WHO doctor warns Ebola outbreak in central Africa may be spreading faster than first thought
Recent field data reported by BBC Health suggests the Ebola outbreak spreading in eastern Democratic Republic of the Congo and Uganda may be entering its most difficult window over the next few weeks. A WHO doctor on one of the field teams told the BBC: "There are strong indicators that there are cases below the reported numbers — cases that are not being recorded."
The outbreak began about three months ago in a rural area of DRC's Tshopo province. Since the initial cluster showing classic Ebola symptoms, case numbers have been reported at approximately 246 suspected and 65 deaths. But the limited health infrastructure in the outbreak region raises the likelihood that the true case count is significantly under-reported.
The WHO doctor said the main concern is the limited testing capacity at border crossings. The DRC-Uganda border had been equipped with upgraded testing booths in recent years, but a portion of the equipment is now offline for technical reasons. Suspected cases have also been observed in two districts on the Uganda side, close to the border.
The picture for international support poses a serious challenge to the response. Recent cuts to US donations and a reassessment of emergency health funds by some European countries mean that of the 14 health centres WHO had planned to operate in DRC, only eight are at full capacity. The doctor said the gap "has the effect of a week lost every day in outbreak management."
The team that responded to the 2014-2016 outbreak in Guinea and Sierra Leone, citing a lesson drawn from that crisis, emphasised one point: in early response, a seven-day delay in case detection and contact tracing can result in the outbreak doubling in scale. Closing the funding gap quickly is therefore a critical issue in the response.
Vaccination work in the affected zone of DRC uses the national Ebola vaccine, rVSV-ZEBOV. Field teams report administering about 12,000 doses in the past month. The cold-chain requirement for the vaccine is being managed regionally; in the rainy season, reaching some remote villages is harder because vehicle and helicopter resources are limited.
Another important component of the response is community communication. WHO has issued a call for adaptation of family and community-level funeral practices to slow transmission. In past Ebola outbreaks, certain traditional funeral practices were the main cause of intra-family transmission in periods when the body carried high viral load.
The BBC's field reporter conveyed a quote from a family spokesperson in the outbreak zone: "Our neighbour Onyango died a week ago; his family held the funeral in the traditional way, and now three of his relatives have symptoms." The family spokesperson said they had asked for protective equipment and an explanation of WHO funeral protocols.
Greenpeace Africa public health expert Dr Adaeze Onyema said in comments to the BBC: "In outbreak management it is not only the medical pathway but social management mechanisms that are critical. Community leaders, religious leaders and traditional healers must spread outbreak messages in their own language."
Three key factors that will shape the outbreak in coming weeks are listed in WHO's reporting: the number of health centres that can be operated with additional funding, testing capacity at border crossings, and the pace of vaccination. The return of international donations has not yet been confirmed; but in the field doctor's words, "acting now is wiser than managing a much more expensive crisis later."