London/Nairobi/Geneva: In an Ebola outbreak, hours matter. Yet the response to the deadly and fast-spreading epidemic in the Democratic Republic of Congo is weeks, if not months, behind and is missing thousands of people who may be at risk.
Interviews with global health officials and documents from a meeting led by the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention show how far behind authorities are in tackling the latest outbreak.
Caused by a strain of the virus known as Bundibugyo, for which there is no vaccine or treatment, the outbreak has already caused a suspected 220 deaths and 900 cases, according to the WHO. It has spread to Uganda, where there are seven cases.
Health teams are racing to find thousands of people who may have been exposed to the virus, while also grappling with numerous challenges that make it difficult to contain.
Problems at a local level include a lack of basic supplies, as well as mistrust from communities scarred by previous outbreaks. Globally, the response is hampered by the withdrawal of the United States from the WHO and wider funding cuts, many health sources said.
Documents from Friday’s virtual coordination meeting show that, as of last week, only 7% of the 1,261 people identified as contacts of suspected Ebola patients had been found and followed up. The WHO put the number at more than 2,000 on Wednesday.
Outpacing the response
The outbreak is “outpacing the response”, WHO Director-General Tedros Adhanom Ghebreyesus posted on Wednesday.
“Attacks on health facilities make tracking cases and their contacts nearly impossible.”
In eastern Congo, the worst-hit area, hospitals have been attacked and isolation tents burned by angry mobs reclaiming the bodies of loved ones, apparently unaware of the risks from infectious corpses.
This is hindering efforts to stop the spread of the virus and track those at risk in an area already affected by conflict and poor health infrastructure, three experts said. In a summary of Friday’s meeting, partners agreed that reaching more contacts is now the key priority, as funding and emergency response personnel slowly arrive.
“Bottom line: No vaccine exists. No therapy exists. The virus circulated undetected for six weeks. Cross-border spread is confirmed. Healthcare workers are dying. Every day without a fully resourced response is a day the outbreak gains ground,” a presentation by the WHO Africa team stated.
Professor Salim Abdool Karim, a leading South African epidemiologist advising the Africa CDC, said the outbreak was moving at “breakneck speed”.
“If you had to choose a bad place for this to happen, it would be Ituri,” he said of the province at the epicentre.
While Congolese officials are well-versed in fighting Ebola — this is the 17th outbreak since 1976 — shortages remain a problem, including the lack of appropriate tests to detect the Bundibugyo strain rather than other Ebola viruses. This also delayed initial detection.
“There are very few people on the ground, and there are other problems as well, like getting fuel for vehicles. It goes on and on,” Karim said.
United States missing
Several sources, including a US official briefed on the Ebola response and another working with the WHO, said problems would have been resolved more easily and quickly in the past, when the US worked with the WHO and often co-led international outbreak responses.
The United States left the organisation in January and has reduced international aid funding more broadly, alongside several other wealthy countries.
“The organisations that would have been able to do this work are not there any more,” one US official said.
Amadou Bocoum, CARE’s country director, said his emergency response team had been reduced by a third.
With the scale and origins of the outbreak unclear, it is a “hell of a job” to find all potential cases and contacts, said Marion Koopmans, a Dutch virologist on the WHO’s emergency committee.
Ebola spreads through direct contact with the bodily fluids of infected people once they develop symptoms, contaminated materials, and the bodies of those who have died from the illness. Contacts must be identified and monitored for 21 days, the virus’s incubation period. If symptoms develop, they can isolate to prevent further spread.
“We’re going back to the basics of Ebola outbreak response, when we did not have the means to contain it as we did before vaccines and therapeutics,” said Dr Alan Gonzalez, deputy director of operations for Médecins Sans Frontières, which has called for staff worldwide to reinforce teams in Congo.
There is also a major psychological obstacle.
“People are afraid,” said Mamadou Kaba Barry, head of mission in Congo for the Alliance for International Medical Action, which has run 60 health centres in Ituri for several years. He said some cases are disappearing and others are not being reported due to mistrust.
He and many others fear a repeat of the worst-ever Ebola outbreak, which spread across West Africa between 2014 and 2016, causing more than 28,000 cases and 11,000 deaths.
“In West Africa, people hid, thinking, ‘What’s the point of dying and having my family unable to recover my body?’” he said, adding that, a decade later, some lessons still need to be learned.
“We never get used to Ebola. It’s always frightening.”