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Congo's Bundibugyo Ebola deaths pass 4,000 as unpaid contact tracers protest in Bunia
Congo's Health Ministry counts 4,018 deaths among 8,300 confirmed Bundibugyo Ebola cases, a strain with no known treatment or vaccine. Weekly confirmed cases have fallen since July, though Africa CDC cautions that insecurity and poor community cooperation could account for the decline.
The Scientist · Science desk
What happened
- Soldiers searching for weapons burned an Ebola-hit camp that housed a patient transit centre at Kigonze, outside Bunia, forcing 19,000 people to flee, a senior UN official said.
- Health workers gathered in Bunia, the capital of Ituri province and the centre of the outbreak, to demand wages they are owed, and officials quickly dispersed them.
- More than 50 health workers have died after contracting the virus since the outbreak began.
- Marie-Célestin Karondwa, a ruling-party official in Butembo, was beaten to death on Sunday for defending the government's Ebola measures, and his house was set on fire.
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Why it matters
- contradiction The falling weekly count and the WHO's warning about spread into new health zones point in opposite directions, so the September decline cannot yet be read as the outbreak turning.
- cost Replacing the Kigonze centre will need money and staff that Harneis says are already short, and the same shortage of money has left surveillance workers unpaid.
- constraint This week the fire hit patient isolation and the pay dispute hit contact finding, the two parts of the response that a strain without a vaccine leaves most exposed.
- exposure The 19,000 people who fled lived in a camp already hit by Ebola, and their contacts become harder to trace once they scatter.
The ministry's deaths come to 48% of its confirmed cases [1]. Both figures cover only people the system has confirmed. Someone who died at home without a test is in neither number, and patients confirmed in the past few weeks may still die, so the share will move as outcomes are recorded.
The weekly counts have come down. About 850 confirmed cases and 470 deaths a week in mid-July became averages of 490 cases and 230 deaths a week in September [13]. That is 42% fewer cases and 51% fewer deaths per week [2][3]. Africa CDC's caveat applies to exactly these numbers [12], because a case reaches the confirmed column only after someone finds it. The disease has slowed in some areas and accelerated in others [20], and the WHO has warned of rapid spread into new health zones [15].
Finding people is the job of the surveillance teams, who identify everyone exposed to an infected patient. Team members were among the protesters in Bunia, carrying placards that read "No money, no data!" and "No payment for months." [4] Front-line workers have struck several times since the outbreak began [5]. The record does not show how much of September's decline reflects fewer infections and how much reflects fewer people looking. Until those teams are paid and working, I would treat the September counts as a lower bound on infections.
The fire at Kigonze hit the other end of the response, where patients are isolated and moved to care. Julien Harneis, the UN's senior Ebola coordinator, said building transit and treatment centres takes money and staff, and both are in short supply [9]. "When we lose a center, that means we lose capacity, we lose investment, and we have to start again. And above all, it means that people do not get access to the care that they really need," Harneis said [8].
The risk to staff extends beyond Congolese workers. Doctors Without Borders (MSF) said one of its aid workers was infected in Congo. The worker was flown to the Netherlands and admitted late Thursday to a high-level isolation unit at Leiden University Medical Center [10].
The Associated Press calls this the fastest-growing Ebola outbreak in history [2]. MSF said communities are "facing the largest Ebola disease outbreak ever recorded in the country" [19]. It is Congo's 17th Ebola outbreak [17], declared on May 15 [3]. Authorities launched a village-centred approach last month. It has met residents who dismiss Ebola as a hoax, and a deep distrust of government rooted in its handling of past outbreaks and in chronic corruption [18].
What to watch
- Whether Africa CDC or the WHO publish test positivity or contact follow-up rates next to weekly confirmed counts, which would separate fewer infections from less searching.
- Whether surveillance workers' back pay is settled in Ituri, and whether weekly confirmed cases rise once they return to work.
- Whether a replacement transit centre opens near Bunia, and where the people displaced from the Kigonze camp end up.