Authorities in eastern Congo are adopting a village-centered strategy to combat a fast-moving Ebola outbreak that has spread to 60 health zones and claimed over 3,000 lives since mid-May. The Africa Centers for Disease Control and Prevention (Africa CDC) indicated that the outbreak has likely not yet peaked, noting that the virus is spreading faster than containment efforts can keep pace.
The current outbreak has recorded significantly more cases and deaths than the 2014-2016 West Africa epidemic, which was the deadliest on record. Eastern Congo's response faces challenges in several key areas, including limited community-based surveillance, delays in detection, and inadequate community engagement.
Surveillance and Trust Challenges
A major gap identified by the U.S. Centers for Disease Control and Prevention is the insufficient community-based surveillance needed to quickly investigate alerts and slow the virus's spread. Delays in reporting cases and a general distrust in health authorities contribute to preventable deaths, with at least 63% of recent deaths occurring outside of treatment centers, according to Africa CDC data. The region's ongoing rebel conflict in Ituri province further complicates efforts to build trust with residents.
Quickly identifying and tracing contacts of infected individuals remains a significant hurdle. While 81% of listed contacts are followed up with, this figure does not account for the vast number of untraced individuals. Based on an average of 60 contacts per confirmed case, Africa CDC estimates that cases from the last three weeks should have generated nearly 97,600 contacts, but only 19% of these have been traced.
Treatment Capacity and Laboratory Gaps
Despite an expansion of treatment center capacity to over 1,300 beds by late August, with an occupancy rate of 67% currently, experts are calling for more treatment and isolation facilities. Some affected health zones are difficult for surveillance teams and health workers to access, and cases often go undetected or unreported due to distrust. The World Health Organization previously reported that treatment and transit centers in Ituri, the outbreak's epicenter, were saturated, and North Kivu, the second-most affected province, lacked sufficient specialized facilities for patient referrals.
Furthermore, laboratory testing capacity needs to be expanded to enable prompt case identification and treatment. Health workers at existing centers report exhaustion, with one stating, "Ebola is tiring us all the more because we don’t know when this scourge will end. This ordeal is unbearable for me."
Burial Practices and Security
Safe and dignified burial teams have been deployed for the more than 3,000 victims, but gaps persist in their execution. Ebola can spread through direct contact with the bodily fluids of infected individuals, including deceased bodies. In Ituri and other affected areas, burial teams have faced attacks, sometimes from families wanting to protect deceased loved ones. It is also common for people to gather near graves during burials, often within meters of the coffins, increasing transmission risk.