Ebola outbreak in DRC nears deadliest in history as response shifts to community level

The Ebola outbreak in eastern Democratic Republic of Congo is poised to become the deadliest in history, the World Health Organization (WHO) warned, three months after declaring it a global health emergency, according to a press release by Direct Relief. More than 4,400 cases have been confirmed in DRC and more than 2,000 people have died, a case fatality rate of roughly 46%, based on European Centre for Disease Prevention and Control data through Aug. 11. The WHO estimates the true count is likely two to four times the official figures. Genomic sequencing shows the virus had been circulating since February, with early cases wrongly attributed to malaria and typhoid. Direct Relief has delivered 19.5 tons of PPE, essential medicines, and supplies, valued at $11.3 million, to partners across DRC, Uganda, and South Sudan since May.

WHO Director-General Tedros Adhanom Ghebreyesus said the outbreak is on track to eclipse the West African Ebola outbreak of 2014 to 2016, which killed more than 11,000 people. Most people dying in this outbreak are dying in their communities rather than in treatment units, roughly two-thirds of deaths, according to the WHO. The Africa Centres for Disease Control and Prevention says more than 70% of new infections are found among people who weren’t being monitored through contact tracing. Africa CDC Director-General Dr. Jean Kaseya told reporters that an outbreak this size would normally generate 160,000 to 200,000 contacts to trace, against roughly 17,000 currently listed. On Aug. 5, DRC adopted a village-centered response run through community health workers selected by each affected village.

More than 21,000 community health workers have been trained so far, Tedros said Wednesday, and contact tracing now reaches about 80% of known contacts, still short of the 95% target the WHO says is needed to interrupt transmission. In DRC’s Ituri, Haut-Uélé, and Tshopo provinces, VillageReach has supported the Ministry of Health in training more than 1,000 community health workers, with Direct Relief supplying two large shipments including more than a quarter million N95 respirators delivered to Bunia, the outbreak’s epicenter. A further shipment of nearly five tons of supplies for VillageReach awaits final DRC import documentation. In Beni Health Zone in North Kivu, Direct Relief is supporting a new Ebola response project by Humanitarian Action for Africa, with a shipment valued at $1.9 million packed and ready. Along South Sudan’s border with DRC, the International Organization for Migration has screened hundreds of thousands of travelers and reached nearly half a million people with Ebola awareness messaging.

Uganda declared itself Ebola-free on July 28 after stamping out its outbreak of 20 confirmed cases and two deaths. Mulago National Referral Hospital, the largest public hospital in Uganda, served as a primary response center, treating 18 of the 20 confirmed Ebola patients, all of whom recovered. Direct Relief is preparing to ship PPE, medicine, and an ultra-low-temperature pharmaceutical freezer to Mulago. “Whereas at the moment we’re Ebola-free, we still must remain prepared to identify, isolate, test, and manage suspected or confirmed cases, while also maintaining essential medical services to other patients,” said Dr. Vicky Nyombi, principal pharmacist at Mulago. She noted the hospital critically needs N95 respirators, coveralls, and sterile gowns, and is short of body bags.

Of the $518 million required for the continental Ebola preparedness and response plan, just over half has been disbursed, Tedros said Wednesday. During the 2014–16 West Africa outbreak, researchers estimated that reduced access to treatment for malaria, HIV/AIDS, and tuberculosis caused more than 10,000 additional deaths. Direct Relief’s shipments since May also include supplies for Jericho Road’s Wellness Clinic in Goma and insulin for the Association des Diabétiques du Congo. “There is still a long road ahead as cases continue to rise,” said Dr. Jeffrey Samuel, Direct Relief’s regional director for Africa. Direct Relief said it will remain engaged for the long term, working with partners across all three nations as the fight moves to the community level.