Congo Ebola Cases Pass 11,000, Deaths Reach 5,387 as Bundibugyo Outbreak Spreads

Since Congo declared the Bundibugyo Ebola outbreak in mid-May, the count has climbed past 11,000 confirmed cases. Government data released Tuesday, Nov. 10, show 11,042 confirmed infections and 5,387 deaths.

That is roughly a 49% fatality rate among confirmed cases.

The previous milestone came in the Oct. 26 update from Congo's Ministry of Public Health, which put the death toll at 4,887 and reported 96 new confirmed cases and 46 deaths in a single 24-hour period. The toll has since risen by 500 in about two weeks.

Where the outbreak stands

Only the 2014-2016 West African epidemic was bigger. It infected more than 28,600 people and killed more than 11,000.

But this one is moving faster. NPR reported that at the 10,000-case mark, the West African outbreak had reached only about 4,000 infections. It is also the widest-ranging Ebola outbreak on the continent. Cases have been reported in East, Central and West Africa.

Eight of Congo's 26 provinces are affected: Bas-Uele, Haut-Uele, Ituri, North Kivu, South Kivu, Sud Ubangi, Tshopo and Nord-Ubangi. Ituri accounts for 71.7% of confirmed cases, the health ministry said. Many deaths have occurred outside treatment centers.

Dieudonne Mwamba Kazadi, director general of the National Institute of Public Health, said response teams are concentrating on five health zones that hold more than 80% of cases: Mambasa, Beni, Katwa, Bunia and Rwampara. He put contact-tracing follow-up at about 87% and said more than 2,500 people had recovered as of late October.

There are no approved treatments or vaccines for the Bundibugyo species.

Spread beyond Congo

The CDC says Kenya's first case was reported Oct. 6 in a man who traveled from Congo through Uganda to Nairobi. He was hospitalized and died in an isolation unit. The CDC said he did not contract the virus in Kenya. The remaining Kenyan cases, including a second death, were relatives and health workers who had close contact with him and were already in quarantine when diagnosed. Kenya's Ministry of Health has reported no community transmission.

Nigeria's Ministry of Health said in an Oct. 23 update that genetic analysis showed its case was related to the virus identified in Kenya. It said more investigation was needed to determine whether the two cases are directly linked.

Children hit hardest

About a third of those who have died have been children, NPR reported. Roughly three out of four infected children under 5 have died.

"Behind every figure is a life interrupted, a family mourning, a health worker under pressure and a community seeking reassurance," said Mohamed Janabi, WHO regional director for Africa.

Why it got a head start

The outbreak was declared in May, but more recent evidence suggests the virus was spreading in February or March. Katie Thomas-Canfield, interim Ebola response director for the International Rescue Committee, said months of undetected spread meant responders "started at a disadvantage."

Bundibugyo is a rarer species, and existing tests were not calibrated for it, which delayed detection. The region is remote and conflict-ridden. Nahid Bhadelia, an infectious disease physician at Boston University, said U.S. cuts to foreign aid may also have slowed disease surveillance. That claim is hers, and the sources offer no measurement of the effect.

Gunmen and an emptied hospital

Conflict is not just background. Local authorities in North Kivu reported an attack by the Islamic State-linked Allied Democratic Forces on a community that includes the Kelele Hospital Center. Sources told Reuters at least 33 people were killed and a health center was set on fire.

Christian Kakule Vulembera, the hospital's head doctor, said gunfire began around 11 p.m. and caused panic. By about midnight, he said, "All the patients left, including those who were in isolation for suspected Ebola virus infection." He told Reuters at least one person who fled was confirmed to have Ebola and five others were in quarantine as suspected cases.

Hospital officials do not know where those patients went. They fear the patients may have carried the virus into communities with no documented cases.

At a community meeting the following day, local leader Bravo Vukulu demanded that the Congolese army, the U.N. mission MONUSCO, Ugandan forces and the Wazalendo militias conduct simultaneous operations against the rebels. "We are fed up, we are tired," he said. Residents objected to what they described as poor coordination among security forces.

What to watch

Two questions are open. Health officials have not located the patients who left Kelele Hospital. And Nigeria has not said whether its case is directly linked to the Kenyan one.

Kazadi also said a mid-term review of the response would be held in Tshopo Province to guide the next phase. No results from that review have been published.