The Most Basic Step of the Ebola Response Is Falling Short

The Ebola outbreak in the Democratic Republic of the Congo has worsened significantly, with the head of Africa CDC, Jean Kaseya, announcing that it has become the second worst in history. Cases are doubling approximately every ten days, and over 1,800 people have died, although the actual death toll may be even higher. A crucial issue hindering the response is the ineffective testing process, which allows the virus to spread more rapidly.

Health-care workers initially rely on symptoms to diagnose the disease, but accurate diagnosis requires testing.

In response, Congo has stockpiled GeneXpert devices, which can detect the Zaire species of Ebola virus within an hour, and hundreds have been distributed to hospitals across the country. Initially, the tests came back negative, leading health officials to believe the outbreak had been contained. However, it turned out that the virus was a different species, Bundibugyo, which could not be detected by the GeneXpert cartridges.

This realization only came after samples were sent over 1,000 miles away for more robust PCR testing, creating a delay of four weeks.

PCR testing is currently the only reliable method to detect the Bundibugyo strain in Congo, but the current system is inefficient. Tests are picked up by a car, transported to labs, and then returned with handwritten results. Some routes take longer due to roadblocks caused by conflicts. Despite improvements, one in eight Ebola tests still takes more than 72 hours to provide a result. The proportion of positive tests remains constant at around 45 percent, indicating that Ebola testing is still insufficient.

To improve the situation, health officials are considering distributing GeneXpert cartridges capable of detecting Bundibugyo. This would allow for same-day results and help identify cases earlier, enabling proper isolation and reducing transmission. Although a fast-track testing solution is under development by several companies and institutions, including the Gates Foundation, the World Health Organization, and Cepheid, the final approval process is still underway.