Six months into the Democratic Republic of Congo's Ebola outbreak, the virus is still spreading out of control, many cases are likely being missed and transmission inside hospitals is rife in some areas, the medical charity Médecins Sans Frontières (MSF) warned in Geneva on Thursday, November 12.
Source: Reuters
This warning follows the government figures reported earlier this week, when confirmed cases passed 11,000 and deaths reached at least 5,387 — making this the deadliest Ebola outbreak in Congo's history and the second-worst on record anywhere. Read the earlier report: Congo Ebola cases pass 11,042, deaths 5,387
"Empty hands and empty pockets" on the front line
"Despite the vast amounts of money provided for the response, many frontline responders are left trying to contain the outbreak with empty hands and empty pockets," Dr Javid Abdelmoneim, MSF's international president, said on Thursday. "Our teams are often left speechless by the dysfunctions they witness in many areas. Six months into the response, this situation is simply unacceptable." MSF pointed to untrained and unpaid staff, ambulances without fuel, and a lack of surveillance teams and supplies to manage suspected cases safely, Reuters reported.
The outbreak was declared in mid-May and is caused by the rare Bundibugyo species of the Ebola virus, for which there are no approved treatments or vaccines. MSF called on the Congolese government and UN agencies, including the World Health Organization (WHO), to make sure the resources already mobilised actually reach the ground. The Congolese government did not immediately respond to Reuters requests for comment.
Only half of cases likely detected, modeller warns
At a separate briefing on Wednesday, British epidemiologist Neil Ferguson of Imperial College London, who has been modelling the outbreak in real time, said case detection remained a major challenge. "Throughout the outbreak, we think we're probably only detecting about half of cases which are occurring," he said. His team estimated there are currently between 2,000 and 3,000 Ebola patients in Congo, and he warned transmission would likely still be going on a year from now and could outstrip the 2014–2016 West African outbreak — the biggest ever, with more than 28,600 cases and more than 11,000 deaths.
Hospitals spreading the virus, deaths in the community
MSF said the picture varied across Congo's regions, some of them conflict zones. In Ituri province, only 9 percent of Ebola patients treated by MSF were known contacts of existing cases — a sign surveillance is missing most chains of transmission. Over the last month, close to two-thirds of reported Ebola-related deaths happened in communities rather than in treatment centres. In the Beni health zone of North Kivu, a lack of basics from water to chlorine meant almost three-quarters of Ebola patients are believed to have caught the disease inside healthcare settings, MSF said.
Asked about MSF's criticism, the WHO pointed to remarks by its Director-General Tedros Adhanom Ghebreyesus on Tuesday, in which he acknowledged problems such as health-worker payment delays. He said the WHO was working with Congolese authorities, the Africa CDC and other partners to strengthen the response, but warned insecurity — notably attacks on health facilities — had become one of the biggest obstacles. An attack last week on Cantine-Aloya in North Kivu killed 66 civilians, including 3 health workers, he said — double the toll first reported by local authorities — and led to more than 1,000 contacts being lost to follow-up and 3 confirmed Ebola patients being left unaccounted for.
MSF wants the money already pledged for the response converted into staff, fuel, surveillance teams and supplies on the ground. With modellers estimating only about half of infections are being found, health officials expect the outbreak to run well into next year unless detection and hospital infection control improve quickly.