Challenges and inefficiencies at the start of the Ebola outbreak in Congo may have delayed recovery, sources said

When health officials confirmed a new Ebola infection in eastern Congo last week, the number of suspected cases meant the disease was already one of the largest in history.

A series of challenges and missteps delayed detection, two Congolese officials familiar with the response told Reuters, allowing the disease to spread undetected in rebel-held territory in the east and across the border to the Ugandan capital.

Local burial practices helped the virus spread before any alarms were raised, diagnostic tests at a local laboratory measured the wrong type of Ebola, and samples sent to Kinshasa, the Congolese capital, were not stored or shipped properly, officials said.

Experts say that the delay caused by efforts to limit the outbreak of the disease, the World Health Organization (WHO) at the weekend declared a public health emergency of concern to the whole world.

“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 Dr. Craig Spencer, an emergency physician and professor of public health at Brown University in Rhode Island. “It’s going to take some time before you can put this together.”

A health worker was the first known case

The outbreak is centered in the northeastern province of Ituri, a remote part of Congo that is plagued by health infrastructure problems and conflict.

The WHO has so far reported 80 suspected deaths, eight laboratory-confirmed cases and 246 suspected cases in Congo, although the actual number may be much higher.

The first known patient developed fever, vomiting and bleeding and died at a medical center in Bunia, the capital of Ituri, on April 24, Samuel Roger Kamba, Congo’s health minister, told reporters on Saturday.

This person was a health care worker, which means they are unlikely to be the first to get sick, Spencer said.

The bodies of Ebola victims are being spread, but mourners have gathered for the funeral, believing that the death was caused by a mysterious illness, Kamba said.

“Everybody touches him, everybody does this…that’s when the cases start to explode,” he said.

Jean-Pierre Badombo, the former mayor of Mongbwalu, told Reuters that an estimated 60 to 80 people were dying in Mongbwalu alone, with “six, seven, eight deaths a day,” prompting local officials to alert health authorities.

Failed testing and sending samples

The WHO said it was alerted to an unknown disease and multiple deaths in Mongbwalu on May 5, including four health workers who died within four days, and dispatched an emergency response team.

Jean-Jacques Muyembe, director of Congo’s National Institute for Biomedical Research (INRB), said local health officials in Ituri have started taking samples for testing in Bunia.

The laboratory there used test cartridges specific to the Zaire strain of Ebola, which is the strain behind 15 previous Ebola outbreaks in Congo, including the 2018-20 epidemic in the east of the country that killed more than 2,200 people.

But the current outbreak is caused by the Bundibugyo strain, which last appeared in Congo in 2012 and, according to Médecins Sans Frontières, has a fatality rate of 25 to 40%.

The Bunia laboratory does not have the genetic sequencing equipment needed to identify species outside of Zaire, Muyembe said, noting that only laboratories in Kinshasa and the rebel-held eastern city of Goma can do that work.

After testing in Bunia came back negative for the Zaire strain, the lab set the samples aside rather than uploading them, Muyembe said.

“The reflex should have been to contact Kinshasa and send them to our laboratory here for further investigation,” he said, adding that when the samples were finally sent to Kinshasa, the process was unsuccessful.

The images reached a temperature of 17 C (63 F), when they should have been stored at 4 C (39 F), Muyembe said. They are also sent in microliters rather than milliliters, which limits the number of tests the INRB can initiate, he said.

Discounts are subject to feedback

Africa’s top public health agency finally declared the disease on May 15, and WHO director-general Tedros Adhanom Ghebreyesus made his declaration of a public health emergency the next day.

To do so, he made the decision personally, without consulting an emergency committee of experts – the first time he has done so in the history of the International Health Regulations, the global rulebook for responding to disease outbreaks. Now the committee is called.

In internal documents seen by Reuters, the WHO lamented the “critical detection gap of four weeks” between when the first known case begins to show symptoms and laboratory confirmation of the outbreak, saying this “raises a low index of suspicion among health providers.”

Dr. Lievin Bangali, who is the chief health coordinator of the International Rescue Committee in Congo, said that the reduction of foreign aid affecting the Congo may be to blame.

“Years of underinvestment and recent funding cuts have severely weakened health services in the east [Congo]including key disease surveillance programs to detect and contain outbreaks early,” said Bangali.

The cuts also have challenges as officials race to make up for lost time.

“Some activities previously received budget support from donors, especially the provision of PPE [personal protective equipment] resources at health facilities,” Bangali said. “Today, Ituri is working as a model, with almost no PPE kits available.”