Congo Ebola outbreak may be 3 times larger than official count: Africa CDC | World News

By Jason Gale, Melos Ambaye and Janice Kew

The Ebola epidemic sweeping the Democratic Republic of Congo may be three times larger than official figures indicate, Africa’s top public-health agency said, suggesting thousands of infections are going undetected as authorities struggle to track transmission.

Congo has officially recorded 5,713 confirmed infections and 2,744 deaths through Aug. 25. An outbreak three times that size would imply about 17,100 infections. The confirmed case-fatality ratio has climbed to 48 per cent from 27 per cent two months earlier.

Still, the proportion of deaths occurring in the community has fallen significantly over the past three days in areas where health workers have been deployed, Kyeng Mercy, the epidemic intelligence unit lead at the Africa Centres for Disease Control and Prevention, told reporters Thursday. 

The assessment underscores how little health authorities may know about the true extent of an epidemic that has spread across six provinces in eastern Congo. Weak contact tracing, insecurity and disruptions to the response have made it difficult to identify infected people and isolate them before they spread the virus.

International attention, political focus and resources were still lagging behind the situation on the ground, United Nations Secretary-General António Guterres said Thursday.

“We know how to contain Ebola, how to interrupt transmission and how to save lives,” he said, “but we must also overcome another virus: the virus of indifference.”

Hidden Spread

Africa CDC has previously acknowledged that the official numbers don’t capture the full outbreak. On Aug. 6, Africa CDC Director-General Jean Kaseya said more than 70 per cent of new infections were being found in the community rather than among known contacts and that authorities believed additional cases weren’t being reported.

Contact-tracing data provide evidence of substantial under-detection, according to Africa CDC. Authorities identified only about one-fifth of the contacts the agency would have expected from confirmed cases over the three weeks through Aug. 25.

Africa CDC estimates the effective reproduction number nationally at a little over 1, though transmission varies substantially between health zones. Infections are declining in some major Ituri hotspots while continuing to grow in areas including Katwa in North Kivu.

The agency has responded by shifting toward active case finding, including going house-to-house in affected communities rather than relying principally on lists of known contacts. Implementation is expanding across affected areas, although coverage remains uneven.

Genomic Clues

Genomic sequencing can help reveal transmission that traditional contact tracing misses, but the data can’t yet determine the true size of the epidemic, said virologist Jason Kindrachuk, Canada research chair at the University of Manitoba who is involved in genomic analysis of the outbreak.

Almost all the viral sequences analyzed by Kindrachuk and colleagues so far have come from Ituri, leaving much less visibility into how the virus is evolving and spreading elsewhere in the country. Some people with mild infections are probably going uncounted, while cases in areas beyond the reach of response teams may also be missed, he said.

Despite an influx of funding, shortages and payment problems continue to disrupt the response.

About $867 million had been released for the response, Africa CDC said, though it’s still working with the WHO and other partners to reconcile financing figures. Getting money already mobilized through administrative and payment systems to frontline workers remains a problem.

“The challenge we are seeing in these locations is at the last mile,” Africa CDC spokesperson Saran Koly said.

Response Strains

Five Ebola checkpoints in Haut-Uélé were still closed on Aug. 25 because unpaid workers were on strike, while treatment capacity for suspected cases in North Kivu was above available bed capacity.

One problem has been getting workers recruited by different response partners registered on the government payroll, making the process of reconciling staffing and payments “quite tedious,” said Yap Boum, head of emergency preparedness and response at Africa CDC.

About 2,800 health workers have now been paid by the government and partners, while an agreement has been reached to pay community care workers $150 a month, he said.

Separately, Congo began vaccinating health workers and other frontline responders in Kisangani on Thursday, with the campaign initially targeting personnel involved in the response in Tshopo, Bas-Uélé and Haut-Uélé, according to the National Institute of Public Health.