Congo Defends Ebola Response as WHO Warns Contact Tracing Is Failing Amid Insecurity

(Bloomberg) -- Congo’s health minister pushed back against claims the country’s Ebola outbreak was spiraling out of control, even as World Health Organization officials warned insecurity and population displacement were preventing responders from tracing most suspected contacts.

“I’ve heard in the press that the epidemic is ‘out of control,’” Roger Kamba, the Democratic Republic of Congo’s Minister of Public Health, Hygiene, and Social Welfare, told reporters Thursday in Bunia, the outbreak’s epicenter. “We need to put into perspective the alarmist cries.”

Revised surveillance data released Thursday showed 906 suspected cases and 223 suspected deaths linked to the outbreak, down from more than 1,000 suspected infections reported Wednesday after investigators removed non-cases and laboratory-confirmed infections from the broader tally.

Still, Kamba said the government expects the outbreak could take about six months to fully contain, while health officials cautioned that insecurity and mass displacement are hampering efforts to stop transmission of the rare Bundibugyo strain of Ebola, which has spread into neighboring Uganda and infected at least seven people.

“It’s a very difficult situation,” Marie Roseline Belizaire, WHO’s emergency response director for Africa, told the BBC from Bunia. Teams have been able to trace just over a third of more than 2,500 identified contacts because of insecurity and population movement, she said. “And in an Ebola outbreak — or any infectious disease — when you cannot trace the contacts, it means you cannot stop the transmission chain.”

‘Catastrophic Collision’

WHO Director-General Tedros Adhanom Ghebreyesus warned Wednesday that eastern Congo faced a “catastrophic collision” of war and disease as fighting and displacement accelerated the spread of Ebola. “We cannot build community trust or isolate the sick while bombs are falling,” he said.

Many suspected Ebola cases are later ruled out after testing, Kamba said, arguing that authorities are deliberately casting a wide surveillance net rather than risk missing infections.

“We’d rather be mistaken overcounting than undercounting,” he said.

The outbreak has also prompted the US to expand border screening measures. The US expanded enhanced Ebola airport screening to New York’s John F. Kennedy International Airport effective midnight Thursday, adding the country’s busiest international gateway to a growing network of screening hubs that already includes Washington Dulles, Atlanta and Houston, the US Centers for Disease Control and Prevention said.

The measures form part of what the CDC described as a layered response that includes overseas exit screening, airline illness reporting and post-arrival monitoring. Bloomberg previously reported that the agency had asked employees to volunteer for public health screening duties at airports.

The outbreak now spans 13 health zones across the Congolese provinces of Ituri, North Kivu and South Kivu. 

Containment Struggles

Congo’s internal Ebola situation report released Thursday described the mining town of Mongbwalu — considered the epidemic’s point of origin — as an area affected by armed groups and frequent cross-border population movement into Uganda. A confirmed Ebola patient fled care at a treatment facility in Ituri, the report also noted, underscoring difficulties responders face containing the outbreak in conflict-hit areas.

The Bundibugyo strain can be especially difficult to identify because it doesn’t always produce the severe hemorrhagic bleeding associated with the more common Zaire strain of Ebola, Kamba said. Early symptoms can instead resemble malaria, typhoid and other common illnesses in eastern Congo, complicating efforts to quickly identify cases and determine causes of death.

Kamba also sought to downplay fears that the outbreak had already spread widely beyond Ituri province, saying only 21 confirmed cases had been identified outside the region. “Maybe there are cases we don’t know about, but you know that in our country, nobody can hide a corpse,” he said. “Everyone is buried. If there were hidden burials we would know.”

Bundibugyo may also prove less deadly than Zaire, the more common type of Ebola, if patients receive supportive treatment early, Kamba said, noting the current survival rate appears to be around 70%.

Egypt recently donated supplies of Gilead Sciences Inc.’s antiviral remdesivir, which may help in some cases, Kamba said. Congo is also in talks with US officials to obtain an experimental monoclonal antibody treatment that has shown activity against the Bundibugyo, Sudan and Zaire forms of Ebola.

Congo plans to add about 130 isolation beds across two treatment centers in the coming days as authorities race to expand capacity in outbreak areas, Kamba said. Officials are also working with community radio stations to counter misinformation and encourage people with symptoms to seek treatment early.

--With assistance from Madison Muller.

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