The Ebola outbreak surging across multiple African nations is likely far more severe than official reports indicate, according to health experts. The International Rescue Committee (IRC), a New York-based aid organization, warned on Monday that response efforts in the Democratic Republic of the Congo (DRC), the epicentre of the ongoing outbreak, are hampered by delayed detection and insufficient contact tracing.
Current Situation in the DRC
The outbreak is caused by the rare and incurable Bundibugyo variant, which has now resulted in over 1,000 suspected cases and more than 200 suspected deaths in the DRC, as reported by the country's Ministry of Health. Of these, 282 cases and 42 deaths have been confirmed. The variant, which currently has no approved treatments or vaccines, has a fatality rate of up to 50 percent among those infected.
Spread to Neighbouring Countries
A growing number of cases have been detected in Uganda and South Sudan, with patients under observation in Italy and Brazil. An American who tested positive for the virus was evacuated to Germany for treatment. The IRC suspects the disease may have been spreading undetected since before March, potentially three months before the epidemic was declared in mid-May.
Rachel Howard, senior technical emergency health advisor at the IRC, estimated that only about 20 percent of contacts are currently being traced, hampering efforts to identify new transmission sources. The IRC also notes that cases could spread to other neighbouring countries like Burundi.
Challenges in Response
Howard stated that shortages of diagnostic cartridges and testing backlogs are slowing case confirmation, obscuring the true extent of the outbreak. At least six healthcare workers have died, including two doctors in recent days, and many residents are avoiding health facilities. This raises concerns that infected individuals remain in vulnerable communities rather than seeking treatment.
"As a result, transmission is spreading across multiple areas, and communities are losing trust in the response," Howard said. "Strengthening local, community-based prevention and infection control should be the immediate priority to control the outbreak at the source. Without urgent funding, the situation could deteriorate rapidly."
US Response and Travel Advisories
In response to the outbreak, the United States is requiring travellers arriving from the DRC, Uganda, or South Sudan to reroute through one of four airports for enhanced screening: John F Kennedy International Airport in New York, Washington Dulles International Airport, Hartsfield-Jackson Atlanta International Airport, and George Bush Intercontinental Airport in Houston. Last week, health officials in Kenya rejected a US plan to quarantine Americans exposed to Ebola in the country, pending hearings scheduled for Tuesday. Estimates suggest up to 5,000 Americans are in the DRC.
Dr Peter Stafford, an American medical missionary, became infected with the Bundibugyo virus while in the DRC and was evacuated to Charité Hospital in Germany. Health officials reported that Stafford is weak but not critically ill, has not required intensive care, and his viral counts are decreasing with antiviral medications. He is being treated in a fully isolated ward, and his wife, Dr Rebekah Stafford, has tested negative and remains symptom-free, though the family is quarantined.
The CDC has issued a Level 3 travel advisory for the DRC, urging Americans to reconsider nonessential travel to the Ituri, Nord-Kivu, and Sud-Kivu provinces. For those who must travel, the CDC recommends travel insurance, avoiding contact with symptomatic individuals, bodily fluids, and contaminated objects, as well as avoiding bats, forest antelopes, primates, and their meat. Travellers should monitor for Ebola symptoms for 21 days after leaving the DRC. Level 2 advisories are in place for Uganda and South Sudan.
Historical Context and Expert Commentary
Ebola has been present in the DRC since 1976, with the current outbreak being the 17th in the country. Previous outbreaks in 2018 and 2020 in eastern Congo killed over 1,000 people each. The largest outbreak occurred in West Africa from 2014 to 2016, with over 28,600 cases. The World Health Organization (WHO) has stated that the current outbreak does not meet the criteria for a pandemic emergency, but neighbouring countries like Uganda and Rwanda are at increased risk.
Symptoms of Ebola include fever, headache, muscle pain, weakness, diarrhoea, vomiting, abdominal pain, and unexplained bleeding or bruising. The virus can cause severe disease with a mortality rate as high as 90 percent without treatment. The Bundibugyo strain has only been implicated in two previous outbreaks (2007 and 2012) and has a mortality rate of 25 to 50 percent. Unlike the Zaire strain, which has treatments and a vaccine, the Bundibugyo variant lacks proven countermeasures.
Amanda Rojek, Associate Professor of Health Emergencies at the University of Oxford, noted: "Unfortunately, Bundibugyo has fewer proven countermeasures than Zaire ebolavirus, where vaccines have been highly effective in controlling outbreaks."
