DRC Ebola outbreak spreads to sixth province; experts warn of year-long epidemic

The Ebola outbreak spreading across the Democratic Republic of the Congo has now reached a sixth province, and the numbers tell a story of an epidemic accelerating beyond the capacity of the response. As of mid-August, health authorities confirmed 4,727 cases and 2,214 deaths across 55 health zones in Bas-Uele, Haut-Uele, Ituri, North Kivu, South Kivu, and Tshopo provinces. The newest affected area is Buta health zone in Bas-Uele, where a person who had traveled from Isiro in neighboring Haut-Uele died after arriving there. The epicenter remains Ituri province, but the virus is no longer contained.

What makes this outbreak particularly difficult to control is where people are dying. More than 63 percent of deaths are occurring in communities—in homes, in villages—rather than in hospitals or treatment centers where health workers can monitor contacts and manage the spread. When someone dies at home, the chain of transmission becomes invisible. Health authorities don't know who touched the body, who prepared it for burial, who sat with the family in those critical hours after death. Contact tracing, the backbone of outbreak response, becomes guesswork. The formal contact follow-up rate stands at 82.6 percent, but that number masks a deeper problem: many contacts are never identified in the first place. The Africa Centers for Disease Control and Prevention has warned that the proportion of registered contacts being followed does not reflect whether contact tracing itself is actually working.

The timeline of the outbreak adds another layer of uncertainty. The DRC formally declared the epidemic on May 15, but studies suggest transmission may have begun around February. That means three months passed—January through May—when the virus was circulating undetected, infecting people, spreading through communities, establishing transmission chains that remain unmapped. "We have no clue about what happened from February to May," said Jean Kaseya, the Africa CDC's director-general. The figures collected since the formal declaration should not be treated as a complete picture of the epidemic. Investigators are now trying to reconstruct those lost months by asking communities to identify people who died or fell ill with Ebola-like symptoms between January and May, even when laboratory confirmation is no longer possible.

The speed of this outbreak has alarmed global health officials. "It's moving faster than any previous Ebola outbreak," said Tedros Adhanom Ghebreyesus, the World Health Organization's director-general. At its current pace, it is on track to surpass the 2014-2016 West African epidemic, which infected more than 28,600 people and remains the largest Ebola outbreak ever recorded. That epidemic lasted nearly two years and killed more than 11,000 people. The prospect of matching or exceeding those numbers has prompted warnings about the duration of the current crisis.

Planning for the outbreak's trajectory has shifted into worst-case scenarios. The WHO's moderate scenario assumes the outbreak could continue for about six months. But there is a darker possibility: the outbreak could last nine months to a year. Kaseya went further. "If we don't stop this outbreak," he said, "it could last more than a year and ultimately become the largest Ebola epidemic ever recorded." That conditional warning carries weight because it is not speculation—it is a projection based on current transmission rates and the gaps in the response.

Turning the trajectory requires a fundamental shift in how the response operates. Kaseya outlined the necessary measures: moving more surveillance and response responsibility to villages themselves, ensuring people have access to essential health services, strengthening the referral of suspected cases to treatment centers, deploying additional medical tools, and improving coordination among the many organizations working to contain the virus. The outbreak has now infected 976 people who have recovered, but the momentum remains with the virus. The question facing health authorities is whether they can interrupt transmission chains faster than the virus can establish new ones.