More than 2,500 people have died in an Ebola outbreak in the Democratic Republic of Congo, the fastest-spreading outbreak of the virus ever recorded, according to health officials.
The outbreak, Congo’s 17th in recent decades, has tested the country’s resources. Aid cuts, including the closure last year of the U.S. Agency for International Development, have hampered the international response. Early surveillance and testing failed to identify the outbreak, and fighting in eastern Congo has displaced millions of people, making the virus even harder to trace.
The Congolese health ministry said on Saturday that the death toll had reached 2,557, as health officials struggle to curb transmission. Congo has confirmed 5,375 cases since May 17 when the Africa Centers for Disease Control and Prevention, the public health agency of the African Union, announced the outbreak. Nearly half of confirmed patients are dying in this outbreak, according to the government.
“We must act at the scale the emergency demands,” said Dr. Jean Kaseya, the director general of the Africa Centers for Disease Control and Prevention, said on social media on Sunday.
There are no targeted vaccines or treatments for the type of Ebola virus behind this outbreak, which is known as Bundibugyo, but clinical trials have begun in Congo for possible treatments, and for a drug that could prevent infection in people exposed to the virus.
Where is the outbreak?
Ituri Province in northeastern Congo, where the outbreak was first identified, remains by far the worst-affected province, health officials said.
More than 900,000 people in Ituri have been displaced by conflict, according to the United Nations, and the region’s artisanal gold mines draw laborers from a wide area. The World Health Organization has said that the high degree of population movement has made it easier for the virus to spread. It has also made contact tracing difficult.
The government says the outbreak has now spread to six provinces in eastern Congo including Haut-Uele, which borders South Sudan, and Tshopo, whose main city, Kisangani, is one of the largest in the country. Kisangani is a particular concern, health officials say, because boats ferry passengers down the Congo River from the city to the capital, Kinshasa.
In neighboring Uganda, there were 20 Ebola cases and three deaths, but health officials contained the outbreak and have recorded no new cases since June 21. Last month the country declared its outbreak over.
What is it like on the ground?
Congo’s health ministry said on Saturday that 737 people were currently hospitalized or in isolation. The W.H.O. has warned that many others have not been able to reach a clinic and are being cared for or dying at home.
Patients cannot always find the care they need or even food or clean drinking water. Relatives come to care for the sick or to collect bodies for burial, often without wearing protection against the highly contagious disease.
And even though Congo has been through outbreaks before, many health workers have not been trained to deal with the disease. Some have died themselves.
What are the biggest concerns?
Health officials say they fear they are losing the battle to contain the virus.
“The epidemic is increasing faster and spreading wider than our ability to respond,” said Julien Harneis, the senior Ebola coordinator for the United Nations. “When the epidemic gets into new areas where the people working in the health system aren’t prepared, that’s where we see the heaviest toll.”
To turn the situation around, health workers say they must build more teams of professionals and volunteers trained in aspects of Ebola response, including the care of patients, the safe and dignified burial of victims, and the education of local communities about precautionary measures. Increasingly, those teams need to be deployed or activated away from the main health centers.
A particular fear is that the virus could spread to South Sudan, a country whose health system has been weakened by conflict, and to the Congolese capital, Kinshasa, one of Africa’s biggest cities.
What about international aid?
The State Department said this month that it had committed more than $512 million to the outbreak in what it called a “rapid and comprehensive response.”
The European Commission said in July it had committed 493 million euros (around $576 million) to the effort, and other governments including Congo’s have donated smaller sums.
What is the international impact?
While the outbreak is centered in Congo, citizens of other countries have contracted the virus. An American working for an evangelical disaster relief organization in Congo tested positive for Ebola, the U.S. Centers for Disease Control and Prevention said in July. The aid worker was the second American to contract the disease, after a missionary doctor tested positive soon after the outbreak was declared on May 15.
The month before, a French doctor who had traveled to Congo tested positive for the virus.
Several countries are screening travelers or have tightened their borders.
The Trump administration has invoked a public health law, known as Title 42, to bar entry into the United States for all immigrants and U.S. permanent residents and citizens who had been in Congo, Uganda or South Sudan in the previous 21 days.
In late May, U.S. officials unveiled plans for a 50-bed quarantine center at an air base in central Kenya to house Americans who have been exposed to the virus. The project incited deadly protests in the town of Nanyuki, close to the air base, by Kenyans fearing contagion. Seven American aid workers who had recently been in Congo were quarantined at the facility in July.
During previous U.S. administrations, Americans exposed to the Ebola virus were brought home to be treated at specialized medical units.
In June, Congo’s government introduced a system to regulate travel for people who have been in affected areas, which included a 21-day quarantine in certain cases.
Ebola is an illness caused by a group of related viruses, known as orthoebolaviruses, which fruit bats are thought to carry without being sickened by them. Outbreaks have mostly occurred in sub-Saharan Africa. The largest began in 2014, with cases in southeastern Guinea, Liberia and Sierra Leone, and lasted two years.
People can contract Ebola through contact with the bodily fluids of an infected, sick or dead person or with contaminated objects like clothing, bedding, needles or medical equipment.
Four of the six known species of Ebola viruses can be fatal to humans. People may first experience so-called dry symptoms such as fever, aches, pains and fatigue before progressing to wet symptoms. These include diarrhea, vomiting and bleeding, according to the C.D.C.
What are the challenges of the Bundibugyo species?
Vaccines and an antiviral drug have been approved for the Zaire species of Ebola, the most common one. But there is no vaccine or specific treatment for the Bundibugyo species.
Its incubation period ranges from two to 21 days, and people are usually not infectious until symptoms appear. Early symptoms like fever and fatigue resemble those of other illnesses, including malaria, so early detection can be difficult.
Fatality rates during the last two outbreaks of this form of Ebola ranged from 30 percent to 50 percent of those infected, according to the W.H.O.
Lynsey Chutel, Ephrat Livni and Amelia Nierenberg contributed reporting.
