The outbreak only spread to a city after a rural origin—and that could make a huge difference. “Having that advanced warning meant that a lot of things were already put in place,” says Nicole Hoff from UCLA, who is currently in the Congo. “All the emergency operations that were being set up were in Mbandaka, since it’s the closest city to Bikoro. We’ve always discussed what would happen if Ebola made it to the city.”
The new case was confirmed in Wangata, one of three “health zones” in Mbandaka, and the closest to Bikoro. The newly confirmed patient was at a funeral in Bikoro before traveling to Mbandaka and attending a church service, according to Jessica Ilunga, a spokesperson for the Ministry of Health. The ministry has started tracing everyone who attended either the service or the funeral. The latter is particularly important: In Congolese traditions, friends and family members will touch, dress, hug, and even kiss the body of a loved one, providing routes for Ebola to spread. In this case, the deceased person was buried before they could be tested for Ebola.
This is the DRC’s ninth Ebola outbreak, and most of the others have hit remote areas. The last urban outbreak in the country happened in 1995, when the virus infected 317 people in the western city of Kikwit, and killed 245.
An urban case is always cause for concern, but it isn’t necessarily a disaster. Ebola is not an airborne disease. It can only spread through contact with infected bodily fluids, so effective hygiene and public health can still contain it in a densely populated area. During the DRC’s very first Ebola outbreak in 1976 (which was also the first one in the world), a sick nun was evacuated to a hospital in the megacity capital of Kinshasa, and even though nothing was known about the disease at the time, it didn’t spread. Similarly, in July 2014, Nigeria successfully controlled Ebola after it arrived in Lagos, Africa’s most heavily populated city; only 19 people were infected, and only eight died.
The latest figures from the WHO suggest that as of Tuesday, 44 potential cases of Ebola have been reported, including 40 in Bikoro and Ikoko, and 4 in Wangata. Of these, only 3 have been confirmed in laboratory tests: 2 in Bikoro and 1 in Wangata.
But new figures presented at a meeting on Thursday show that as of Wednesday, another suspected case has been identified in Bikoro, and 11 of the existing suspected cases have now been confirmed in lab tests. That gives a total of 45 cases across the whole outbreak, of which 14 have been lab-confirmed. The number of confirmed cases has gone up because a mobile lab is now up-and-running in Bikoro, rather than because the epidemic itself is progressing.
Lab tests are crucial since the symptoms of Ebola are not as horrific as commonly believed, and are often indistinguishable from more common diseases like malaria or typhoid. For example, the Mbandaka case was detected when a doctor in the city’s hospital noticed two patients with potential Ebola symptoms. A team from the Ministry of Health took blood samples and did rough diagnostic tests, which came back with two positive results. But when they sent the samples to the INRB for more rigorous testing, only one of them came back positive.