Congo's Ebola Outbreak Outpaces Response as Cases Climb Past 6,000 and Peak Remains Distant

On Thursday, Africa's top public health agency said that authorities in eastern Congo are changing how they fight Ebola, moving toward what it calls a village-centered approach. The change comes because the virus is spreading faster than the teams trying to track and contain it, and the Africa Centers for Disease Control and Prevention said the outbreak has likely not yet peaked.

The numbers show how far it has traveled. Declared in mid-May, the outbreak began in three health zones and now covers 60. Government data put the toll at 6,250 cases, including 3,039 deaths. The Africa CDC attributes the spread mostly to insecurity, displacement and heavy population movement. Measured against the 2014 to 2016 West Africa epidemic, the deadliest on record with more than 11,000 deaths, the current outbreak has logged six times as many confirmed cases and five times as many deaths, the agency said.

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, meaning the ability to investigate alerts quickly enough to detect and slow transmission. Late 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, according to Africa CDC data.

That is where the village-centered approach comes in. Yap Boum, head of emergency preparedness and response at Africa CDC, said officials are working with community leaders to build trust and cooperation with residents. It is hard going 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.

Contact tracing is the second gap, across all six affected provinces. Surveillance teams have followed up with 81% of listed contacts, but that figure flatters the picture because it counts only people already on the list. 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 treatment and isolation capacity. Treatment centers grew to more than 1,300 beds in late August, and occupancy now stands at 67%, with 869 patients. Experts nonetheless want more centers and beds in affected zones to prepare for cases not yet detected. Many of those zones are places where cases go unreported or unnoticed, partly because of distrust of health authorities, and some are not accessible to surveillance teams or health workers at all, Boum said. 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.

Fourth, laboratory testing capacity remains limited, and experts say it must grow so cases can be identified and treated promptly. The strain shows among staff. Jeannot Krikeija, who works at an Ebola treatment center in Bunia, Ituri's capital, 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 they 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 victims' bodies still carry large amounts of active virus. In Ituri and elsewhere, burial teams have been attacked several times, often by families trying to protect their dead. People commonly crowd 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 in Ituri and North Kivu, where conflict, insecurity and displacement continue to work against the response.