Congo's Ebola Outbreak Outpaces Response as Africa CDC Says Peak Not Yet Reached

On Thursday, Africa's top public health agency said the Ebola outbreak in eastern Congo is spreading faster than the people tracking it can keep up, and that it has most likely not yet peaked. The Africa Centers for Disease Control and Prevention also said authorities are shifting to a village-centered approach, built around community leaders, in an effort to catch up.

The numbers frame the problem. Since the outbreak was declared in mid-May, it has grown from three health zones to 60. Government data show 6,250 cases, including 3,039 deaths. The agency attributes the spread mostly to insecurity, displacement and heavy movement of people. Measured against the 2014 to 2016 outbreak across West Africa, the deadliest on record with more than 11,000 deaths, the current one has recorded six times as many confirmed cases and five times as many deaths, according to Africa CDC.

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, the ability to investigate alerts quickly enough to detect, track and slow the virus. Delays in detection, reluctance to report cases and weak community engagement are contributing to preventable deaths. At least 63% of deaths recorded in the past week happened outside Ebola treatment centers, Africa CDC data show.

That is where the village-centered approach comes in. Yap Boum, head of emergency preparedness and response at Africa CDC, said authorities are working with community leaders to build trust and improve cooperation with residents. It is hard work in Ituri province, where the outbreak is concentrated and which sits 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 contacts, but that figure counts only contacts already listed, not those yet to be found. Africa CDC estimates that cases confirmed in the last three weeks should have produced 97,600 contacts, assuming an average of 60 per confirmed case. Only 19% of that expected total has been traced.

Third is capacity to treat and isolate patients. 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 the affected zones to prepare for cases not yet detected. Many of those zones are places where cases go unreported or unnoticed, in part because of distrust in health authorities, and some are not reachable by surveillance teams or health workers, Boum said.

Fourth, laboratory testing capacity remains limited, and experts say it must grow so cases can be identified and treated promptly. The World Health Organization said last month that several treatment and transit centres in Ituri, the epicenter, were "saturated," while North Kivu, the second-most affected province, lacked enough options for referring patients to specialized facilities. The strain shows among staff too. Jeannot Krikeija, who works at an Ebola treatment center in Bunia, Ituri's capital, said the uncertainty is wearing everyone down. "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 sick with or who has died from the disease, and experts have warned that victims' bodies still carry large amounts of active virus. In Ituri and other areas, burial teams have been attacked several times, often by families trying to protect their dead. It is also common to see people standing around graves, sometimes within a few meters of the coffins.

What to watch now is whether the village-centered approach can raise that 19% contact-tracing figure and draw more of the sick into treatment centers, in a region where conflict makes trust slow to build.