Congo's Ebola Outbreak Outpaces Response as Africa CDC Says It Has Not Yet Peaked

On Thursday, Africa's top public health agency said that authorities in eastern Congo are changing tack in their fight against Ebola, moving toward what they call a village-centered approach. The shift comes because the virus is still spreading faster than the people chasing it, and the Africa Centers for Disease Control and Prevention says the outbreak has likely not yet peaked.

The numbers show how far it has traveled. When the outbreak was declared in mid-May, it was confined to three health zones. It now touches 60. Government data put the toll at 6,250 cases, including 3,039 deaths, with the spread driven largely by insecurity, displacement and heavy movement of people. Africa CDC says the outbreak has recorded six times as many confirmed cases and five times as many deaths as the 2014 to 2016 West African epidemic, which killed more than 11,000 people and remains the deadliest Ebola outbreak on record.

A report this week from the U.S. Centers for Disease Control and Prevention identified five areas where the response is falling short. The first is community-based surveillance. Without systems that can quickly investigate alerts at the village level, detection lags, people are reluctant to report cases, and communities are not engaged. The consequences are measurable: at least 63% of deaths recorded in the past week happened outside Ebola treatment centers, according to Africa CDC data. Yap Boum, who leads emergency preparedness and response at Africa CDC, said authorities are now working with community leaders to build trust and improve cooperation with residents. That is hard in Ituri province, where the outbreak is concentrated and which is also at the center of the rebel conflict in eastern Congo. "Building that trust in the middle of an outbreak is quite complex," Boum said.

The second gap is contact tracing, which remains difficult across the six affected provinces. Surveillance teams have followed up with 81% of listed contacts, but that figure covers only people already on the list, not those who have yet to be found. Africa CDC estimates that cases confirmed in the last three weeks should have produced 97,600 contacts, using an average of 60 contacts per confirmed case. Only 19% of that expected total has been traced.

Third is treatment and isolation capacity. Treatment centers expanded to more than 1,300 beds in late August, and occupancy now stands at 67%, with 869 patients. Even so, experts want more centers and beds in affected health zones to prepare for cases not yet detected. Many zones are places where cases go unreported or unnoticed, partly because of distrust in health authorities, and Boum said some zones cannot be reached at all by surveillance teams or health workers. The World Health Organization said last month that several treatment and transit centers in Ituri were "saturated," while North Kivu, the second-most affected province, lacked enough options for referring patients to specialized facilities.

Fourth is laboratory testing, which experts say must expand so cases can be identified and treated promptly. The strain shows among staff as well. Jeannot Krikeija, who works at an Ebola treatment center in Bunia, the capital of Ituri, said health workers are exhausted. "Ebola is tiring us all the more because we don't know when this scourge will end. This ordeal is unbearable for me," he said.

The fifth gap is burials. Safe and dignified burial teams have been deployed for the more than 3,000 people who have died, but the U.S. agency says gaps remain in how burials are carried out. Ebola spreads through direct contact with the blood or other bodily fluids of someone who is sick or has died of it, and experts warn that bodies of victims still carry large amounts of active virus. In Ituri and other affected areas, burial teams have been attacked several times, often by families trying to protect relatives who died. It is also common to see people gathered around graves during burials, sometimes within a few meters of the coffins.

What to watch now is whether the village-centered approach can win trust quickly enough, and whether tracing, testing and safer burials can improve while insecurity in Ituri continues.