Why the fastest-growing Ebola outbreak in history is becoming more challenging
The fastest-growing Ebola outbreak in history has killed more than 1,000 people in eastern Congo as health officials race to contain the virus amid ongoing conflict, mistrust and the absence of an approved treatment.
While Congolese officials say the sharp rise in new cases appears to be slowing, they caution the outbreak has not yet peaked. The latest report by the country's public health institute said transmission remains sustained, with recent fluctuations in cases likely influenced by reporting delays and ongoing data consolidation.
The latest update from Congo’s public health institute said there have been 2,536 confirmed Ebola cases and 1,033 deaths, with at least 738 patients in isolation or hospitalised.
The outbreak declared on May 15 is unlike most previous instances of Ebola spreading through communities because the Bundibugyo virus responsible has no approved vaccines or treatments.
“There’s never been an Ebola outbreak that started with so many cases because it was so late to be identified,” Trish Newport, emergency programme manager for Doctors Without Borders, who has been working in Congo, told the Associated Press (AP).
In a worst-case scenario, the current outbreak could approach the worst in history, according to computer modelling by researchers at the United States Centers for Disease Control and Prevention (US CDC) last month.
In comparison, the West Africa epidemic in 2014-2016, the largest Ebola outbreak to date, caused more than 11,000 deaths and took about eight months from the first case to reach 1,000 deaths.
The current outbreak is mostly concentrated in remote Ituri province, which accounts for nearly 90% of cases, but cases have also been confirmed in five other provinces, including one of Congo’s largest cities, Kisangani, and in neighbouring Uganda.
An outbreak in an unstable region
Part of the outbreak is unfolding in a major city and humanitarian hub, Goma, that rebels backed by neighbouring Rwanda seized over a year ago, further complicating the response.
Fighting involving the Rwanda-backed M23 rebels, attacks by the Islamic State-linked Allied Democratic Forces and mass displacement have complicated surveillance, contact tracing and access to affected communities.
AP journalists noted that outsiders can be looked upon with suspicion, and community outreach teams have worked to spread the word about Ebola prevention measures in the face of abuse and accusations that the outbreak is a scam.
Now there is unrest among local Ebola responders themselves after weeks of risky crisis work and little or no pay from the Congolese government. Some staff have gone on strike at treatment centres and blocked access. Striking staffers included epidemiologists, case investigators, drivers and gravediggers.
Community resistance and lack of testing slow response
Lack of trust and resistance from locals remain one of the biggest obstacles to containing the outbreak, according to authorities and health workers.
Rumours about Ebola treatment centres, fears of isolation and resistance to safe burials have led some people to avoid testing or seek care only after becoming critically ill.
Responders are also struggling to understand how far the outbreak has spread and how much worse it might become, with only around 77% of known contacts monitored nationwide, well below the 95% target health officials say is needed to interrupt transmission.
Risk of the outbreak spreading globally remains low
The WHO continues to assess the risk from the outbreak as “very high” inside Congo and “high” in Uganda, where it spilled over, and neighbouring countries, citing cross-border spread, frequent population movement and ongoing transmission in eastern Congo.
The agency said the global risk of transmission is low, noting Ebola spreads through direct contact with an infected person’s bodily fluids rather than through the air, making it much harder to transmit than respiratory viruses.
While the WHO says additional imported cases are likely as the outbreak grows, those cases have so far been rapidly detected and contained.
