British doctor tested positive for Ebola is hospitalized in London hospital

Government data released on Tuesday indicated that the Ebola outbreak in Congo has reached over 10,000 confirmed cases, while health authorities work intensively to control the spread of the disease in several African countries.

This outbreak is considered the fastest growing in history, and according to information from the Congolese Ministry of Health, nearly half of the 10,060 diagnosed individuals have died, making it the deadliest of the disease in the country.

The outbreak, which was reported in May, is caused by the Bundibugyo virus, a pathogen for which there are no approved vaccines or treatments. Response teams face numerous obstacles, including armed conflicts, poor road infrastructure, and public hostility driven by misinformation and distrust.

These obstacles hinder people's adherence to reporting symptoms and seeking medical assistance in communities that historically deal with violence and successive epidemics.

Comparison with previous outbreaks

Compared to the Ebola outbreak in West Africa between 2014 and 2016—the largest and deadliest in history, with over 28,000 cases and more than 11,000 deaths—the current outbreak has recorded at least three times more cases and deaths since its declaration in the same period.

The disease has spread throughout Africa, surpassing any previous outbreak, and has reached three regions. Cases have been registered in five nations, including Uganda, as well as France, which currently has no active cases.

A persistent problem in the disease's spread in Africa is the apparent failure in surveillance, given that most initial cases were only confirmed long after the onset of symptoms or after individuals traveled.

Distribution and Challenges in Congo

In Congo, the disease has expanded to 66 health zones across eight provinces, a significant increase from the three zones existing when the outbreak was declared in May. Professionals involved in the response informed the Associated Press that treatment centers in certain areas are overwhelmed, and that part of the population remains distrustful, reacting with violence.

Furthermore, health professionals have regularly gone on strike due to delays or absence of salary payments. Sephora Bgosi, a member of the team responsible for burying Ebola victims in the Ituri province, the epicenter of the outbreak, warned: 'Some people still don't seem to understand the seriousness of the situation, even though they are directly exposed to the risk.' She emphasized that 'Ebola is extremely dangerous and can be fatal.'

It is estimated that about 80% of the registered cases are still identified outside the monitored contact circle, suggesting the existence of transmission routes unknown to health authorities. The African Centre for Disease Control and Prevention (Africa CDC) points out that for the outbreak to be considered widely controlled, at least 95% of cases should be among known contacts.

At least half of the registered deaths occurred among individuals who were not admitted to treatment centers, indicating that in many localities, residents are still not reporting their symptoms.

In various areas, health professionals face everything from basic shortages, such as a lack of appropriate vehicles, to more complex issues, such as persuading families to hand over sick or deceased relatives for safe burial.

Last week, in the Nia Nia health zone in Ituri province, some Ebola response workers, including surveillance and community mobilization agents, went on strike over unpaid bonuses since the end of August, a recurring problem in several affected regions.

More than five months after the start of the outbreak, health professionals continue to be attacked by residents. A nurse was murdered and another professional was seriously injured while responding to an Ebola alert in Bafwasende, Tshopo province, last Saturday.

Impact on Healthcare Services in Congo

The outbreak has compromised essential health services, which were already operating with resource scarcity and overload, and diverted focus from other epidemics faced by the country, such as cholera.

There is an increase in maternal deaths, as pregnant women avoid hospitals for fear of infection and isolation, resulting in double the maternal mortality in some provinces shortly after the outbreak was declared.

The epidemic has also affected routine services, such as childhood vaccination, interrupted classes in regions where millions of children were already out of school, caused stigma and trauma in affected families, and worsened the living conditions of many people already in vulnerable situations.

Health experts warned Lusa that local population distrust and a history of violence in eastern Democratic Republic of Congo (DRCongo) are complicating the fight against Ebola, causing the epidemic to advance underreported in official statistics.

Mohamed Yakub Janabi, Regional Director of the World Health Organization (WHO) for Africa, reported that on October 20, DRCongo registered 9,704 confirmed cases and 4,687 deaths, resulting in a mortality rate of 48.3%. However, field perception indicates that the real numbers are considerably higher.

Tomás Bandeira, head of tropical medicine at Médecins Sans Frontières (MSF), warned that available data likely underestimate the reality, allowing the disease to spread 'in the shadows' and indicating that the problem is 'far from being solved.'

The MSF representative reported that many cases do not reach treatment in time, in inaccessible areas, either because communities do not accept the teams or due to security conditions.

The Portuguese doctor explained that the local population showed distrust towards international teams because they had no history of contact with humanitarian organizations and were accustomed to seeking help from foreigners linked to mining or using traditional treatments.

To overcome this lack of trust, which led to attacks on treatment centers, such as occurred in Nyankunde in July, the WHO and its partners intensified work with community leaders, religious figures, traditional medicine practitioners, survivors, and local health agents, as detailed by Mohamed Yakub Janabi.

In Nyankunde, 32 dialogues involving over 1,500 leaders and influential figures were held. This action raised daily community alerts from a peak of 11 to something between 60 and 70 in September, and there have been no new attacks in the area since July.

Similarly, in Mongbwalu, almost six months after MSF's arrival, engagement with local authorities and community leaders helped ensure the treatment center was accepted by the population, leading people to return to the hospital.

Ebola is characterized by being highly contagious, transmitted through direct contact with bodily fluids of infected individuals, including vomit and blood, or by touching contaminated surfaces and materials, such as bedding and clothing.

The epidemic, caused by the Bundibugyo virus—about which clinical uncertainties persist due to a lack of comparative data—is classified by Tomás Bandeira as 'a crisis within a crisis.'

The doctor recalled that the situation in the country, neighboring Angola, occurs in a context of armed conflict, with the presence of various paramilitary groups, which generates high levels of population displacement and concomitant outbreaks of cholera and malaria.

The WHO director stressed that while Ebola requires reliable access to patients and contact tracing, cholera demands potable water, sanitation, and specific vaccination.

Additionally, the Portuguese doctor observed that the exclusive focus on Ebola is diverting attention and resources from vaccination campaigns and the fight against other deadly diseases, such as malaria.

To contain transmission, the WHO regional director advocated for urgent needs, including ensuring safe humanitarian access, securing predictable funding, providing reliable support and payment to frontline professionals, in addition to supplying appropriate supplies and materials.