Congo's Ebola Outbreak Outpaces Response as Officials Shift to Village-Centered Approach

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

The outbreak was declared in mid-May in three health zones. It has since reached 60. Government data shows 6,250 cases, including 3,039 deaths. The agency attributes the spread mostly to insecurity, displacement and intense movement of people. Measured against the 2014 to 2016 West Africa epidemic, the deadliest on record with more than 11,000 deaths, the current outbreak 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. Delays in detection, reluctance to report cases and weak community engagement are contributing to preventable deaths, and at least 63% of deaths recorded in the past week occurred outside Ebola treatment centers, Africa CDC data showed. Yap Boum, who leads emergency preparedness and response at Africa CDC, said authorities are now working with community leaders to build trust and 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 contacts, but that figure covers 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, based on an average of 60 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. 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, partly because of distrust in health authorities, and Boum said some are not accessible to surveillance teams or health workers at all.

Fourth, laboratory testing capacity remains limited, which slows the identification of cases and the start of treatment. 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. 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 sick with or dead from the disease, and experts have warned that victims' bodies still carry large amounts of active virus. Burial teams have been attacked several times in Ituri and elsewhere, often by families trying to protect their dead. People also commonly gather around graves during burials, sometimes within a few meters of the coffins.

What to watch is whether the village-centered approach can win enough trust to move more of the sick into treatment centers and raise the share of contacts actually traced from 19%.