DRC Ebola Outbreak Spreads to Sixth Province as Death Toll Exceeds 2,100
The Ebola outbreak in the Democratic Republic of the Congo has spread to a sixth province, Bas-Uele, with Africa CDC director general Jean Kaseya confirming that a death had been recorded there. The man who died had travelled from Isiro, in Haut-Uele province, to Buta, the capital of Bas-Uele, according to Kaseya The Guardian.
The outbreak, caused by the Bundibugyo virus, has now killed more than 2,100 people out of more than 4,500 cases, according to the latest government figures cited by The Guardian. This death toll was reached almost three times faster than in the 2014-16 west Africa Ebola outbreak, the worst in history, which killed more than 11,000 people. WHO director general Tedros Adhanom Ghebreyesus said the DRC outbreak could eclipse the 2014-16 west Africa outbreak. Tedros also stated that the Ebola crisis in the DRC had been declared a public health emergency of international concern The Guardian.
The trajectory of the outbreak has escalated rapidly since it was declared on 15 May. The WHO said sequencing showed it actually began months earlier, in February. By June 11, a total of 708 confirmed Bundibugyo virus disease cases and 141 deaths had been reported across the DRC and Uganda. As of August 9, the DRC had reported a total of 4,381 confirmed cases with 2,011 deaths, Uganda had reported 20 confirmed cases, and the DRC confirmed 87 new cases. On 12 August, the DRC published a situation update reporting a total of 4,566 confirmed cases, including 2,128 related deaths, according to the ECDC.
Six of DRC's 26 provinces have now been affected. Cases had previously been confirmed in Haut-Uele, Ituri, Nord-Kivu, Sud-Kivu, and Tshopo provinces. On 13 July, the outbreak spread to two more northeastern provinces, Haut-Uele and Tshopo, according to Reuters. More than 97 percent of all cases were concentrated in the Ituri, North Kivu, and South Kivu provinces, according to the Africa Center for Strategic Studies Africa Center for Strategic Studies.
The regional risk has materialized beyond DRC's borders. As of 28 July, Uganda had reported 20 confirmed Ebola cases including two deaths, per the country's Ministry of Health.
The epidemiological picture is grim. Health authorities said between 60% and 70% of new DRC Ebola cases are recorded outside contacts being monitored, a signal that surveillance and contact tracing are not capturing transmission chains. WHO regional director for Africa Dr Mohamed Yakub Janabi said of the outbreak: 'We are chasing the virus; the virus is ahead of us.' The Guardian.
Compounding the response challenges, there are no approved vaccines or treatments for the Bundibugyo virus responsible for the current outbreak. Clinical trials of two possible treatments for the Bundibugyo-type Ebola began last month in Ituri province. However, health workers at the Nizi treatment centre in Ituri province went on strike on Thursday, temporarily closing the centre, after not being paid for three months.
Bas-Uele is no stranger to Ebola. In 2017, an Ebola outbreak was detected in the Likati Health Zone of Bas-Uele province. The current outbreak is the 17th Ebola outbreak in the Democratic Republic of the Congo, according to the US CDC.
Looking at what this means for the trajectory of the outbreak, the convergence of geographic spread, unmonitored transmission, and operational disruption points to a response that is losing ground rather than gaining it. The Bundibugyo virus species, unlike Zaire ebolavirus, lacks the toolset of approved vaccines and therapeutics that proved decisive in prior DRC outbreaks. The strike at the Nizi treatment centre, coming just as clinical trials of two candidate treatments get underway in Ituri, underscores the fragility of the operational backbone. When frontline workers go three months without pay, the question of whether trial protocols can be sustained becomes pressing. The declaration of a public health emergency of international concern and Tedros's warning that the outbreak could eclipse the 2014-16 west Africa epidemic together signal that the institutional alarm is at its highest level. Whether that alarm translates into the surge of resources, coordination, and financial discipline needed to overtake the virus remains the operative question.
