Ebola outpaces containment in eastern Congo as contact tracing falters

(Bloomberg) — Ebola is spreading faster than rescuers can track it in eastern Congo, where health workers have managed to make contact with barely one in five identified contacts in a single day.

Authorities in the Democratic Republic of Congo reported 83 confirmed infections, 746 suspected cases and 1,603 identified contacts as of May 21, according to the health ministry. However, health workers were only able to follow up on 342 contacts that day – about 21% of the total number of people being monitored, according to ministry figures released on Friday.

The numbers suggest the response is lagging behind the epidemic itself, even as governments and international agencies put in place emergency measures after the World Health Organization declared the outbreak a public health emergency of international concern on May 17.

The outbreak has now spread to three provinces including South Kivu, where officials this week confirmed a case near Bukavu, a large city near Congo’s border with Rwanda. Two cases were confirmed earlier this week in neighboring Uganda, while health officials warn that insecurity, population movements and mistrust of authorities are complicating efforts to trace infections and isolate cases.

The epidemic is unfolding in “one of the most challenging possible operational environments”, the WHO’s emergency committee said on Friday.

Tensions around the containment measures are already emerging. According to local media reports, relatives of a man who died at Rwampara Hospital near Bunia, the capital of Ituri province where the outbreak was first detected, clashed with medics after authorities refused to release the body for burial due to the risk of infection. During the unrest, Ebola treatment tents run by the humanitarian group Alima were set on fire and six patients, including three confirmed Ebola cases, fled the facility, according to reports from the area.

The outbreak is caused by the rare Bundibugyo strain of Ebola, for which there are no approved vaccines or antibody treatments. The virus appears to have circulated undetected in Ituri province for months before authorities recognized what they were dealing with.

Health officials are now trying to track thousands of people who may have been exposed to the infections, which are spreading through remote mining areas and urban centers including Bunia and Goma, cities with populations approaching 700,000 and 860,000, respectively.

More than 11 metric tons (12 tonnes) of emergency supplies – including protective gear, medical kits and materials for safe burials – have already been airlifted to Bunia, the WHO said on Friday.

The latest figures from the ministry indicate that the confirmed transmission is spreading beyond the gold mining center of Mongbwalu, which was initially thought to be the epicenter. While Mongbwalu remains the largest suspected cluster, confirmed infections are increasingly concentrated in surrounding health zones, including Rwampara and Bunia.

Nyankunde, home to a major referral hospital serving about 200,000 people, has also emerged as a growing cluster, with 11 confirmed cases and 340 contacts being traced, according to the ministry.

The WHO warned that weak surveillance and laboratory capacity were hampering the response, noting that the GeneXpert diagnostic platform widely used during previous Ebola outbreaks could not detect the Bundibugyo strain. Virus-specific PCR kits are also in limited supply, the medical organization Médecins Sans Frontières said this week.

Countries should rapidly expand laboratory testing, contact tracing and community outreach while negotiating “safety corridors” to allow rescuers to safely reach affected communities, the WHO said in interim recommendations issued on Friday.

The Congolese government has reported a positivity rate of nearly 46%, suggesting that many infections may still be undetected.

The outbreak is taking place in one of the world’s most volatile regions, where armed groups control large areas, roads are bad and millions of people move between mining camps, cities and neighboring countries. The alliance, which includes the Rwandan-backed M23 rebels, on Friday announced its own Ebola response structure in territories under its control, urging communities to work with health workers and avoid politicizing the epidemic.

The risk inside Congo is now considered “very high”, while neighboring countries face a “high” regional threat, the WHO said. Uganda tightened border controls and suspended passenger transport links with Congo. Rwanda also tightened control measures, saying on Friday that most foreign travelers who had recently visited Congo would be denied entry, while returning residents would face mandatory quarantine.

The risk to the general public in the EU remains “very low”, although the bloc has begun coordinating laboratory preparedness and travel guidelines through the Health Security Committee, European health authorities said on Friday. The US has taken a more restrictive approach, such as temporarily banning some green card holders who have recently visited affected areas from entering the country.

The outbreak has also exposed growing concerns about the fragility of global outbreak response systems after years of aid cuts and shifting political priorities.

“We are behind, we are not yet under control,” Anne Ancia, the WHO representative in Congo, said this week.

–With help from Sonja Wind, Jessica Nix and John Tozzi.

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