The current Ebola outbreak in the Democratic Republic of Congo has thus far been confined to remote rural areas, but one case has now been confirmed in Mbandaka, a city of almost 1.2 million people. “We are moving to a new phase of the epidemic, and we are putting all the means in place to respond to it in a quick and effective way,” said Oly Ilunga, the DRC’s minster of health, on Thursday evening.
The outbreak initially hit the northwestern town of Bikoro and a nearby village called Ikoko-Impenge that is 30 kilometers away. Both are small and hard to reach, especially in the current rainy season, when roads become pockmarked with gullies and potholes. Mbandaka’s larger population, and its location on the Congo River, provides new opportunities for the virus to spread. And, at 150 kilometers from Bikoro, it significantly widens the area affected by the outbreak. “Confirmation of urban Ebola in DRC is a game changer,” Peter Salama, from the World Health Organization, tweeted. “The challenge just got much, much tougher.”
“It’s a big city,” says Patrick Mukadi, a lab director at the National Institute for Biomedical Research, or INRB, in Kinshasa. “There’s a lot of people passing through, and doing business with surrounding countries. There are regular flights between Mbandaka and Kinshasa [the capital city with a population of more than 11 million]. There are boats to Kinshasa, although it takes two weeks. We don’t know if the outbreak will be big, but it’s better to overestimate than underestimate in terms of the response.”
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 the University of California, Los Angeles, 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 spokeperson for the ministry of health. The ministry has started tracing everyone who attended either the service or