The Ebola outbreak in the Democratic Republic of Congo has reached 3,200 confirmed cases and 1,405 deaths, according to government figures released on Sunday and carried by Al Jazeera. Nearly 90% of cases are in the north-eastern province of Ituri, which borders South Sudan and Uganda, and the World Health Organization says the virus is now present in five provinces, two of them reached recently.
The rate of change is easier to see against the WHO’s own last full accounting. Its disease outbreak notice of 17 July, with a Congolese data cut-off of 15 July, recorded 2,124 confirmed cases and 828 deaths in DR Congo. Comparing like with like — Congolese figures against Congolese figures — the eleven days to 26 July added 1,076 cases and 577 deaths, an average of about 98 cases and 53 deaths a day.
Those two rates are not moving together. Cases rose 50.7% over the period while deaths rose 69.7%, pushing the crude case-fatality rate from 38.98% to 43.91%, a jump of nearly five percentage points. A rising ratio of that kind can mean the illness is being caught later or treated worse, or simply that deaths are confirmed faster than infections in a strained surveillance system. It is a signal to watch rather than a conclusion, and it is the figure to check first when the next update lands.
The WHO notice sets out how concentrated the outbreak is. Of 2,145 cases across all affected countries at its cut-off, Ituri accounted for 1,904 — 89.6% — and 692 of the 830 deaths. Within Ituri the heaviest health zones were Bunia with 570 cases, Rwampara with 418 and Mongbwalu with 347. The outbreak spans 46 health zones. It was declared on 15 May and became a public health emergency of international concern two days later.
The response is being carried by health workers who are themselves being infected and, in places, not being paid. The WHO recorded 119 confirmed cases among health workers and 36 deaths, a case-fatality rate of 30.3%. Strikes over unpaid wages have disrupted the response, and access is a problem in its own right. “In many cases the humanitarian community wants to help, but the real challenge is getting there,” Hedley Tah of the UN Humanitarian Air Service said.
The vaccine picture is the one thing that has genuinely changed. Oxford University said on Friday that a first group of volunteers had received an experimental vaccine aimed at the Bundibugyo strain — the strain driving this outbreak, and the one for which, as the WHO stated as recently as 17 July, no approved vaccine or treatment exists. Al Jazeera reports that several other candidate vaccines are being fast-tracked into clinical trials and that two potential treatments are in development.
That distinction is the whole difficulty. The vaccine used successfully against Ebola in eastern Congo in earlier years targets the Zaire species, and it does not protect against Bundibugyo. It is why an outbreak declared in May could run for ten weeks with no immunological tool available at all, and why a Phase 1 safety trial in England counts as the most significant development of the month for a province 6,000 kilometres away.
There is one piece of better news. Uganda, which recorded 20 cases and two deaths, has had no new case since 21 June and began a 42-day countdown to being declared free of the outbreak on 16 July. The WHO assesses the risk as very high in DR Congo, high in Uganda and neighbouring countries, and low globally.