5 challenges Congo faces in containing its fast-moving Ebola outbreak

ABUJA, Nigeria (AP) — Authorities in eastern Congo are shifting to a village-centered approach to fight the Ebola outbreak, Africa’s top public health agency said Thursday, as the virus continues to spread faster than efforts to track and contain it.

The Africa Centers for Disease Control and Prevention said the outbreak has likely not yet peaked. Since it was declared in mid-May, it has spread from three health zones to 60, with 6,250 cases, including 3,039 deaths, government data showed, mostly fueled by insecurity, displacement and intense population movements.

Compared with the outbreak of 2014 to 2016 across West Africa — the deadliest Ebola outbreak on record with more than 11,000 deaths — the current outbreak has recorded six times as many confirmed cases and five times as many deaths, the Africa CDC said.

Here are five areas where Congo’s response to the outbreak is still falling short, according to a report this week from the U.S. Centers for Disease Control and Prevention:

Limited community-based surveillance systems

One major gap in the response is limited community-based surveillance to quickly investigate alerts to be able to detect, track and slow the spread of the virus, the U.S. health agency said.

Delays in detection, reluctance to report cases and inadequate community engagement are contributing to preventable deaths. At least 63% of deaths recorded in the past week occurred outside Ebola treatment centers, Africa CDC data showed.

Authorities are now using a “village-centered approach,” working with community leaders to help build trust and improve collaboration with residents, said Yap Boum, head of emergency preparedness and response at Africa CDC.

Ituri province, where the outbreak is concentrated, is also at the center of the rebel conflict in eastern Congo, complicating efforts to gain trust from residents. “Building that trust in the middle of an outbreak is quite complex,” Boum said.

Contact-tracing needs to improve

Quickly identifying and tracing the contacts of those who had come in contact with Ebola patients remains challenging across the six provinces affected.

Although 81% of contacts have been followed up with by surveillance teams, that figure does not reflect the full reality as it only refers to the listed contacts and doesn’t include those who have yet to be traced.

Africa CDC estimates that cases confirmed in the last three weeks should have generated 97,600 contacts, based on an average of 60 contacts per confirmed case. Only 19% of those total expected contacts have been traced.

More treatment and isolation capacity is needed

Health data shows that treatment centers had expanded capacity to more than 1,300 beds in late August while their occupancy rate is currently at 67% with 869 patients.

However, experts have called for more treatment and isolation centers and beds in affected health zones to prepare for cases that have yet to be detected.

Many affected health zones are in areas where cases go undetected or unreported for several reasons, including distrust in health authorities.

Some health zones are also not accessible to surveillance teams or health workers trying to treat patients, said Boum.

Laboratory testing capacity remains limited

Experts also say that laboratory testing capacity needs to be expanded in order to promptly identify cases and treat patients.

The World Health Organization said last month that several treatment and transit centres in Ituri, the outbreak’s epicenter, were “saturated” while North Kivu, the second-most affected province, lacked sufficient options to refer patients to specialized facilities.

Health workers at existing treatment centers are also exhausted, said Jeannot Krikeija, who works at an Ebola treatment center in Bunia, Ituri’s capital. “Ebola is tiring us all the more because we don’t know when this scourge will end. This ordeal is unbearable for me,” Krikeija said.

Gaps remain in how burials are carried out in affected health zones

Authorities have deployed safe and dignified burial teams for the more than 3,000 people who have died from Ebola, but gaps remain in how the burials are carried out, according to the U.S. health agency.

Ebola can spread between people through direct contact with the blood or other bodily fluids of someone who is sick with or has died from Ebola, and experts have warned that bodies of victims still carry large amounts of active virus.

In Ituri and other affected areas, burial teams have been attacked on multiple occasions, often by families seeking to protect loved ones who died of Ebola. It’s also common to see people surrounding graves of Ebola victims during burials, sometimes within a few meters away from the coffins.

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AP writer Constant Same Bagalwa in Bunia, Congo and Mike Stobbe in New York contributed to this report.