KINSHASA, June 22 (Xinhua) -- Confirmed Ebola cases in the Democratic Republic of the Congo (DRC) have topped 1,000, a new mark in an outbreak that remains active and continues to grow.
The DRC Health Ministry said Sunday that the country has recorded 1,003 confirmed cases, including 254 deaths, since the outbreak was declared in mid-May.
Public health officials and experts said the outbreak has yet to show signs of peaking. The specific virus involved, gaps in case detection and contact tracing, and the complex security and humanitarian situation in eastern DRC have all made it difficult to determine when the outbreak will stabilize.
PEAK NOT YET IN SIGHT
The outbreak remains in a "growth phase" or "ascending phase," DRC Health Minister Roger Kamba said Thursday at a press briefing in Bunia, the capital of the eastern Ituri province and an epicenter of the outbreak.
Kamba said the rise in cases should not necessarily be seen as negative, as it also reflects expanded case-tracking and the identification of previously undetected cases in communities.
Kamba said the outbreak can only be declared as peaked when key indicators stabilize or fall, adding that response efforts must continue for now.
According to figures released by the health ministry on Sunday, 100 patients have recovered, while 365 patients are in isolation or hospitalized. The current contact-tracing rate stands at 58 percent, still far below the ministry's target of 95 percent.
"We are still in the middle of the outbreak. We can say we are in an ascending phase, an active phase," Dieudonne Mwamba Kazadi, head of the National Institute of Public Health, told Xinhua.
Kazadi said rising case numbers were straining Ebola treatment centers and that additional capacity must be prepared in advance to accommodate more suspected and confirmed cases.
Marie Roseline Belizaire, a WHO expert, said the increase in cases also shows that the epidemiological surveillance system is beginning to function and detect cases in the community, including living patients and community deaths.
Belizaire also warned that each Ebola-positive community death could represent "another chain of transmission that continues."
The outbreak is caused by the Bundibugyo Ebola virus, for which there are currently no approved vaccines or licensed therapeutics. Kamba said the disease is clinically difficult to detect because many patients do not show bleeding symptoms commonly associated with Ebola. Early symptoms can resemble malaria or other common illnesses in the area, delaying diagnosis and treatment.
Kamba said patients have a better chance of recovery when they reach treatment centers early. Many, however, arrive after developing severe diarrhea and vomiting, when they are already significantly weakened.
RESPONSE SCALED UP
As cases continue to rise, the DRC government, regional institutions and international partners are stepping up response measures.
According to the DRC Health Ministry, measures being intensified include case tracking and investigation, community awareness and mobilization, and treatment and testing capacity.
Kamba said more than 500 beds had been set up in about one month, while laboratory capacity had increased from about 20 tests a day from the outset of the outbreak to more than 2,000 tests a day.
Belizaire said dedicated Ebola treatment centers increased from zero to nine, providing medical treatment, as well as psychosocial and nutritional support.
Kazadi said treatment centers, beds and patient transfer capacity in Ituri had been reinforced and would be further expanded. The government also plans to build a larger Ebola treatment facility to prepare for a possible further increase in cases.
At a high-level virtual meeting on the Ebola response held on June 16, African Union Commission Chairperson Mahmoud Ali Youssouf called for sustained solidarity and collective action among African countries and their partners to prevent further transmission of the disease and invest in resilient health systems across the continent.
Youssouf underscored the importance of enhancing national and regional response plans, strengthening cross-border coordination, and scaling up preparedness, surveillance and containment measures.
The Africa Centers for Disease Control and Prevention (Africa CDC) said the meeting had mobilized 910 million U.S. dollars, including 80 million dollars from African member states, to counter the outbreak. It warned that if transmission is not rapidly contained, projected needs could rise to as much as 1.5 billion dollars.
GAPS TO BE CLOSED
Despite the expanding response, major gaps remain. Inadequate contact tracing remains a major bottleneck in containing the outbreak.
Kazadi told Xinhua that to contain the outbreak, "we must be sure that all contacts of confirmed cases have been listed and are being followed." The main danger, he added, is the emergence of cases outside known epidemiological chains.
"Once all contacts are being followed, and all new cases arising from contacts are isolated, then we can be sure we are on the path toward controlling the epidemic," he said.
Wessam Mankoula, an Africa CDC official, said the outbreak's spread was outpacing current response capacity. Based on the scale of confirmed cases at the time, the contact list should have included roughly 35,000 people, but only about 12 percent of expected contacts were under active follow-up, he said.
In addition, the existing humanitarian crisis in eastern DRC is increasing transmission risks.
The WHO said that the outbreak is unfolding in a complex humanitarian and conflict-affected environment, characterized by highly mobile and often displaced populations, often lacking access to basic services, including food, clean water, shelter, healthcare and protection. Overcrowded displacement camps have added to prevention pressures.
The WHO also said increasing security incidents affecting health facilities had disrupted surveillance and response activities, restricted access for response teams in some areas and heightened the risk of undetected transmission.
Although Ituri remains the epicenter of the outbreak, Africa CDC also singled out North Kivu as a major concern. Highlighting the security situation in the province, he warned that if humanitarian corridors and access for responders continue to be delayed, teams might eventually enter those areas only to find a surge in cases.
Community-level response measures remain fragile amid mistrust and resistance from the local population.
Kamba said given the absence of approved vaccines or specific therapeutics for the virus causing the current outbreak, the response still depends mainly on early detection, isolation and care, contact tracing, safe burials, and other community-based public health measures.
However, the effectiveness of these measures ultimately depends on community cooperation. Pierre Akilimali, an incident manager with the National Institute of Public Health, said that risk communication and community engagement are part of a behavior-change process that "is not automatic."
He said communities often respond to an outbreak with hostility, denial and mistrust at the beginning, and that changing attitudes takes time, adding that community engagement is essential to breaking transmission chains. ■