The outbreak's trajectory

The Bundibugyo strain Ebola outbreak in the Democratic Republic of Congo has reached 452 confirmed cases and 82 deaths in the DRC, with an additional 19 cases and two deaths in neighboring Uganda, according to the World Health Organization's daily report on Friday. The total of 471 cases and 84 deaths represents a single-day increase of 100 cases and 20 deaths. The DRC health ministry confirmed 71 new cases in a 24-hour period and warned of rapid community transmission.

“The epidemic is advancing rapidly and we are still running after it.”

The outbreak was declared on May 15 in northeastern DRC, but the WHO estimates the virus had been circulating in Ituri province for about two months before the declaration. The WHO classified it as a public health emergency of international concern on May 17.

CDC modeling and warnings

The U.S. Centers for Disease Control and Prevention published three Morbidity and Mortality Weekly Report documents on Friday, the first such reports since the WHO emergency declaration. CDC model scenarios show that without strong public health interventions, the outbreak could become as large as, or larger than, the 2014-2016 West Africa outbreak that killed more than 11,000 people.

“In modeled scenarios where the isolation of patients is limited the outbreak could become one of the largest ever documented.”

Dr. Satish Pillai, incident manager for the CDC's Ebola response, said the documents were published in part to marshal resources across the international community. The CDC has about 30 people in its DRC country office and approximately 100 in Uganda, with additional experts deployed in recent weeks.

The Bundibugyo strain

There is no approved vaccine or treatment for the rare Bundibugyo species of Ebola virus causing the current outbreak. The strain has a case fatality rate between 30% and 50%, according to the WHO. Ebola is transmitted through direct contact with bodily fluids of infected people or animals and causes severe hemorrhagic fever, vomiting, diarrhea, and internal bleeding. The virus has killed more than 15,000 people in Africa over the past 50 years.

International response and funding

The United States announced on Friday an additional $38 million for Ebola response efforts, bringing total U.S. direct funding to more than $200 million. The State Department said it was working closely with the CDC, the DRC, and Uganda to mount a rapid and comprehensive response. The WHO and the Africa CDC launched a $518 million (€446 million) plan on Friday to combat the epidemic over the next six months, focusing on strengthening surveillance, laboratory testing, and infection prevention.

“We must stop the epidemic where it is, support the countries taking action right now, and ensure that neighboring countries are ready to detect and act quickly if cases appear.”

China sent a five-person team of medical experts to Kinshasa this week with protective equipment and lab supplies, though Beijing has not yet publicly responded to an official African appeal for $319 million in aid. Uganda has maintained a temporary border closure with the DRC since May 27.

Challenges on the ground

The epicenter of the outbreak is the mining town of Mongbwalu in Ituri province. Violence and constant displacement in the region have made it difficult for specialists to assess the full scale of the outbreak even weeks after its declaration. Many confirmed patients developed symptoms between May 14 and May 23, followed by a second cluster between May 25 and June 3, suggesting the virus continued spreading in communities before the outbreak was formally recognized. More than 5,000 people are under surveillance due to contact with infected individuals. Treatment centers in Mongbwalu are in dire need of equipment, medicine, and basic supplies, and a lack of testing has made it harder to slow the spread.

“Now we are in this moment of truth. This is really going to force them to answer the question: do we just let this thing run wild and let there essentially be a leadership vacuum, or do we step into the breach?”