Africa’s top health agency offered a grim outlook on the Ebola crisis raging in eastern Democratic Republic of Congo on Thursday, warning that contact tracing was dangerously behind where it needed to be to end the spread.
“If we don’t stop this outbreak now,” Dr. Jean Kaseya, the director general of the Africa Centers for Disease Control and Prevention, said on Thursday, “for sure it will be the largest Ebola outbreak ever.”
The first step to breaking the chain of transmission in an outbreak is to identify anyone who has been in contact with an infected Ebola patient. This enables health workers to monitor people, test them if they develop symptoms and isolate those who test positive before they can spread the virus.
Dr. Kaseya said at a briefing on Thursday that health workers needed to track and trace 80 percent of a confirmed Ebola patient’s contacts to end the outbreak. The current figure stands at just 30 percent.
“There is huge, huge community transmission,” he said.
Most of the people testing positive for Ebola in Ituri Province, the epicenter of the outbreak, are not on health workers’ radar, he said. Health agencies are recruiting 20,000 paid workers, many of them young people from affected communities, who will be trained in the coming weeks to do contact tracing and to educate residents on how to protect themselves, he said. They will also be taught how to conduct safe burials.
More than 1,100 people have tested positive for Ebola since May. Congo’s health ministry says that more than 250 people have died, though the true number is likely far higher, as the virus appears to have spread for months before it was identified.
Epidemiologists expect a minimum of 20 contacts to be identified for each infected person, but Dr. Kaseya said that in urban areas, 40 contacts is a more realistic number.
And the virus causing the current outbreak, Bundibugyo, is now spreading in camps that are home to about a third of the one million displaced people in the region where conflict has raged for years. In a camp setting, an infected person would likely have 120 contacts, Dr. Kaseya said.
Almost all the beds in emergency Ebola treatment facilities in eastern Congo — a staggering 95 percent — are already occupied by patients, Dr. Kaseya said. That number suggests that the local health system is close to its breaking point.
While there are no approved treatments for Bundibugyo, clinical trials of medications to treat the virus, and of a drug that could stop infection in people exposed to it, are expected to begin as early as next week. That is an unusually swift timeline that reflects longtime efforts by researchers to have trials ready in the event of an Ebola outbreak. It normally takes months, or even years, to get regulatory approval and to organize the logistics to test a drug.
Many past Ebola outbreaks ended before clinical trials could even begin.
One trial will test treatment for patients who are already sick: some will receive the antiviral remdesivir, which has shown efficacy in treating people with other species of Ebola viruses. Others will receive remdesivir plus a monoclonal antibody — a molecule that locks onto the surface of a virus and prevents it from getting into cells — called MBP-134.
MBP-134 has shown promise against Bundibugyo in animal studies and is expected to arrive in Bunia, the capital of Ituri province, on Friday, said Dr. Mosoka Fallah, the director for science and innovation at Africa C.D.C.
Another trial will test a 10-day course of an oral form of remdesivir called obeldesivir as what is called post-exposure prophylaxis. This kind of treatment aims to stop people who have been exposed to the virus from getting sick.
If it works against Bundibugyo, obeldesivir could provide a critically important weapon against the virus both by protecting those who have been exposed to it and by stopping them from passing it along to others.
This trial is expected to begin in mid-July and will enroll 1,200 people. Dr. Fallah said that if data analysis after 600 patients shows it is protecting people, the goal will be to extend access to the drug to all contacts for the duration of the outbreak.
