Congo Ebola response under strain a month after WHO emergency declaration

BRAZZAVILLE: Efforts to contain the Ebola outbreak in eastern Democratic Republic of Congo remain under severe pressure a month after the World Health Organisation declared an international emergency, with shortages of staff, ambulances and basic construction materials hampering the response, according to officials and aid workers cited by Reuters.

The outbreak of the rare Bundibugyo strain has now exceeded 800 confirmed cases, and warnings are increasing that it could become the largest Ebola outbreak on record, overtaking the 2014-16 West Africa epidemic that killed more than 11,000 people. Jean Kaseya, director general of the Africa Centres for Disease Control and Prevention, told Reuters that response teams are so overstretched that tens of thousands of contacts linked to confirmed cases have still not been traced.

He said insecurity, as well as the outbreak’s location in an urban area with extensive mining and trade activity, were major obstacles to containment. In comments made late on Tuesday, Kaseya said health workers were not reaching everyone who should be listed for contact tracing and warned that failure to do so would undermine efforts to bring the outbreak under control.

“After four weeks we have an outbreak in an urban area where there is insecurity, where there is this mining and trade activity, and also where we are not reaching all the people who must be in the contact list,” he said late on Tuesday. “If we don’t reach these people, we cannot say that we can win with this outbreak.”

Gaps in follow-up and care

Kaseya also said even the cases that have been identified may represent only a portion of the real total because testing is insufficient and data gaps remain. He added that not all identified patients are being isolated and treated properly. According to him, some admitted patients have left treatment centres, some people who tested positive were not admitted, and some of those who were hospitalised were not receiving the support they needed.

“We have people who were admitted who decide to escape for many reasons. We have people who are positive who are not admitted. And we saw also a number of people who are admitted but we believe that they are not getting appropriate support,” Kaseya added.

A WHO report showed that, as of June 14, about one-third of 241 alerts involving new suspected cases in Ituri, the worst-affected province, were not being followed up. Manel Rebordosa, Oxfam’s Ebola response coordinator in Bunia, told Reuters that during a visit this week to a medical centre in Rwampara, he saw a woman with symptoms including fever and bleeding who had been waiting for hours.

“They were calling the surveillance system but they didn’t show up as they cover many health zones and don’t have enough ambulances,” he said.

Africa CDC said teams in Ituri responsible for safe burials and decontamination had only around 15 per cent of the personnel required and 7pc of the vehicles needed.

Ministry disputes claims response is lagging

Congo’s Health Minister Samuel-Roger Kamba rejected the suggestion that the outbreak was advancing faster than the response. Speaking at a government briefing on Monday, he said the ministry had trained 1,200 community relay workers and sent 1,000 of them door to door to identify contacts and suspected cases. He said contact follow-up was currently at 63pc.

At the same time, ministry documents shared with Ebola response teams in Ituri on Wednesday highlighted operational difficulties including lost contact cases, patients moving between health zones and fuel shortages affecting mobile units.

Shortages of supplies and funding

Professor Salim Abdool Karim, who advises the Africa CDC and visited Ituri last week, said the most serious difficulty was the lack of supplies. In a report he is due to present at an emergency meeting, he said the response needed more resources across the board, from personal protective equipment to gravel.

“There is a need for more resources of almost everything from PPE (Personal Protective Equipment) to gravel,” he said in a report he will present at an emergency meeting soon.

He said a shortage of gravel had delayed the construction of isolation wards, while prefabricated wall, floor and roof panels were also missing. He added that the absence of USAID, which Reuters reported was dismantled by US President Donald Trump last year, was being felt. The United States says it remains the biggest donor to the response and has asked other partners to contribute.

Reuters reported that medics are short of masks, and dozens of health workers have contracted the Bundibugyo strain, for which there is no proven vaccine or treatment. Kaseya said some required supplies were at times sitting in warehouses instead of reaching the field.

The African Union says it has received only one-fifth of the funding needed for its $518 million response plan, while aid workers say donor backing is lower than in previous Ebola outbreaks. Asked whether Western governments should increase their support, Kaseya said: “I think they are starting to understand that it’s serious.”