The head of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus has clear words: "The epidemic is far from under control. This is now the second largest Ebola outbreak ever recorded, and it is spreading faster than any previous one."
Experts from the World Health Organization and the African health authority Africa CDC already fear that the Ebola outbreak in Congo could become the largest on the continent. In the worst outbreak to date, more than 11,000 people died in West Africa in 2014 and 2015.
“There is still a large number of unreported cases,” emphasizes Maximilian Gertler, a tropical medicine doctor at the Berlin Charité, who worked for the aid organization Doctors Without Borders during the major Ebola outbreak in West Africa and also worked for the organization in the Congo. “One has to assume that many cases and deaths are not even registered.”
“We have seen well over 2,000 deaths since the outbreak became known,” says Gertler. "In the comparable period during the major epidemic in West Africa, there were around 300 deaths. The vast majority of new cases were not previously registered as contact cases, so we still don't see the whole thing."
The 17th Ebola outbreak in Congo was officially announced in mid-May. Given the already high number of cases at the time, experts assumed that the highly contagious infectious disease had already been circulating for a long time. “The outbreak was certainly noticed very late and has probably been going on since at least the beginning of the year,” estimates Gertler.
“The perfidious thing about Ebola is that there are no particularly specific symptoms in the early phase,” says Gertler. The patients have a fever, a general feeling of illness, whole-body aches and headaches, similar to flu infections or malaria. If medical professionals do not have access to adequate laboratory diagnostics and sick people do not visit the already weak health facilities out of fear, it is difficult or impossible to detect the disease immediately.
When the Ebola outbreak was announced, initially only the Ituri province in northeastern Congo was affected - the fever has now occurred in six provinces of the Central African country, which is the second largest country in Africa in terms of area.
“The current challenge is that we are seeing more and more cases and deaths in remote regions,” says Gertler. These are areas that are sparsely populated, difficult to reach and usually very unsafe. It is difficult for help to arrive on site - this applies to tests, isolation, treatment and educational work.
In larger cities such as Bunia, the capital of Ituri province, treatment and laboratory capacities were expanded quite quickly. Médecins Sans Frontières alone operates a total of seven treatment centers and numerous isolation wards in Ituri, North Kivu and South Kivu as well as in Tshopo Province, where a new treatment center is currently being built. According to Gertler, there are a total of around 430 beds and more than 1,400 employees in the region. “My local colleagues keep telling me that where we can treat sick people, the trust of the population also increases,” says the doctor. “Patients then come earlier and we recognize more contacts.”
In rural regions, however, there are serious gaps and hardly any access to rapid diagnostics. “This is of course essential in order to actually recognize cases, register them, treat them adequately and also to reliably identify non-cases,” says Gertler. More isolation wards urgently need to be set up, particularly in rural regions.
There are numerous armed groups and armed conflicts, especially in the east and northeast of Congo, which have been going on for decades. The region is characterized by a high level of insecurity - which also makes access for helpers difficult. There are also restrictions on border and air traffic. “They are delaying the arrival of medical supplies, humanitarian aid and specialized personnel in a very dramatic way,” says Gertler.
The next rainy season is now approaching in the Congo. During this time there is usually a significant increase in infectious diseases such as malaria, diarrheal diseases such as cholera, but also measles and respiratory infections. This could make the current situation even more difficult because malaria alone is causing massive cases of fever, which must be diagnostically differentiated from Ebola cases.
But fear among the population about the isolation of Ebola patients is also making it more difficult to combat the epidemic, reports the aid organization Action Against Hunger. Ebola treatment centers are still often equated with a death sentence. Out of fear, some families hide sick relatives, delay their transfer to specialized facilities or first seek out traditional healers, according to country director Julie Drouet. Also: “For a motorcycle taxi driver, a market vendor or a gold prospector, a day in isolation means a day without food for his children.” And hunger is seen as a greater threat than the virus, whose existence many deny.
Last week, cases of Ebola were reported in Tshopo Province. Ships regularly sail from the provincial capital Kisangani on the Congo River to the capital Kinshasa, where around 17 million people live. An Ebola outbreak there could drastically worsen the situation. In the past there have been repeated outbreaks of cholera brought in by ship travelers. Doctors in the Congo and beyond are still hoping that this will not happen in the case of Ebola. Training measures should nevertheless prepare for such a possibility.
