Deadly Ebola strain spreads in Congo as global aid falters

LONDON/NAIROBI/GENEVA – In an Ebola outbreak, hours matter.

Yet the response to the deadly epidemic in Congo is lagging – and health officials are missing thousands of people who may be at risk.

Interviews with global health officials and internal meeting documents show how behind the curve authorities are in fighting the latest outbreak, as cases spread and hospitals come under attack.

The outbreak is caused by a virus strain known as Bundibugyo, for which there is no vaccine or treatment. The World Health Organization said it has caused a suspected 220 deaths and 900 cases, and has spread to Uganda.

Health teams are racing to find thousands of people who may have been exposed to the virus while also grappling with myriad challenges that make containment difficult.

Health officials say that problems at a local level include lack of basic supplies as well as mistrust from a community scarred by previous outbreaks. Globally, the response is hampered by the withdrawal of the U.S. from the WHO and wider funding cuts.

Documents from Friday's virtual coordination meeting between the WHO and the Africa Centers for Disease Control and Prevention show that, as of last week, only 7% of the 1,261 people identified as contacts of suspected Ebola patients had been reached. 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 crowds reclaiming bodies of loved ones, apparently unaware of risks from 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 with poor health infrastructure, health officials said.

In a summary of the meeting Friday, the partners agreed that reaching more contacts is the key priority as funding and emergency response personnel trickle in.

"Bottom line: No vaccine exists. No therapy exists," reads a presentation by the WHO Africa team from the meeting. "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."

While Congolese officials are well-versed in fighting Ebola – this is the 17th outbreak since 1976 – shortages remain a problem, including of the correct tests to detect Bundibugyo rather than other Ebola strains.

The shortages also delayed detection.

U.S. missing

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

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 unclear, it was 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 have symptoms, contaminated materials, and the bodies of those who have died of the illness. Health workers monitor contacts of Ebola patients for 21 days, the virus's incubation period. Those who experience symptoms can isolate, stopping further spread.

“We’re going back to the basics of Ebola outbreak responses when we didn't have the means to contain it like we did before vaccines and therapeutics,” said Dr. Alan Gonzalez, deputy director of operations for Medecins Sans Frontieres, which has asked staff worldwide to apply to reinforce the Congo workforce.

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 province, the epicenter of the outbreak. He said some cases are disappearing and other suspected cases are not being reported because of the 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 later, some lessons still need to be learned.

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