Ebola Outbreak in the DRC Spreads to a Sixth Province as Cases Climb Past 4,500

The Ebola outbreak in the Democratic Republic of the Congo (DRC) has spread to a sixth province, Bas-Uele, after a man who had travelled from Isiro, in Haut-Uele province, died in Buta, the capital of Bas-Uele. The director general of Africa CDC — the African Union's public health agency — Jean Kaseya, confirmed the death The Guardian.

The outbreak is caused by the Bundibugyo virus, one of several species of Ebola. As of the latest government figures cited by The Guardian, more than 2,100 people have died out of more than 4,500 cases. That death toll was reached almost three times faster than during the 2014–16 west Africa Ebola outbreak, the deadliest in history, which killed more than 11,000 people. WHO director general Tedros Adhanom Ghebreyesus said the DRC outbreak could surpass the 2014–16 epidemic and confirmed that it has been declared a public health emergency of international concern — the highest alert level the WHO can issue The Guardian.

The outbreak was officially declared on 15 May, but the WHO said genetic sequencing showed it actually began months earlier, in February. By 11 June, 708 confirmed cases and 141 deaths had been reported across the DRC and Uganda. As of 9 August, the DRC had reported 4,381 confirmed cases and 2,011 deaths, with 87 new cases that day alone, while Uganda had reported 20 confirmed 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 (the European Centre for Disease Prevention and Control).

Six of the 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 extended beyond the DRC's borders. As of 28 July, Uganda had reported 20 confirmed Ebola cases, including two deaths, according to the country's Ministry of Health.

The epidemiological picture is troubling. Health authorities said that between 60% and 70% of new DRC Ebola cases are being recorded outside the network of contacts that are being monitored — meaning contact tracing, the process of identifying and tracking everyone who may have been exposed to an infected person, is not keeping up with transmission. 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 challenge, there are no approved vaccines or treatments for the Bundibugyo virus responsible for this outbreak. Clinical trials of two possible treatments began last month in Ituri province. However, health workers at the Nizi treatment centre in Ituri 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 outbreak was detected in the Likati Health Zone of the province. The current outbreak is the 17th Ebola outbreak in the DRC, according to the US CDC.

The broader picture is one of a response that appears to be losing ground. Three forces are converging: the outbreak is spreading geographically, transmission chains are going undetected, and the operational backbone of the response is under strain. The Bundibugyo virus species, unlike the Zaire ebolavirus that drove earlier DRC outbreaks, lacks the approved vaccines and treatments that proved decisive in the past. The strike at the Nizi treatment centre, arriving just as clinical trials for two candidate treatments get underway, raises real questions about whether trial protocols can be sustained when frontline workers go three months without pay. The declaration of a public health emergency of international concern, together with Tedros's warning that the outbreak could eclipse the 2014–16 west Africa epidemic, signals that 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 is the central question going forward.