Lancet urges compassionate care as central to controlling DRC’s Bundibugyo Ebola outbreak

A commentary published in The Lancet is arguing that compassionate care is not a secondary concern in the Democratic Republic of the Congo’s fast-growing Ebola outbreak, but a core part of controlling it. The comment comes as the country’s outbreak, caused by Bundibugyo ebolavirus, has become the largest Ebola outbreak ever recorded in the DRC and the second-largest globally, after the 2014-2016 West Africa epidemic, according to the World Health Organization and the U.S. Centers for Disease Control and Prevention.

Using figures from Congolese and WHO situational reporting, the comment points to the scale of the emergency. As of Sept. 6, the DRC had recorded 6,686 confirmed cases and 3,226 confirmed deaths, according to the country’s public health institute, for a crude case-fatality ratio of 48.3%. Health care workers have also been heavily affected, with about 167 confirmed infections and 47 deaths by early September. The comment notes that 68 infected health care workers had recovered by Aug. 9, in line with earlier WHO reporting.

The focus on “compassionate care” is not just about bedside treatment. It reflects a practical problem for the outbreak response: many patients are still dying outside the formal health system. WHO’s Africa office reported that in the week of Aug. 31 to Sept. 6, about 75% of confirmed deaths occurred in the community rather than in treatment centers. That suggests many people are either not reaching care quickly enough or are avoiding Ebola facilities altogether — a major obstacle in an outbreak where delays can fuel household transmission, unsafe burials and infections among relatives and frontline staff.

That dynamic helps explain why the comment’s framing matters. In an outbreak marked by under-detection, strained treatment capacity, infection prevention and control gaps, and insecurity, the quality and accessibility of care can shape whether people seek help early or stay away.

Bundibugyo ebolavirus is a rarer Ebola species than Zaire ebolavirus, the strain behind several previous major outbreaks. That matters because most licensed vaccines and many therapeutics were developed primarily for Zaire ebolavirus, leaving uncertainty about how well they work against Bundibugyo virus. There is no licensed vaccine specifically authorized for Bundibugyo ebolavirus.

WHO said in August that evidence was insufficient to support routine use of Ervebo — a vaccine licensed for Zaire ebolavirus — against Bundibugyo virus, and recommended it only under research or protocol arrangements. By Sept. 6, WHO said about 2,007 people had been vaccinated under those arrangements. A therapeutic study known as the PARTNERS trial began enrolling patients on July 2 and had recruited more than 300 confirmed patients by early September, according to WHO.

The DRC declared the outbreak on May 15, and WHO declared it a Public Health Emergency of International Concern on May 17. By Sept. 6, the outbreak had spread to six provinces, with Ituri as the epicenter and accounting for most cases. There have also been outbreak-linked cases outside the DRC: Uganda reported 20 confirmed cases before later declaring its outbreak over, and France reported one imported case.

WHO’s consolidated figures published Sept. 7 were slightly higher than the DRC’s Sept. 6 totals, reflecting different reporting cutoffs and data reconciliation rather than a contradiction. But both sets of reporting show the same picture: a rapidly expanding outbreak that is putting exceptional pressure on treatment systems and health workers.

The Lancet piece does not present new original data. Its warning is about what the existing numbers imply. If large numbers of patients are still dying at home or in the community, then supportive care is not only a medical issue but an operational one that affects trust, case finding and transmission. As WHO said in a Sept. 7 outbreak update, “Rapid recognition of cases, testing and optimized supportive care can reduce mortality, and improve community perceptions and acceptance of health care within the response.”