Ebola Response in the DRC: Contact Tracing Gaps and the Role of Community Trust

Nearly 6 months into the latest Ebola outbreak in the Democratic Republic of the Congo (DRC), the numbers tell a complicated story.¹ More than 10,000 cases have already been recorded,² and the outbreak’s footprint continues to expand, with travel-related cases recently surfacing as far away as Kenya and Nigeria.¹ Yet behind the numbers of confirmed cases and deaths lies an operational reality that chills me as an infection preventionist (IP) to the core. In the DRC alone, health officials are attempting to monitor nearly 40,000 known contacts every single day. This is a herculean task where managing an 84% daily follow-up rate is a massive victory against overwhelming odds.²

Despite the heroic efforts of the front-line teams on the ground, the virus continues to spread. New cases have averaged 72 per day over the last 11 days.^2,3 Current patient contact tracing efforts capture barely a fifth of historical benchmarks, leaving an estimated half a million unknown and unmonitored contacts.⁴ As of November 5, after nearly 3 months without a sustained decline, current efforts are making an impact, while the containment curve remains unbent.⁵ The reality on the ground is that the fight is far from over, and resources need to keep pace with where the virus is spreading.

Watching this outbreak scale so rapidly leaves me with a troubling question: what is the tipping point at which even international resources and support can no longer keep up with the sheer number of cases?

Transmission Is Still Intense and Still Spreading

This outbreak is the largest Ebola disease outbreak ever recorded in the DRC and the country's second documented Bundibugyo outbreak (after 2012).¹

As of November 4, the World Health Organization reports 10,699 confirmed cases globally, 5202 deaths, 2905 recoveries, and a case fatality rate of 48.6% across 5 countries: the DRC, Kenya, Nigeria, Uganda, and France (Figure 1).⁶

In the DRC, reported cases span 8 provinces.² Since September, confirmed cases have been identified in 2 new provinces: South Ubangi⁷ and North Ubangi⁸ (Figure 2).

In South Ubangi, there were 2 isolated cases,² the first reported on September 10.^7. A total of 112 contacts were identified, and follow-up ended on October 13.^9. No additional cases were identified.²

In North Ubangi, 8 cases have been identified, with 1 death.² The first 2 cases were announced on October 19.⁸ On October 24, reports indicated both confirmed patients escaped isolation at a local hospital.³ The province did not have a designated treatment center or isolation space for suspected cases.³ The additional cases were reported without any details,^2,10 and as of the last report from the province, no contacts are under follow-up.²

At present, 5 of 8 affected provinces reported new cases in the past 3 weeks (Figure 3).²

Within active provinces, transmission patterns have shifted. While Ituri was the initial epicenter and still holds the highest total case count, over the last 7 days North Kivu has rapidly caught up with 232 cases, surpassing Ituri at 207 new cases.^2,11

Most Chains of Transmission Are Invisible

Of the many metrics I have been tracking throughout this outbreak, a few offer insight into the story beneath the case counts.

On November 5, the Africa Centres for Disease Control and Prevention (Africa CDC) reported that, on average over the last 25 weeks, only 11% of confirmed cases were among known contacts (1112 of 10,368),⁴ with weekly rates varying between 6% and 23%. Based on these numbers, Africa CDC believes that more than 85% of new cases are occurring outside known contact-tracing lists.⁴ From a containment perspective, Africa CDC’s benchmark is 60 contacts for each confirmed case.⁴ Put another way, at most about 15% of new cases are arising among people already on a contact list.⁴ The DRC's national response has set a target of 95% for daily contact follow-up²; the DRC has reported rates below that target every day since October 24 (Figure 4), including 83.9% on November 3.²

Figure 4 illustrates the contacts being followed. Note that Ituri province has consistently been reporting at nearly 90% or higher, while North Kivu has been ranging from 79% to 83%. Tshopo is also reporting increased transmission, from 19 cases in July and August to 75 from August 30 to November 3 (Figure 3), with contact follow-up ranging from 45% to 80%.

When we shift to metrics on validated suspected cases under investigation, a deeper understanding emerges. Since October 24, barriers have limited both affected provinces’ ability to report and health officials’ ability to investigate suspected cases.

