KINSHASA, July 22 (Xinhua) -- The ongoing Ebola outbreak has claimed more than 1,000 lives in Africa, with health officials warning of an even bleaker outlook if urgent action is not taken.
"It is now the third-largest Ebola outbreak on record, and in the past month, it has expanded faster than any previous outbreak," World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus said on July 16, a day after the Democratic Republic of the Congo (DRC) marked two months since declaring the Ebola outbreak.
As of July 20, the DRC had recorded 2,473 confirmed cases, including 999 deaths and 482 recoveries, according to an official report released Wednesday. Uganda has recorded 20 confirmed cases, including two deaths, bringing the total death toll across the two countries to 1,001.
In its latest situation report, DRC health authorities assessed that the epidemic, caused by the rare Bundibugyo ebolavirus, remained in a phase of sustained transmission, with high levels of virus circulation.
UNKNOWN CHAINS
In the DRC alone, 737 patients remained hospitalized or in isolation, while Ebola treatment facilities were operating at an average of 86.7 percent capacity nationwide. The report also revealed that 121 health workers and other frontline responders have been infected since the outbreak began, of whom 36 died.
WHO officials said earlier that the official figures might represent only part of the outbreak.
At a United Nations briefing in Geneva on July 14, Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme, said that about 80 percent of new cases have emerged through "unknown chains of transmission."
WHO modeling suggested that the actual scale of the epidemic could be "at least two to four times" the reported caseload, he added.
The large number of unlinked cases has raised concerns that surveillance teams are continuing to detect patients only after transmission has already occurred within families or communities.
Addressing a separate briefing on July 17, International Organization for Migration (IOM) Regional Director Frantz Celestin said nearly 66 percent of reported deaths occurred in communities rather than health facilities, pointing to persistent challenges in early detection, surveillance and timely access to treatment.
WHO spokesperson Christian Lindmeier told the same briefing that four out of five known contacts were being followed, but that this remained insufficient given uncontrolled population movements and challenges in body transfer and burial.
Andrew Mbala, an IOM crisis manager, said the organization has documented frequent movement of bodies through internal checkpoints in the DRC, with Ebola tests on those deceased returning positive.
IOM preparedness and response efforts have supported about 200 points of entry or control across affected and at-risk countries.
Meanwhile, the virus continues to spread amid a combination of medical and social challenges, particularly in the DRC's eastern provinces, which are affected by armed conflict, repeated displacement, fragile health services and constant movement between cities, mining areas, villages and neighboring countries.
VARIOUS PATTERNS
Apart from unclear transmission chains, the outbreak is not progressing at the same pace across all affected areas.
Thierno Balde, WHO incident manager for the Ebola response, told reporters on Tuesday that the agency has identified several main patterns, including high-intensity transmission, newly emerging areas and locations beginning to show signs of stabilization.
Balde identified Bunia and surrounding areas as major transmission hotspots, where the WHO has prioritized safe and dignified burials, referral systems and clinical management capacity in the most heavily affected areas.
Mongbwalu town in Ituri, the epicenter of the outbreak, is showing signs of stabilization, with a similar trend detected in Goma, the capital of North Kivu province. In Kisangani, the capital of Tshopo province, all five confirmed patients were imported cases from Ituri, and no secondary cases had been detected by the time of the briefing, according to Balde.
The WHO has deployed rapid response teams to Kisangani, a city of more than 1.6 million people and a major transport hub linking eastern and western DRC, amid wider transmission risks along key transport corridors, including the Congo River.
"The outbreak is dynamic," Balde said, explaining that population movements could spread the virus to new areas or cause cases to reappear where transmission had appeared to be stabilizing. "This outbreak remains ahead of us. We are still in the phase of catching up."
According to the WHO, it is adapting its response to local conditions rather than applying the same strategy across all affected provinces. It is also developing additional control measures along the Congo River, which Balde described as a crucial transit route requiring rapid intervention.
"The response team needs to rethink its approach, as the outbreak is now moving beyond the city and spreading into outlying areas," Jean-Paul Ngabu Tsunde, a national lawmaker representing Djugu in Ituri province, warned on Monday.
TRIPLE CRISIS
Celestin, the IOM official, said the epidemic was unfolding amid a "triple crisis" of insecurity, repeated displacement and limited access to essential services.
On Monday, the UN Office for the Coordination of Humanitarian Affairs (OCHA) said confirmed Ebola cases have been reported in at least 16 displacement sites hosting more than 270,000 people in Ituri province.
The OCHA warned that overcrowding and limited access to water, sanitation and healthcare were increasing the risk of transmission in the sites.
Community distrust and violence against health facilities further hampered the response.
Pierre Akilimali, an incident manager with the DRC National Institute of Public Health, told reporters in Bunia on Saturday that four Ebola treatment centers in Ituri had been attacked since the outbreak was declared on May 15.
"These incidents have disrupted patient care and exposed health workers and our partners to serious security risks," Akilimali added.
Ihekweazu from the WHO said attacks on treatment centers and resistance to health teams could be reduced only through greater openness and transparency with affected communities.
"Before any new center is opened, we invite leaders of the community to see what is being done" and to speak with the health care providers who have left their homes to support the response, he said.
REGIONAL SPILLOVER
The expansion of the outbreak into Haut-Uele and Tshopo provinces has fueled concern that the virus could spread farther across the DRC or into neighboring countries, notably Uganda and South Sudan.
Uganda discharged its last Ebola patient on July 16 after the patient tested negative, starting a 42-day countdown before the outbreak can officially be declared over. The country has reported 20 confirmed cases, including two deaths.
At the July 17 briefing, Celestin said the risk of regional spillover remained "real," urging stronger surveillance at land borders, river crossings and communities along the Congo River.
Uganda has already reported epidemiologically linked cases, and infections in northern DRC have moved closer to the border with South Sudan, Celestin noted.
Speaking at an African Union health summit in Accra, Ghana, on Tuesday, Africa Centers for Disease Control and Prevention Director-General Jean Kaseya stressed the need for stronger political commitment, sustainable health financing, resilient health systems and African-led solutions.
"If we do not stop this outbreak today, it could become one of the worst Ebola outbreaks the world has ever documented," Kaseya said. ■
