have been recorded.

Community resistance to Ebola teams, particularly those carrying out safe burials, has also hampered the response.

Robert Ndjalonga, head of civil protection in Ituri province, said some communities have refused to allow burial teams to operate because they prefer traditional burials, increasing the risk of further transmission.

“The biggest challenge remains resistance from or outright refusal by some communities to accept response teams,” Mr Ndjalonga said.

“On several occasions, burial teams have had to be escorted by security forces to ensure that safe and dignified burials could be carried out without incident.”

Shortages of burial supplies have delayed responses to reported deaths, while some affected health zones still lack operational burial teams, Mr Ndjalonga said.

Attacks on health facilities and response teams have also forced front-line workers and aid groups out of some areas. Some health workers have gone on strike, saying they haven’t been paid since the outbreak started.

A member of a team carrying out safe Ebola burials was recently injured when assailants threw stones at the team’s vehicle following a burial in Bunia last week, according to provincial civil protection authorities.

The attack highlighted the challenges facing the response in eastern Congo. In Ituri’s Irumu territory, the local military administrator recently described Ebola as a greater threat than the Islamic State-affiliated Allied Democratic Forces insurgency and urged residents to support, rather than attack, health workers.

Containment efforts are faltering

A humanitarian worker involved in the response, speaking on condition of anonymity because he was not authorized to speak publicly, cited poor coordination between response agencies, delays in transferring patients to treatment centres and waits of more than four days for some Ebola test results.

“At times, it’s unclear who is doing what and where,” the worker said.

The delays have led some patients to leave health facilities before they can be diagnosed, increasing the risk of further transmission, the worker said.

Africa CDC head Dr Kaseya called for intensified efforts to slow the outbreak on the first day of the health summit in Ghana Tuesday.

“If we do not stop this outbreak today, it could become one of the worst Ebola outbreaks the world has ever documented,” Dr Kaseya said.

Less than 9 per cent of the contacts of confirmed patients who are expected to be traced are currently being monitored, far below the level needed to contain the outbreak, according to Africa CDC. More than 60 per cent of deaths are occurring in the community before patients can receive care.

Pierre Akilimali, the Ebola response incident manager at the National Public Health Institute of the Democratic Republic of the Congo, said the high number of community deaths suggests many infections are not being detected or isolated in time, allowing the virus to continue spreading.

Experts warn of a worsening crisis

Last month, researchers at the US Centres for Disease Control and Prevention used computer modelling to estimate how the outbreak could evolve. In a worst-case scenario, they said it could approach the scale of the 2014-2016 West Africa epidemic.

“There’s never been an Ebola outbreak that started with so many cases because it was so late to be identified,” said Trish Newport, emergency program manager for Doctors Without Borders, who has been working in Congo.

“It’s like the outbreak is outrunning the response,” Ms Newport said.

University of Pittsburgh epidemiologist Dr Jean Nachega, who is advising African health authorities, said he does not expect the outbreak to reach the CDC’s worst-case scenario but cautioned that the challenges remain “huge”.