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More than 1,000 people have died in the Ebola outbreak in Congo, Africa's top public health agency has said, as the disease spreads amid conflict, resistance from some communities and gaps in the response. Speaking at a health summit in Ghana, Africa Centres for Disease Control and Prevention director-general Dr Jean Kaseya said 1,031 deaths had been confirmed.
Kaseya warned that the outbreak was moving at a pace not seen before. He said, "These are people dying. They are dying because we don't have vaccines, we don't have medicine, we don't have funding." He also called for stronger action, saying, "If we do not stop this outbreak today, it could become one of the worst Ebola outbreaks the world has ever documented."
Congo's Ministry of Health said that as of Monday, 2,473 cases had been recorded in the outbreak and at least 737 patients were in isolation or in hospital. The outbreak was declared on May 15 and is different from most previous Ebola outbreaks because the Bundibugyo virus behind it has no approved vaccines or treatments.
According to the report, it has killed more people at a faster rate than any Ebola outbreak on record. The 2013-2016 outbreak, regarded as the worst on record, caused more than 11,000 deaths from at least 28,000 cases, but it took about eight months from the first case to reach 1,000 deaths. The World Health Organisation has said the actual scale of the current outbreak could be two to four times higher than official figures, with some communities at the centre of the outbreak still hard to reach because of fighting involving rebel groups.
Officials have said 80 per cent of new cases have appeared outside known chains of transmission, showing the outbreak is spreading faster than health officials can track it. The response has been stepped up in Ituri province, the epicentre of the outbreak, and in four other provinces where cases have been recorded. Africa CDC said less than 9 per cent of contacts of confirmed patients who should be traced are currently being monitored, well below the level needed to contain the outbreak. More than 60 per cent of deaths are happening in the community before patients receive care.
Pierre Akilimali, the Ebola response incident manager at the National Public Health Institute of the Democratic Republic of the Congo, said the high number of community deaths suggested that many infections were not being detected or isolated in time, allowing the virus to keep spreading. Ebola is rare but highly contagious and can spread through contact with bodily fluids such as vomit, blood or semen. It can cause severe illness and is often fatal.
Resistance from some communities has also hurt the response, especially over safe burials. Robert Ndjalonga, head of civil protection in Ituri province, said some communities had refused to allow burial teams to work because they preferred traditional burials, raising the risk of further transmission. "The biggest challenge remains resistance from or outright refusal by some communities to accept response teams," Ndjalonga said. "On several occasions, burial teams have had to be escorted by security forces to ensure that safe and dignified burials could be carried out without incident." He said shortages of burial supplies had delayed responses to reported deaths and some affected health zones still did not have operational burial teams.
Attacks on health facilities and response teams have also forced front-line workers and aid groups out of some areas. Some health workers have gone on strike, saying they have not been paid since the outbreak began. Provincial civil protection authorities said a member of a team carrying out safe Ebola burials was recently injured after attackers threw stones at the team's vehicle following a burial in Bunia last week. In Irumu territory in Ituri, the local military administrator recently described Ebola as a greater threat than the Islamic State-affiliated Allied Democratic Forces insurgency and urged residents to support health workers instead of attacking them.
A humanitarian worker involved in the response, who spoke on condition of anonymity because he was not authorised to speak publicly, pointed to poor coordination between response agencies, delays in moving patients to treatment centres and waits of more than four days for some Ebola test results. "At times, it's unclear who is doing what and where," the worker said. He added that the delays had led some patients to leave health facilities before they could be diagnosed, increasing the risk of further spread.
Last month, researchers at the US Centers for Disease Control and Prevention used computer modelling to estimate how the outbreak could develop. In a worst-case scenario, they said it could approach the scale of the 2014-2016 West Africa epidemic. "There's never been an Ebola outbreak that started with so many cases because it was so late to be identified," said Trish Newport, emergency programme manager for Doctors Without Borders, who has been working in Congo. "It's like the outbreak is outrunning the response," Newport said. University of Pittsburgh epidemiologist Dr Jean Nachega, who is advising African health authorities, said he did not expect the outbreak to reach the CDC's worst-case scenario, but warned that the challenges remained "huge".
The outbreak in Congo has now crossed 1,000 deaths as health officials struggle with missing treatments and vaccines, weak tracking of contacts, violence, resistance from some communities and delays in care. With official figures likely to understate the scale of the crisis, health authorities have warned that stronger and quicker action is needed to slow its spread.
With PTI Inputs
