The long-running Ebola outbreak in northeastern Democratic Republic of the Congo has encountered another setback, with health authorities confirming on Friday that a new case has been discovered after 52 days without a positive diagnosis.

The country had been expected to declare the outbreak over on Monday, which would have been 42 days after the last Ebola survivor had been declared free of infection and discharged from an Ebola treatment clinic. Forty-two days is the length of two incubation periods of the disease and is considered the point at which it can be reasonably safe to declare an outbreak over.

Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said he convened a meeting Friday of the Ebola emergency committee — a group of external experts advising the WHO on this outbreak — to inform them of the news.

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“Unfortunately this means the government of DRC will not be able to declare an end to the outbreak on Monday as was hoped,” Tedros, as he is known, said during a media briefing about the Covid-19 pandemic. “But WHO and all partners remain on the ground and committed as ever to working with the government … to end the outbreak.”

The new case was a 26-year-old man at Beni, who has died from the infection. It is not yet known how he contracted the virus, but given the number of days since the last confirmed case, it seems likely the man was part of a chain of transmission that has gone undetected.

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Mike Ryan, head of the WHO’s health emergencies committee, said a “deep investigation” is underway to determine how the man was infected.

Ryan said the outbreak response has remained in place, and active surveillance for cases has continued.

“Everyday we investigate 2,600 alerts across the two affected provinces still. We take thousands of samples every single week. And we will continue that active surveillance right the way through,” Ryan said. “It’s a testament to the strength and resilience of workers in North Kivu, to the local workers who continue to trace and track, continue to investigate, continue to report and continue to leave in place the infrastructure needed.”

The Congolese government, the WHO, and partners “are ready to respond and react if things were in any way to deteriorate,” said Ryan, who has often warned the road to the end of the outbreak would likely be long, with unexpected twists and bumps. “Never be surprised,” he said.

The outbreak, in the provinces of North Kivu and Ituri, is the second largest on record. To date at least 3,454 people have been infected and at least 2,274 have died.

While those numbers make this substantially smaller than the historic West African outbreak of 2014-2016 — which involved more than 28,000 cases and 11,000 deaths — this epidemic has been one of the most difficult responses the WHO and its partners have ever had to mount.

North Kivu and Ituri have been mired in conflict for decades. Ongoing violence, some of it aimed at Ebola response workers, has fueled transmission of the deadly virus. On multiple occasions, hard-won progress has been lost when violent attacks on communities forced outbreak response workers to shelter in place for days, allowing the virus to spread unchecked.

The outbreak is believed to have begun in late April 2018, but was only detected in late July of that year. Laboratory confirmation that Ebola was spreading in this part of DRC came on Aug. 1, 2018, when the WHO declared an outbreak was underway.

  • “Investigating 2 affected provinces (in the DRC)” apparently excludes all the other provinces – and/or also the neighbouring countries? Of course detecting any spread will be hampered by such limitation. So – just like for the coronavirus: BLOCK travel and migrations for 42 days ! Where people are not willing to listen (or do not comprehend) force may be necessary. Truly, if an “outbreak is over” declaration is aspired, such measures may need to be taken. It would also help curb Covid-19 spread.

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