Congo Ebola Cases Pass 10,000 With 4,887 Deaths, and About 80% of New Cases Come From Outside Tracked Contacts

Since the Bundibugyo-strain outbreak was declared on May 15, Congo's confirmed Ebola cases have passed 10,000, with the Health Ministry putting the total at 10,060 cases and 4,887 deaths as of Oct. 25.

That is a fatality rate of 48.6 percent. The latest infections were reported in Ituri, North Kivu and Tshopo provinces.

Deaths are happening outside treatment centers

Congo's National Institute for Public Health said 40 of the 46 most recent deaths occurred in communities, not in Ebola treatment centers. Those patients were not reached in time. At least half of all people who have died were never admitted for treatment, according to responders.

The tracing numbers are worse. Africa CDC says at least 95 percent of new cases must come from known contacts of infected people before an outbreak counts as under control. About 80 percent of new cases in Congo are coming from outside monitored contacts.

Wessam Mankoula, an Africa CDC official, told a briefing last Thursday that only about 12 percent of all confirmed cases in Congo were identified among previously known contacts. Some transmission chains are running undetected.

Rebound after a late-September dip

A WHO Regional Office for Africa report published last Wednesday found infections rebounded in early October after falling in late September. It described "renewed intensification of transmission."

Ituri remains the epicenter and accounts for more than 70 percent of confirmed cases, according to Congolese health authorities. The disease has reached 66 health zones across eight of Congo's 26 provinces. It was in three zones when the outbreak was declared.

The WHO has warned that insecurity, displacement and restricted humanitarian access are disrupting surveillance, which raises the risk that infections go uncounted.

Scale against West Africa

The Associated Press calls this the fastest-growing Ebola outbreak in history. Since its declaration it has produced at least three times the cases and deaths of the 2014-2016 West African epidemic over the same period of time.

That epidemic remains the largest on record, with more than 28,000 cases and more than 11,000 deaths over roughly two years. This outbreak is the second-largest and second-deadliest recorded, and the deadliest ever in Congo.

It has also spread farther across Africa than any previous Ebola outbreak. Cases have been recorded in five countries, including Uganda and France, neither of which has an active case at the moment. Kenya and Nigeria have also reported cases, putting the outbreak in three regions of Africa.

Kenya's cluster, Uganda's quarantine

Kenya released 20 contacts of its first imported patient from quarantine Monday after they completed 21 days of monitoring without symptoms. That patient was a Kenyan national living in Congo who traveled to Nairobi via Uganda and died Oct. 5.

Kenya has since recorded eight more cases, all linked to him and all found among people already in quarantine. It had nine confirmed cases as of Monday.

Uganda has ordered a 21-day quarantine for citizens returning from Congo.

A response short of people and trust

Responders told the Associated Press that treatment centers in some health zones are overwhelmed. They also described residents who remain skeptical of responders and sometimes violent toward them. Health workers regularly strike over delayed or unpaid wages.

A nurse was killed and a health worker injured in an attack while answering an Ebola case in Tshopo province, as the outbreak's toll on responders has continued to grow.

Sephora Bgosi, a member of the Ebola burial team in Ituri, said some people "still don't seem to understand the seriousness of the situation even though they are directly exposed to the risk." Many teams lack vehicles and struggle to persuade families to hand over the sick for treatment and the dead for safe burial.

The damage goes beyond Ebola itself. Routine care, including childhood vaccination, has been disrupted, and maternal deaths doubled in some provinces soon after the outbreak was declared.

Vaccine trial and survivors

The outbreak strain has no approved vaccine or treatment. The WHO announced Friday, Oct. 23, that a first clinical trial of a vaccine had started in Congo.

At least 2,600 patients have recovered in Congo. A video this week showed health workers in protective gear dancing as the last two patients were discharged from a treatment center in Mongbwalu, Ituri province.

"The outbreak is far from over, but every life saved is worth celebrating," WHO Director-General Tedros Adhanom Ghebreyesus said of the video.

What comes next

African health ministers are scheduled to hold a virtual summit Wednesday, Oct. 28. Africa CDC head Jean Kaseya has said: "Ebola is crossing borders. Our response must move faster, with stronger coordination, greater solidarity and decisive political leadership."

The test will be the tracing figure. With about 80 percent of new cases arising outside known contact chains, against a 95 percent benchmark, the outbreak remains short of the level Africa CDC itself sets for containment.