Delayed detection and flawed testing worsened Congo Ebola outbreak

KINSHASA: Delays in identifying Ebola infections in eastern Democratic Republic of Congo, combined with testing problems and funeral practices, allowed the outbreak to spread before authorities confirmed cases, according to Congolese officials and health experts cited in a Reuters report carried by Dawn.

By the time health officials confirmed new Ebola infections last week, the number of suspected cases had already made the outbreak one of the largest on record. Two Congolese officials familiar with the response said a series of setbacks slowed detection, enabling the disease to spread unnoticed into rebel-held areas in the east and across the border to Uganda’s capital.

The outbreak is centred in Ituri province in northeastern Congo, an area facing weak health infrastructure and armed conflict. The World Health Organisation has so far reported 80 suspected deaths, eight laboratory-confirmed cases and 246 suspected cases in Congo, although experts have cautioned that the real toll could be higher.

First known case and early spread

Samuel Roger Kamba, Congo’s health minister, told reporters on Saturday that the first known patient developed fever, vomiting and haemorrhaging before dying at a medical centre in Bunia, the capital of Ituri, on April 24. He said the patient was a health worker.

Craig Spencer, an emergency physician and public health professor at Brown University, said that because the first known patient was a health worker, it was unlikely that person was the first to fall ill.

Kamba said funeral rites also contributed to transmission before the outbreak was recognised. He said mourners handled the body, believing the death had been caused by a mystical illness.

“Everyone is touching him, everyone is doing this… and that’s when the cases start to explode,” Kamba said.

Jean-Pierre Badombo, a former mayor of Mongbwalu town, told Reuters that an estimated 60 to 80 deaths had occurred in Mongbwalu alone, with six to eight deaths per day, prompting local officials to alert health authorities.

Testing failures and sample handling problems

The WHO said it was informed on May 5 of an unknown illness with a high death rate in Mongbwalu, including four health workers who had died within four days, and sent a rapid response team.

Jean-Jacques Muyembe, director of Congo’s National Institute for Biomedical Research, said local health officials in Ituri began collecting samples for testing in Bunia. However, the laboratory there used cartridges designed for the Zaire strain of Ebola, the strain responsible for 15 of Congo’s previous Ebola outbreaks, including the 2018-2020 epidemic in the east that killed more than 2,200 people.

Muyembe said the current outbreak is caused by the Bundibugyo strain, which was last recorded in Congo in 2012 and has an estimated case fatality rate of 25-40 per cent, according to Médecins Sans Frontières. He said the Bunia laboratory does not have the genetic sequencing equipment needed to identify strains other than Zaire, and that only laboratories in Kinshasa and Goma can carry out that work.

According to Muyembe, after tests in Bunia came back negative for the Zaire strain, the samples were set aside instead of being referred onward.

“The reflex should have been to contact Kinshasa and send them to our laboratory here for further investigation,” he said.

Muyembe also said the later shipment to Kinshasa was mishandled. The samples arrived at 17 degrees Celsius when they should have been kept at 4C, and they were sent in microlitre rather than millilitre quantities, reducing the number of tests that could be performed.

WHO declaration and funding concerns

Africa’s top public health agency announced the outbreak on May 15, and WHO Director-General Tedros Adhanom Ghebreyesus declared it a public health emergency of international concern the next day. He made the declaration personally without consulting an emergency committee of experts, the first time this has happened under the International Health Regulations. A committee is now being convened.

Internal WHO documents seen by Reuters described a critical four-week gap between the first known case showing symptoms and laboratory confirmation of the outbreak, saying this pointed to a low level of clinical suspicion among healthcare providers.

Lievin Bangali, senior health coordinator for the International Rescue Committee in Congo, said foreign aid reductions affecting Congo may have contributed to the situation.

“Years of under-investment and recent funding cuts have severely weakened health services across eastern DRC, including critical disease surveillance systems that are essential for detecting and containing outbreaks early,” Bangali said.

He also said the cuts were complicating the response as authorities tried to recover lost time.

“Certain activities previously received budgetary support from donors, notably the provision of PPE kits to healthcare facilities,” Bangali said. “Today, Ituri serves as a case in point, with virtually no PPE kits available.”

Spencer said the scale of the outbreak remained unclear because of the delayed detection and fragmented picture on the ground.

“It’s just a scattered mess right now. I don’t think we have anything close to a real idea of how many cases there are,” said Craig Spencer, an emergency physician and public health professor at Brown University. “Its going to be quite some time before you’re able to piece this together.”