Eastern Congo is moving its Ebola response out of treatment centers and into villages as the virus spreads beyond the reach of health workers, the Africa Centers for Disease Control and Prevention said Thursday.
The agency cautioned that the outbreak may not yet have reached its peak. Since authorities declared it in mid-May, Ebola has expanded from three health zones to 60, infecting 6,250 people and killing 3,039, government figures show.
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Conflict, displacement and heavy population movement have made it increasingly difficult to detect infections, trace contacts and interrupt transmission.
The outbreak has already exceeded the scale of West Africa’s devastating 2014-16 Ebola epidemic, which killed more than 11,000 people and remains the deadliest outbreak ever recorded. The Africa CDC said the current crisis has produced six times as many confirmed cases and five times as many deaths.
A report issued this week by the U.S. Centers for Disease Control and Prevention identified major weaknesses in Congo’s response.
Here are five areas where authorities continue to face difficulties:
Limited community-based surveillance systems
A central problem is the limited use of surveillance networks rooted in local communities, the U.S. health agency said. Such systems are needed to investigate alerts quickly, identify infections and track how the virus is spreading. Without them, valuable time is lost before patients are found and isolated.
Slow detection, hesitation to report suspected cases and weak community engagement are contributing to avoidable deaths. Africa CDC data showed that at least 63% of Ebola deaths recorded during the past week occurred outside treatment centers.
Authorities have begun adopting a “village-centered approach,” working through community leaders to build confidence and encourage residents to cooperate with health teams, said Yap Boum, Africa CDC’s head of emergency preparedness and response.
Ituri province, where the outbreak is concentrated, is also deeply affected by the rebel conflict in eastern Congo. The insecurity has made it harder for health officials to establish relationships with residents.
“Building that trust in the middle of an outbreak is quite complex,” Boum said.
Contact tracing needs to improve
Surveillance teams are struggling to identify and monitor people who have been in contact with Ebola patients across the six affected provinces.
Officials say teams have followed up with 81% of listed contacts. But that figure does not capture the full scale of the challenge, because it excludes people who have not yet been identified or traced.
Based on an average of 60 contacts per confirmed case, Africa CDC estimates that infections confirmed during the past three weeks should have produced about 97,600 contacts. So far, only 19% of that projected total has been traced.
More treatment and isolation capacity is needed
Health data indicates that treatment centers increased their capacity to more than 1,300 beds in late August. They currently hold 869 patients, giving the facilities an occupancy rate of 67%.
Experts nevertheless say additional treatment and isolation centers, along with more beds, are needed in affected health zones to prepare for infections that have not yet been detected.
In many of those zones, cases remain hidden or go unreported because residents distrust health authorities, among other reasons. Some areas are also inaccessible to surveillance teams and medical workers attempting to treat patients, Boum said.
Laboratory testing capacity remains limited
Experts are also urging authorities to expand laboratory capacity so suspected cases can be confirmed quickly and patients can receive appropriate care.
The World Health Organization said last month that several treatment and transit centers in Ituri, the outbreak’s epicenter, were “saturated.” North Kivu, the second-most affected province, did not have enough options for referring patients to specialized facilities, the WHO said.
Medical staff at existing centers are also under severe strain, said Jeannot Krikeija, who works at an Ebola treatment facility in Bunia, the capital of Ituri.
“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
Authorities have organized safe and dignified burial teams for the more than 3,000 people killed by Ebola. The U.S. health agency, however, said shortcomings remain in the way some burials are conducted.
The virus can spread through direct contact with the blood or other bodily fluids of a person who is sick with Ebola or has died from the disease. Health experts have warned that the bodies of victims may still contain high levels of active virus.
Burial teams have faced repeated attacks in Ituri and other affected areas, often from relatives trying to protect the remains of loved ones who died of Ebola. During some funerals, people have also gathered around graves, at times standing only a few meters from the coffins.
