By Michael Gwarisa
More than two-thirds of people dying from Bundibugyo virus disease in the Democratic Republic of the Congo are still dying in their communities, raising concerns that patients are not reaching treatment facilities early enough to survive.
The latest World Health Organization situation report shows that 193 of 284 confirmed deaths recorded during the week of 7–13 September occurred in communities, accounting for 68% of deaths.
Although the proportion has fallen from a peak of 75%, WHO says the continued predominance of community deaths remains a major concern even as treatment capacity expands. The finding points to a critical gap in the Ebola response: getting people into care before they become critically ill.
The DRC now has 49 treatment centres and units providing 1,390 active beds. But WHO says increasing the number of beds alone may not be enough to reduce deaths because people face barriers along the pathway to care.
These include delays in detecting and reporting cases, delays in referral or transfer to treatment facilities, difficulties recognising the severity of illness, geographical and transport barriers, seeking care outside formal health facilities and challenges around community acceptance and trust.
WHO says these barriers can mean patients arrive at treatment facilities late or die before they can be referred.
The problem is particularly acute in parts of Nord-Kivu, where the outbreak is accelerating.
During the latest 21-day period, confirmed cases in Nord-Kivu rose by 76.1%, from 314 to 553, while deaths increased by 40.4%, from 213 to 299.
The province now accounts for one-third of newly reported cases and more than one-third of newly reported deaths nationally. At the same time, the province’s treatment capacity is under severe pressure. WHO reports bed occupancy of 145.6% in Nord-Kivu and says 45% of hospitalised patients there are being managed outside designated treatment centres. No beds were available in Butembo and Katwa at the time of the report.
This comes as the national outbreak picture becomes increasingly deceptive. Across the DRC, confirmed cases fell by 6.1% during the latest 21-day period, from 1,782 to 1,674. Deaths also fell by 14.7%, from 973 to 830.
But the national decline is being driven largely by improvements in Ituri, the original epicentre of the outbreak, where cases fell by 25%. At the same time, transmission is intensifying elsewhere.
In Nord-Kivu, cases increased sharply, while individual health zones recorded even steeper increases. Beni recorded a 109.4% increase, from 53 to 111 cases, while Butembo nearly doubled from 51 to 101 cases.
The result is an outbreak that is not simply getting smaller or larger, but moving geographically.
WHO describes the epidemic as increasingly heterogeneous, with declining transmission in some areas occurring alongside rapid intensification and geographic expansion elsewhere.
The latest report also reveals weaknesses in the response before patients reach treatment.
Between 7 and 13 September, health authorities received 13,709 alerts, averaging almost 2,000 alerts a day.
But only 82.9% of those alerts were verified, down from 89.4% in the previous reporting period.
Of 2,845 validated suspected cases, 2,720 were investigated. Only 50.4% of those investigated were isolated and transferred to treatment centres within 24 hours, down from 53.2% in the previous period.
WHO says the decline across verification, investigation and isolation indicates gaps in the alert-management system, particularly in ensuring that suspected cases are promptly isolated and referred.
Contact tracing is also struggling to keep pace.
As of 13 September, 27,905 contacts were under follow-up, but only 78.6% had been seen. WHO’s target is at least 95%.
Performance was particularly low in some provinces. In Nord-Kivu, where transmission is rapidly increasing, only 69.2% of contacts were followed up. In Haut-Uélé the figure was 65.7%, while Sud-Ubangi recorded just 41%.
For health authorities, the implications extend beyond the treatment centres themselves.
The data suggest that controlling the outbreak will depend not only on expanding hospital capacity, but also on shortening the distance and time between the first signs of illness and access to appropriate care.
WHO says the response must strengthen early detection, rapid referral and community-level pathways to timely treatment. The warning comes as the outbreak reaches a seventh province. A first confirmed case has now been reported in Bulu Health Zone in Sud-Ubangi, a province bordering both the Central African Republic and the Republic of the Congo.
As of 13 September, the DRC had recorded 7,258 confirmed cases and 3,510 confirmed deaths, with transmission reported across 62 health zones in seven provinces.
WHO continues to classify the risk of further spread within the DRC as very high and says the outbreak remains uncontrolled.
For a response that has expanded laboratories, treatment beds, surveillance and other resources, the continued concentration of deaths outside treatment facilities highlights a less visible challenge: ensuring that people who become sick can actually make it to the care that has been built to save them.
