After visiting health officials and frontline responders in the epicenter of the Ebola outbreak in recent days, the head of the World Health Organization (WHO) said today that, despite numerous challenges, he feels hopeful about stopping the outbreak.

In a press briefing, WHO Director-General Tedros Adhanam Ghebreyesus, PhD, said there have been 344 confirmed Ebola cases and 60 confirmed deaths in the Democratic Republic of the Congo (DRC), where the outbreak began, along with 15 confirmed cases and one death in neighboring Uganda.

But labs in the DRC have been able to work through the backlog of tests, reducing the number of suspected cases to 116 from more than 1,000, Tedros said. And there are now three 80-bed treatment centers up and running in Bunia, the capital of the DRC’s Ituri province, with more coming in other affected areas. Eight people—six in the DRC and two in Uganda—have recovered. 

The current outbreak—the 17th in the DRC since Ebola was first identified in 1976—is caused by the Bundibugyo virus, which has no licensed treatments or vaccines.

“The outbreak had a big head start, and we’re still behind, but under the leadership of the government of DRC, we’re catching up,” Tedros said.

Testing scale-up ‘on track,’ but contact tracing lags

Testing and contact tracing remain challenges, however. Tedros said the WHO is working with DRC officials to scale up laboratory and diagnostic capacity in the country to reduce the delays in case confirmation and support faster response decisions. 

Abdirahman Mahamud, MPH, director of the WHO’s Alert and Response Coordination Department, said the DRC’s main testing lab has conducted 1,445 tests to clear the backlog, and added that the opening of five additional labs next week will enable 1,000 tests a day going forward. “The scale-up is on track,” he said.

To date, only 45% of case contacts have been followed up. Tedros said political instability, displacement, and mobile populations in the region, which has been plagued by violence between the government and armed militia groups, has made contact tracing especially difficult.

“To get ahead of the outbreak, we need to get that number up to above 90%,” he said. 

The outbreak had a big head start, and we’re still behind, but under the leadership of the government of DRC, we’re catching up.

Tedros also cited community mistrust as a barrier to the response, saying that some community leaders told him on his visit to the DRC that they don’t believe Ebola is real. The mistrust has fueled some attacks on Ebola treatment centers.

“Building trust with the communities is therefore critical to bringing the outbreak under control,” he said.

When asked about the theories that the outbreak started much earlier than mid-May, Mahamud said WHO officials are reviewing data and speaking with community members to determine when it began. “What we’ve been saying is that this outbreak started earlier. How earlier? Time will tell,” he said.

Tedros said the WHO is looking at many scenarios. 

“It could be January, could February, March, or April,” he said. “I think proper investigation is needed…but I think the focus now should be on the response.”

Rubio pressed on US response

In other Ebola news, US Secretary of State Marco Rubio yesterday told lawmakers at a hearing on Capitol Hill that the Trump administration is considering a single official to oversee the government’s response to the outbreak.

“I don’t ​want to use the term ‘Ebola czar’, but [it would be] someone with ​the qualifications to sort ​of serve full time in the ‌coordination ⁠of the interagency,” Rubio said, according to Reuters. 

Rubio faced tough questioning from Democrats on the House Appropriations Committee, who pressed him about the impact of Trump administration cuts to global health programs and the administration’s plan to build a quarantine facility in Kenya for Americans who’ve been exposed in the outbreak.

“We have asked numerous US government employees and partners to put themselves in harm’s way to help us keep safe. And how does the Trump administration repay them? By slamming the door in their face,” Rep. Rose DeLauro (D-CT) said, according to The Hill.

Rubio said the United States has given well over $200 million to partners in the response effort and that administration officials meet daily to discuss the crisis. He said the facility in Kenya, which has been temporarily blocked by a Kenyan court, will be an “observation post” where Americans will be observed for 21 days. If infected, they will be transferred to a facility in Europe or “maybe stateside,” Rubio said.