What's the mystery illness sweeping through DRC, baffling health experts?

As most of the global focus remains on conflicts in the Middle East, a mysterious epidemic-like disease has killed dozens of people in a remote part of the Democratic Republic of Congo, putting health experts on the edge as the world still reels under the impact of the coronavirus pandemic.

The World Health Organization (WHO) says that at least 31 people, most of the children, have died in DRC’s Kwango province since the illness was first detected in late October.

Hundreds of more cases have been reported, with patients coming in with fever, cough and fatigue, symptoms that can be associated with a host of diseases such as Malaria and Chikungunya.

“The cause isn't known, the symptoms are vague, and the high numbers of people affected in such a short span of time plus fatalities are concerning as they don't fit the expected pattern of usual diseases endemic in that area,” says Andrew Lee, the professor of public health at the University of Sheffield.

“It could be one of a number of diseases. Hence why, it is challenging to come to a definitive answer rapidly,” he tells TRT World.

The first case of the unidentified disease was identified on October 24 in the southwestern province of Kwango’s district of Panzi.

Panzi is located 700 km from DRC’s capital of Kinshasa. The distance, two days by road, has worsened due to the rains and limited connectivity. This has made it difficult for health officials to collect samples for testing.

While WHO has put the death toll at 31, DRC health officials say that between 67 and 143 people might have died.

"It is currently too soon to speculate what illness has caused the deaths. The people who have died appeared to have suffered from malnutrition as well," Willem van Schaik, professor of microbiology and infection, at the University of Birmingham, told TRT World.

"Malnutrition importantly weakens the immune system and there can thus be a range of infections that have contributed to the deaths of these individuals in the DRC.

Health experts, such as Professor Paul Hunter of the University of East Anglia, say such deadly outbreaks occur several times a year in different parts of the world and are almost all linked to known infections with little concern for global spread.

On Sunday, the WHO sent a team of experts to support health authorities in the Congo to find the cause of this undiagnosed disease. Laboratory tests are being conducted to determine the cause.

“Our priority is to provide effective support to the affected families and communities. All efforts are underway to identify the cause of the illness, understand its modes of transmission and ensure appropriate response as swiftly as possible,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

The disease has spread to seven of Kwango’s 30 health zones, with three zones accounting for the most reported cases. WHO says investigations are underway to determine the cause, including respiratory pathogens like COVID-19 or influenza and other illnesses such as malaria and measles.

Many pathogens are zoonotic (e.g. influenzavirus, mpox virus) and it cannot be ruled out that this is one of those viruses or another zoonotic pathogen, Schaik said.

"I believe it is important to emphasise that there is no evidence so far that this is a ‘novel’ pathogen that has jumped from animals to humans."

Lack of well-equipped labs is a major issue in DRC and other low-income countries, delaying the process of identifying the pathogen and adding to the confusion.

The Africa Centres for Disease Control and Prevention, a regional health body, has made matters worse by labelling the unknown illness as disease X.

“Calling this incident a ‘disease X’ outbreak at this point is simply wrong and counterproductive,” says Jake Dunning, a senior researcher at the Pandemic Sciences Institute.

According to Reuters, civil society leader Cephorien Manzanza described the situation as “extremely worrying,” highlighting the continued rise in infections and fatalities.

Local epidemiologists say women and children were the most seriously affected by the disease.

A region beset with health issues

Over the years, the DRC has struggled with public health crises like Ebola and Mpox. This latest health emergency underscores the ongoing struggles of a nation with fragile infrastructure and a high disease burden.

“It is important to remember this is an area with food insecurity, and there is a lot of malnourishment, so diseases may present differently and have a worse outcome,” says Krutika Kuppalli, an infectious diseases expert at the O’Donnell School of Public Health at the University of Texas Southwestern Medical Centre.

Experts warn that the region’s vulnerabilities—malnourishment, limited food supplies, and poor healthcare access—could exacerbate the outbreak’s impact.

The teams in Kikwit and Kinshasa, two of the biggest cities in DRC, are working hard to identify the pathogen, she tells TRT World.

The lack of facilities is adding to the anxiety around the mysterious disease.

Specialised labs with the kits and equipment for gene sequencing are essential to identify such diseases, says Lee of the University of Sheffield.

“So if a country or region lacks this it adds time delays to confirming the identity of the new pathogen,” he says.

“It takes time to gather the information and samples, and to transport them to labs and to process them. This is not unusual but reflects the health system and infrastructural limitations in these settings that hamper and slow disease control responses.”

Health officials will likely try to confirm or rule out diseases such as malaria and dengue fever, which have been endemic to the region.

Despite the economic and social fallout of the COVID-19 pandemic, one would have thought that maybe the world is better prepared to deal with a health emergency caused by a deadly pathogen.

“You would have thought so, but health funding is finite, and ministries of health worldwide have many priorities to take into consideration. Some work is underway to strengthen global processes, but we're not there yet,” says Lee.