The biggest gaps in Figure 5 are North Kivu's: 86 of 99 uninvestigated suspects on October 30.¹² The Institut National de Santé Publique gave no reason, with the same report noting on October 30, North Kivu’s alert teams were slow to act on alerts sent up from screening points, and the points-of-control team lacked communication equipment.¹² Infection prevention and burial teams needed escorts, and a hut at a local screening point had been set on fire.¹²

While in Tshopo, on October 30, the province investigated none of its 8 validated suspected cases.¹² This was the same time frame as reports of a health worker strike and attacks on response teams.^10-12

Implication of Community Deaths

A constant challenge throughout this outbreak has been discovering and confirming Ebola cases only after death within the community. Africa CDC reports that, on average, 63% of deaths occur in the community, or 1.8 community deaths for every death in a treatment center, and calls community deaths one of the key drivers of the outbreak.⁴

The high percentage of community deaths is viewed as reflecting ongoing gaps in early detection efforts and community hesitancy in seeking care.⁴ The proposed solution is stronger early detection, contact follow-up, safe burials, and suspect transfers.¹¹ However, what continues to be missing is community support and buy-in. While official reports do not say this directly, the reported metrics provide insights into how and why this outbreak is so complicated.

In the DRC, it is customary to bathe and prepare your loved ones for burial. This is a deeply held cultural practice, which gives loved ones a way to honor their dead. People infected with Ebola are highly contagious right before death and continue to be contagious after. This is due to the amount of virus in their bodies and its transmission through direct contact with body fluids.¹³

To prevent transmission after death, health officials seek to implement “safe burial” practices where a trained burial team in protective equipment handles the body of anyone who died of suspected or confirmed Ebola. The process is to place the loved one into a body bag and bury them promptly. The burial team includes the family, asks about religious and family wishes, and offers alternatives to washing the body, such as dry ablution or shrouding. Family members can watch, pray, mark the grave, and throw the first soil.¹³

However, community perceptions of, and willingness to agree to, safe burials vary. There were reports in North Kivu of 50 safe burials being postponed as families did not agree³ and of advocacy against secret burials.² In this same province, burial teams have needed security escorts.¹² While in Ituri, 22 of the 78 planned safe burials were not completed, and local community resistance was reported.³ There are 2 direct implications of this: bodies are not able to be swabbed before burial,^10,11 and confirmed cases are underreported.

When a case is confirmed only after death, nobody listed that person’s contacts while they were sick. The people at highest risk, such as caregivers and those who prepared the body, are found late or not at all. Broader implications include an inability for health teams to follow up with potential suspect cases or provide medical care for those who are infected.

Why the Community Avoids Care

At its core, every secret or refused burial is a question of trust. In Ituri, rumors spread that health teams were contaminating toilets and shower areas and that patients taken to the Ebola treatment center never came home alive. One local pastor first suspected the outbreak was a commercial scheme.¹⁴

What shifted attitudes was dialogue. Community dialogues brought together religious and traditional leaders, young people, women’s associations, motorcycle taxi drivers, and traditional healers, and religious leaders visited an Ebola treatment center in Ituri to see how patients were cared for.¹⁴ A September 10 awareness campaign reached nearly 2500 people, and 2 days later, 110 community volunteers were oriented to support the effort.¹⁴ However, building trust is slow, and gaps remain. In the Ituri health zone where these dialogues took place, the daily contact follow-up rate was 70.0% on October 24.³

Ebola response teams are also countering rumors as they surface. On October 30, a radio rebuttal in Ituri answered a rumor that the response was ending.¹² On November 1, North Kivu held a public forum to address community concerns and combat rumors.⁹ Responders also engaged in a dialogue with a traditional chief, urging him to help stop secret burials.² In Tshopo, 3 of 5 refusals were resolved in Bafwasende on November 1.⁹

Trust Is the Metric That Matters

In a health care environment, trust is paramount, and trust takes time. There is an active and ongoing international effort to provide the necessary tools, support, and resources to educate and build the community's trust. In Ituri, where the outbreak has been most concentrated, efforts have been able to make some inroads, which is illustrated in the general flattening of the number of daily cases and success in following contacts (Figures 3 and 4). Similar community engagement is underway in North Kivu, Haut-Uélé, and Tshopo, where cases are ongoing.

