Ebola deaths double in two weeks as WHO warns virus is outrunning response

KINSHASA – Deaths from Ebola doubled in just over two weeks in the Democratic Republic of Congo, where many infected people aren’t reaching care, allowing the virus to spread through communities in what the World Health Organisation describes as the fastest-growing outbreak it has managed.

Congo has reported 754 confirmed deaths and 2,011 cases, the National Institute of Public Health said on July 14.

The death toll has climbed from 377 on June 28, while the outbreak has spread into two new provinces beyond its original epicentre in Ituri.

The epidemic has already exceeded half the number of cases recorded during Congo’s previous Ebola outbreak, which began in 2018 and lasted almost two years, medical aid group Médecins Sans Frontières said on July 15.

The true scale of the epidemic could be “at least two to four times” larger than the official case count because 80 per cent of new infections are occurring outside health officials’ contact lists, Chikwe Ihekweazu, executive director of the WHO’s health emergencies programme, told reporters on July 14.

“You have to imagine that this is a fire,” Ihekweazu said. “We’ve seen the fastest growth in a single month since the outbreak started and of all the Ebola outbreaks that we have managed.”

The crude case-fatality rate has increased to 37 per cent from 32 per cent a week earlier, a pattern the WHO says reflects persistent delays in diagnosis, isolation and access to care rather than increased disease severity.

The agency’s analysis of 430 confirmed deaths found that some 92 per cent occurred before patients reached treatment facilities.

“We must find the cases earlier, bring them into care as soon as possible so that we reduce transmission in the community,” Ihekweazu said. “The more cases stay in the community, the more they transmit, the more we stay behind the curve.”

Evading treatment

Keeping patients in care remains another obstacle.

More than 240 people have fled Ebola treatment or isolation facilities during the outbreak, including 100 in the past month, highlighting the difficulties health authorities face persuading patients to remain under care.

The response is under growing strain.

Isolation facilities in North Kivu province are operating at more than 120 per cent occupancy, while safe-burial activities in Rwampara, where more than 400 confirmed cases have been reported, have been disrupted because burial teams haven’t been paid, health authorities said.

The shortage of treatment capacity is also discouraging some patients from seeking care.

“People regularly tell us they prefer to wait at home and come only when a bed becomes available,” said Sylvie Kaczmarczyk, emergency coordinator with Médecins Sans Frontières in Bunia, the provincial capital at the centre of the outbreak.

The city’s 90-bed Elikiya Ebola Treatment Centre “is almost always operating at full capacity,” she said in a statement. “As a result, we continue to receive patients who arrive late and are already critically ill.”

The International Rescue Committee warned the outbreak is worsening on two fronts, with transmission accelerating in existing hotspots while spreading into new areas that increase the risk of cross-border transmission into South Sudan.

“The risk to South Sudan is particularly alarming,” said Bob Kitchen, vice president of emergencies at the IRC, in a statement.

“If Ebola crosses the border, it could spread silently before being detected, making the response far more complex and putting countless lives at risk.”

The outbreak has also reached Kisangani, a city of about 1.5 million people on the Congo River that links eastern Congo with Kinshasa.

Difficulty breathing

Doctors are also investigating whether Bundibugyo – the Ebola strain driving the current outbreak – differs clinically from other members of the virus family that includes Marburg.

Difficulty breathing was reported in about a third of patients with confirmed Bundibugyo infection in a report in the New England Journal of Medicine in June.

“Bundibugyo seems to have a respiratory component that we don’t usually see in the other filovirus diseases,” said Armand Sprecher, an emergency physician and epidemiologist with Médecins Sans Frontières, after arriving in Bunia.

Patients are arriving “with some difficulty breathing” and needing more oxygen than clinicians are accustomed to providing, he said in an interview.

Besides a possible direct effect of the virus on the lungs, breathing problems could reflect severe infection combined with conditions common in eastern Congo, including malaria, anemia and malnutrition, which reduce the body’s ability to carry oxygen and make even modest lung injury more dangerous, said Craig Spencer, an emergency-medicine physician who treated Ebola patients during the 2014-16 West African epidemic. BLOOMBERG