Over 4,000 Ebola Bundibugyo cases and 1,800 deaths have been recorded so far in the Democratic Republic of Congo (DRC) – numbers so alarming that health experts intend to research whether the virus is mutating to become more infectious.

This was revealed by Dr Jean Kaseya, the Director General of Africa Centres for Disease Control and Prevention, at a media briefing on Thursday.

In the past 12 weeks, the current outbreak has grown at eight times the pace of the world’s biggest Ebola outbreak, which took place in West Africa between 2018 and 2020.

Every day in the past week, 75 new cases and 35 deaths have been recorded.

Kaseya said that he and World Health Organization (WHO) Director General Dr Tedros Adhanom Ghebreyesus had agreed on Wednesday “to conduct a study to check if there is no additional issue, or maybe if the virus is not mutating, because the level of severity of this Bundibugyo outbreak is unprecedented”.

Tedros, Kaseya and Dr Mohamed Janabi, WHO’s Africa regional director, led a joint high-level mission to the DRC and Uganda earlier in the week, including a meeting with DRC President Felix Tshisekedi.

Following the two-day mission, the two organisations called for “an urgent scale-up of the community-led Ebola response in the DRC, with stronger early detection, contact follow-up, access to care, support for frontline health workers and faster delivery of resources to affected communities”. 

Tedros also said: “Building trust and respecting local traditions, including around safe and dignified burials, are essential to reaching affected communities and stopping transmission.”

Community engagement

Kaseya said one of the main purposes of the delegation’s visit to Bunia, one of the Ebola hotspots in the DRC, was to listen to communities.

“We didn’t go there to blame them. We didn’t go there to tell them what they have to do. We went there to listen. I had a room of more than 100 people coming from organisations, associations, coming from those who were infected with Ebola, and young people, women. All of them were sharing a critical message: We are not involved, and we want to be involved.”

Kaseya said that internet connectivity via Starlink will be extended to all villages in Ituri to enable timely data and information about the outbreak.

After Bunia, the delegation met with Tshisekedi and other top government officials in the DRC capital of Kinshasa and resolved to take the outbreak response to the village level in Ituri’s 6,542 villages to reach people more effectively.

The outbreak has not yet reached Kinshasa, but on Thursday the DRC government stopped a boat with 200 passengers from reaching the capital after a patient with suspected Ebola symptoms had disembarked and died.

The boat had been travelling from Kisangi in the north-east to Kinshasa but had been stopped about 65km from the capital and all passengers were tested. Kinshasa has a population of around 17 million.

Striking health workers

Tedros added that, in their meeting with Tshisekedi, they discussed “the need to continue to protect and support frontline health and community workers, including by ensuring they have adequate personal protective equipment, and are compensated for their work”.

Around 140 health workers have been infected with Ebola in the current outbreak.

There have been several protests and strikes by health and other workers involved in the outbreak response over unpaid wages.

Health workers in Ituri protested outside the governor’s office on Thursday, saying that they have not been paid salaries or allowances since May.

In mid-July, health workers at Bunia General Hospital in northeastern Ituri went on strike, saying that they had not been paid since the outbreak started despite working under difficult conditions.

Healthcare workers and grave diggers at the Rwampara General Hospital, also in Ituri, went on strike over unpaid wages in early July.

However, Kaseya told the media briefing that it was the responsibility of the DRC government, not their outbreak partners, to pay their health workers. 

“We will not hear again about the strikes of health workers. The government yesterday told me that they have money to pay health workers,” he insisted.

But he added that some funding is available from the “humanitarian budget” for free healthcare services to all people in Ituri and North Kivu provinces, which are worst affected by Ebola. Since the start of the outbreak, the DRC government has offered free health services to those living in these provinces to encourage people to go to health facilities.

More deaths in communities than facilities

One of the most disconcerting aspects of the DRC outbreak is that most deaths are being recorded in communities, not health facilities. Last week, 67% of Ebola deaths were in communities, usually identified via tests administered after death.

“The contact lists don’t mean anything because it is not accurate,” said Kaseya, once again highlighting weaknesses around tracing people who have been in close contact with confirmed cases.

On average, around 10 contacts per patient in the DRC have been recorded in comparison to 40+ in Uganda, which contained its Bundibugyo outbreak at 20 cases.

Kaseya also revealed that the bed occupancy rate in Ituri province, one of the hotspots, ranged between 56-69% – way lower than in Nord Kivu, where Ebola treatment centres were 128-157% full.

Several treatment centres in Ituri have been attacked and burnt in the past.

Uganda’s case fatality was 10% in comparison to the DRC’s 44%, and Kaseya suggested this could be because every patient was given the antiviral medicine, Remdesivir. 

A trial to test Remdesivir’s efficacy against Bundibugyo is currently underway in the DRC,  along with another antiviral known as MPP134. However, only 68 people have been recruited so far.

US pledges more funds

Meanwhile, the US State Department announced on Wednesday that it intends to provide an additional $242 million in funding for “immediate Ebola response and preparedness efforts in the region and humanitarian assistance related to the outbreak”.  

“The Department of State’s assistance announcements to combat the outbreak have now exceeded $512 million in direct assistance, enabling implementing organizations to expand the ongoing response in Africa,” said the State Department, adding that it had already made $350 million available for “critical humanitarian assistance in the DRC, South Sudan, and Uganda”.

Kaseya said that, taking into account the latest US contribution, $472 million had been released and almost $700 million was expected.

Image Credits: Aljazeera.