The Ebola epidemic sweeping the Democratic Republic of Congo may be three times larger than official figures indicate, Africa's top public-health agency said, suggesting thousands of infections are going undetected as authorities struggle to track transmission.
Congo has officially recorded 5,713 confirmed infections and 2,744 deaths through Aug. 25. An outbreak three times that size would imply about 17,100 infections. The confirmed case-fatality ratio has climbed to 48% from 27% two months earlier.
Still, the proportion of deaths occurring in the community has fallen significantly over the past three days in areas where health workers have been deployed, Kyeng Mercy, the epidemic intelligence unit lead at the Africa Centres for Disease Control and Prevention, told reporters Thursday.
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About 63% of deaths reported over the two weeks through Aug. 24 occurred in the community, compared with roughly half over the latest several days.
The assessment underscores how little health authorities may know about the true extent of an epidemic that has spread across six provinces in eastern Congo. Weak contact tracing, insecurity and disruptions to the response have made it difficult to identify infected people and isolate them before they spread the virus.
International attention, political focus and resources were still lagging behind the situation on the ground, United Nations Secretary-General Antonio Guterres said Thursday.
"We know how to contain Ebola, how to interrupt transmission and how to save lives," he said, "but we must also overcome another virus: the virus of indifference." Hidden SpreadAfrica CDC has previously acknowledged that the official numbers don't capture the full outbreak. On Aug. 6, Africa CDC Director-General Jean Kaseya said more than 70% of new infections were being found in the community rather than among known contacts and that authorities believed additional cases weren't being reported. Contact-tracing data provide evidence of substantial under-detection, according to Africa CDC. Authorities identified only about one-fifth of the contacts the agency would have expected from confirmed cases over the three weeks through Aug. 25. Africa CDC estimates the effective reproduction number nationally at a little over 1, though transmission varies substantially between health zones. Infections are declining in some major Ituri hotspots while continuing to grow in areas including Katwa in North Kivu. The agency has responded by shifting toward active case finding, including going house-to-house in affected communities rather than relying principally on lists of known contacts. Implementation is expanding across affected areas, although coverage remains uneven. Genomic CluesGenomic sequencing can help reveal transmission that traditional contact tracing misses, but the data can't yet determine the true size of the epidemic, said virologist Jason Kindrachuk, Canada research chair at the University of Manitoba who is involved in genomic analysis of the outbreak. Almost all the viral sequences analyzed by Kindrachuk and colleagues so far have come from Ituri, leaving much less visibility into how the virus is evolving and spreading elsewhere in the country. Some people with mild infections are probably going uncounted, while cases in areas beyond the reach of response teams may also be missed, he said. The outbreak, caused by the Bundibugyo Ebola virus, was declared in mid-May and has expanded with unprecedented speed. Congo's previous largest Ebola outbreak, in 2018-20, recorded about 3,310 confirmed infections over almost two years; the current outbreak surpassed 5,700 cases in less than 15 weeks and could surpass the 2013-16 West African epidemic if it continues at its current pace, according to the World Health Organization. ALSO READ: What Is The Bundibugyo Ebola Strain? DR Congo Outbreak Explained
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