Ebola response lags weeks behind as thousands remain untraced in DRC

Time is critical in an Ebola outbreak, yet the response to the fast-spreading epidemic in the Democratic Republic of Congo is lagging by weeks, possibly months, with thousands of potentially exposed people still untraced.

Interviews with global health officials and documents from a meeting led by the World Health Organization and the Africa Centres for Disease Control and Prevention highlight how far behind the response effort has fallen.

The outbreak, caused by the Bundibugyo strain of the virus for which there is no approved vaccine or treatment, has been linked to an estimated 220 deaths and about 900 cases, according to WHO figures. It has also spread to Uganda, where seven cases have been reported.

Health teams are working to trace thousands of contacts who may have been exposed while facing persistent obstacles that are slowing containment efforts.

At the local level, shortages of basic medical supplies and deep community mistrust shaped by past outbreaks are complicating the response. At the global level, officials say the effort has been weakened by the U.S. withdrawal from the World Health Organization and broader funding cuts affecting international health programs.

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 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 bodies of loved ones, apparently unaware of the risks posed by infectious corpses.

That is hindering efforts to stop the spread of the virus and track those at risk in an area already wracked by conflict and weak health infrastructure, three experts said. In a document summary of the meeting Friday, partners agreed that reaching more contacts is now the key priority as funding and emergency response personnel trickle in.

“Bottom line: No vaccine exists. No therapy exists. The virus circulated undetected for six weeks. Cross-border spread is confirmed. Health care workers are dying. Every day without a fully resourced response is a day the outbreak gains ground,” a presentation by the WHO Africa team from the meeting said.

Professor Salim Abdool Karim, a leading South African epidemiologist and one of the key figures advising 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 added, referring to the province at the epicenter.

While Congolese officials are well-versed in fighting Ebola, this is the 17th outbreak since 1976, shortages remain a problem, including a lack of appropriate tests to distinguish the Bundibugyo strain from other Ebola viruses. This contributed to delays in 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.

U.S. missing

Several sources, including a U.S. official briefed on the Ebola response and another working with the WHO, said problems would have been solved more easily and quickly in the past, when the United States worked with the WHO and often co-led international outbreak responses.

The U.S. left the organization in January and has cut international aid funding more broadly, alongside a number of other wealthy countries.

“The organizations that would have been able to do this work are not there anymore,” said one U.S. official briefed on the response.

Amadou Bocoum, CARE’s country director, said his emergency response team had been cut by a third.

With the scale and origins of the outbreak still 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 show symptoms, contaminated materials and the bodies of those who have died from the illness. Contacts of Ebola patients must be identified and monitored for 21 days, the incubation period of the virus. If symptoms appear, they are isolated to prevent further spread.

“We’re going back to the basics of Ebola outbreak responses when we didn’t have the means to contain it as we do now with vaccines and therapeutics,” said Dr. Alan Gonzalez, deputy director of operations for Médecins Sans Frontières, which has asked staff worldwide to apply to reinforce operations 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 centers in Ituri for several years. He said some cases are disappearing and others are not being reported because of mistrust.

He and many others fear a repeat of the worst-ever Ebola outbreak, which spread across West Africa in 2014-2016 and caused 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 on, some lessons still need to be learned.

“We never get used to Ebola. It’s always frightening.”

DAILYSABAH