Ultimately, containment metrics and epidemiological curves only tell part of the story. Behind every uninvestigated suspect case, every delayed safe burial, and every unreached contact is a fundamental test of human trust. The front-line teams in the DRC are managing an impossible equation: balancing deep-rooted cultural grief and community fear against the ruthless biology of Bundibugyo virus.

For me as an IP, the lesson of this outbreak is clear. We cannot engineer our way out of a public health crisis with logistics alone. Until resources, operational response, and community-led dialogue move at the same pace as the virus, the containment curve will remain stubbornly unbent. Building community trust is not simply a strategy for outbreak response; it is the foundation for successfully ending this outbreak.

As you continue to follow this outbreak, I invite you to look past the number of confirmed cases or deaths and look at the metrics that tell the story under the numbers. The metrics that actually matter.

References

1. Ebola disease caused by Bundibugyo virus - Democratic Republic of the Congo, Kenya and Nigeria. World Health Organization. Disease Outbreak News. October 23, 2026. Accessed November 5, 2026. https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON622
2. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. SitRep No. 173. November 4, 2026. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. Accessed November 5, 2026. https://insp.cd/sitrep-n173-mve-bdbv-03-11-2026/
3. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. SitRep No. 163. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. October 25, 2026. Accessed October 29, 2026. https://insp.cd/sitrep-n163-mve-bdbv-24-10-2026/
4. Special briefing on Ebola outbreak response. Africa Centres for Disease Control and Prevention. YouTube. November 5, 2026. Accessed November 5, 2026. https://www.youtube.com/watch?v=QAOzLZ5Z_Fg
5. Live: Africa CDC extraordinary ministerial meeting on Ebola response in Africa. EAMG TV, YouTube. Africa Centres for Disease Control and Prevention. October 28, 2026. Accessed October 29, 2026. https://www.youtube.com/watch?v=8PdB0ndSW4g
6. Bundibugyo virus disease outbreak: suspected, probable, and confirmed cases, deaths, and recoveries in the Democratic Republic of the Congo, Uganda, and France (15 May-4 November 2026). World Health Organization. Alert and response. Accessed November 5, 2026. https://www.who.int/emergencies/alert-and-response
7. Ebola en RDC: le Sud Ubangi, septième province touchée après avoir enregistré un cas à Gwaka. Actualité.cd. September 11, 2026. Accessed November 5, 2026. https://actualite.cd/2026/09/11/ebola-en-rdc-le-sud-ubangi-sixieme-province-touchee-apres-avoir-enregistre-un-cas-gwaka
8. Nord-Ubangi: deux cas d’Ebola confirmés dans la zone de santé de Wapinda. Agence Congolaise de Presse. October 19, 2026. Accessed November 5, 2026. https://acp.cd/province/nord-ubangi-deux-cas-debola-confirmes-dans-la-zone-de-sante-de-wapinda/
9. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. SitRep No. 171. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. November 2, 2026. Accessed November 5, 2026. https://insp.cd/sitrep-n171-mve-bdbv-01-11-2026/
10. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. SitRep No. 167. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. October 29, 2026. Accessed October 30, 2026. https://insp.cd/sitrep-n167-mve-bdbv-28-10-2026/
11. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. SitRep No. 166. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. October 28, 2026. Accessed October 29, 2026. https://insp.cd/sitrep-n166-mve-bdbv-27-10-2026/
12. Rapport de situation de la 17ème épidémie de la maladie à virus Ebola/RDC. SitRep No. 169. Institut National de Santé Publique, Task Force Présidentielle Ebola 17. October 31, 2026. Accessed November 2, 2026. https://insp.cd/sitrep-n169-mve-bdbv-30-10-2026/
13. New WHO safe and dignified burial protocol - key to reducing Ebola transmission. News release. November 7, 2014. World Health Organization. Accessed November 6, 2026. https://www.who.int/news/item/07-11-2014-new-who-safe-and-dignified-burial-protocol---key-to-reducing-ebola-transmission
14. Ebola in the Democratic Republic of the Congo: in Niania, dialogue transforms mistrust into community engagement. World Health Organization Regional Office for Africa. October 28, 2026. Accessed November 6, 2026. https://afro.who.int/countries/democratic-republic-of-congo/news/ebola-democratic-republic-congo-niania-dialogue-transforms-mistrust-community-engagement