Is Congo's 14 month Ebola outbreak finally nearing an end?

Some 14 months after the Ebola outbreak was declared in the Democratic Republic of Congo, there are signs that the crisis may be winding down.

Despite effective vaccines and experimental treatments, the epidemic is now the second largest in history – 3,227 people have so far been infected and more than 2,150 have died, including 160 health workers.

Efforts to contain the crisis have continually been hampered by mistrust and violence. North Kivu and Ituri, the regions at the heart of the crisis, are largely forgotten corners of the DRC, some 1,600 miles from the capital city, Kinshasa. Both have been torn by conflict for almost 25 years.

But in the last month there are signs that the tide has turned, with the number of new cases and deaths reported falling significantly.

At the peak of the crisis in April, the WHO reported some 130 infections of the highly contagious hemorrhagic fever a week – in the last seven days there were just 20.

And the number of deaths has fallen from a high of almost 100 to just 10, while more than 1,000 people have now survived the disease.

Dr Mike Ryan, executive director of the WHO health emergencies programme, said last week that this success was largely because Ebola has been “squeezed” into a corner.

“We have significantly contained the virus in a much smaller geographic area... essentially a triangle between Mambasa, Komanda, Beni, Mandima, which is a shared space between North Kivu and Ituri,” he said.

But Dr Ryan added that there will be a “somewhat bumpy road to zero” – the remaining hotspot is a remote area which is a five-hour motorbike ride from town, and dozens of armed militia groups are in operation there.

In an update this week, the WHO warned that access and security issues are still impacting efforts to detect cases, conduct safe burials and vaccinate people at risk.

The organisation added that the proportion of people dying outside of Ebola Treatment Centres has risen from 14 per cent to 27 per cent, meaning fewer people are seeking care.

And there has been a drop in the number of new infections in people who had been listed as contacts of existing patients, from 57 per cent of new cases to just 13 per cent.

This is a concern as the process of tracking people who might have come into contact with an Ebola patient helps health workers to contain the virus’ spread.

Gillian Mckay, an Ebola expert from the London School of Hygiene and Tropical Medicine, said this might also mean that there are new Ebola cases that are not being recorded.

“It could be that there are some undetected cases out there,” she told The Telegraph. “I think the risk is always there. But it’s a bit of a known unknown.”

Mrs McKay added that the epidemiological curve (the bar chart mapping case numbers) was encouraging, and suggested that changes in the Ebola response had been effective.

“One of the biggest successes and shifts that has happened is that we are not looking at this outbreak in isolation. The response shifted to look beyond Ebola itself, at the humanitarian crisis in the region, and to tackle these issues too.

“After all, Ebola outbreaks don’t happen in places with strong health systems, not to this extent,” she said.

But Mrs McKay said that it would still be months before the outbreak concluded – for the WHO to declare the crisis over, there have to be 134 consecutive days without a new case.

“We can’t get complacent, we have to maintain a lot of vigilance and we should expect a bumpy end,” she said.

“That’s what we saw in the West Africa outbreak [in 2013-2016], we had many tiny outbreaks for quite a long time after the big bump was over.”

A WHO spokesman added:  “Substantial progress has been made, and we are cautiously optimistic.

“This is the time to intensify our response efforts, because it only takes one missed case to rekindle a new hotspot or spark a new one.”

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