DR Congo Ebola outbreak toll exceeds 3,700 deaths

This article is published in association with United Nations.

More than 130 days into the latest Ebola outbreak in the Democratic Republic of the Congo (DRC), health experts said on Wednesday that response efforts have been scaled up significantly and “the first encouraging signs of progress” are now being seen.

In an update, the UN World Health Organization (WHO) said that in the last 21 days, cases of infection fell by approximately 26 per cent in province of Ituri and by 15 per cent in the province of Haut Uele.

However, over the same period, North Kivu province recorded a 73 per cent increase, clearly indicating that the Ebola Bundibugyo outbreak has a different transmission profile in the seven affected provinces where it has been confirmed.

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“While cases and theft are declining in some provinces, they continue to rise in others,” said WHO Regional Emergency Director for Africa, Dr Marie Roseline Belizaire.

“Those patterns show the outbreak is still not under control and remain spread across a wide geographic area. One of our greatest concerns is that too many people are still dying before reaching treatment.”

Dr Belizaire explained that around one in three new cases of infection are only identified after people have died outside Ebola treatment centres, in the community.

“These are lives that could potentially have been saved through earlier detection and timely access to care,” the WHO medic said, adding that every death in the community increases the risk of further transmission among family members, caregivers and others involved in traditional burial practices.

Children at most risk

Although adults account for most confirmed cases of infection, children under five have the highest case fatality rate, at more than 60 per cent, compared with approximately 40 per cent among adults. 

Ebola infections in children under 5 are proving very hard to detect because they “can’t necessarily explain their signs and symptoms as well as adults, and the presentation (of symptoms) may be confusing,” added WHO medic Dr. Catherine Smallwood.

Youngsters also account for a disproportionate share of those dying in the community and in health facilities where Ebola is not diagnosed in time.
“We must do more to identify sick children earlier and ensure that they receive appropriate treatment without delay; early detection save lives,” Dr Belizaire stressed, in an online update from Kinshasa.
Ongoing efforts to ramp up the disease outbreak response have contributed to higher success in tracing contacts of infected people, now at almost 88 per cent.

But “too many new infections are still being detected without a known epidemiological link; closing the surveillance gap is essential, and we are to detect cases earlier, trace their contact, and interrupt every chain of transmission,” Dr. Belizaire insisted.

Expanding response

The UN agency and partners continue to expand their reach across affected provinces, with nearly 1,400 treatment and isolation beds across 49 Ebola treatment centres. In addition, there are 25 laboratories capable of processing up to 2,500 tests every day.

However, infrastructure alone will not stop the outbreak, she said.

“Our response is no longer simply about the scaling up everywhere; it is about directing teams, expertise, and resources to the areas where transmission is greatest and where the risks are high.”
Speaking from Beni in North Kivu, WHO’s Dr Smallwood highlighted the “massive mobilization” of responders in recent weeks, in response to the worrying spread of infection in rural areas of DR Congo.

However, although new health centre or Ebola treatment centre beds are becoming available every day, “the big challenge now is finding the partners that can work within those health facilities…The human resources gap is one of the biggest gaps,” Dr. Smallwood explained.

The WHO medic underscored the need to shift the response “from the big urban centres of Beni, Butembo and Katwa in North Kivu to the province’s remote villages.

 “Distances are really long and it takes a long time for patients to be referred into the urban centres,” she said. “So, we really need to put priority on decentralising the response to where the cases are into the villages and into the local areas.”

Ebola facts

Ebola disease is a severe, often fatal illness affecting humans and other primates.

The virus is transmitted to people from wild animals (such as fruit bats, porcupines and non-human primates); it then spreads in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected people. It can also be transmitted by contact with bedding or clothing contaminated with these fluids.

The average Ebola disease case fatality rate is around 50 per cent, according to WHO. Case fatality rates have varied from 25 to 90 per cent in past outbreaks.

The first Ebola disease outbreaks occurred in remote villages in Central Africa, near tropical rainforests. 

The 2014–2016 Ebola virus disease outbreak in West Africa was the largest and most complex Ebola outbreak since the virus was first discovered in 1976. 

There were more cases and deaths in this outbreak than all others combined. It also spread between countries, starting in Guinea then moving across land borders to Sierra Leone and Liberia.