Investigating Ebola’s Patient Zero and Funeral Transmission in the DRC
By Giulia Paravicini, Clement Bonnerot and Fiston Mahamba
Tracing the Origins and Spread of the Ebola Outbreak in Eastern Congo
June 11 (Reuters) - By the time the truck pulled away from the morgue in Bunia, the morning heat hung heavily over the road to Mongbwalu.
The body of a 44-year-old Congolese pastor lay inside a wooden coffin strapped into the back of an aging Nissan SUV with the backseats pushed flat. A group of young relatives were crammed in, too, sitting atop the casket.
The drive across Ituri province takes about three hours, longer when the dirt roads are as dry and broken as they were that February day. The four-wheel-drive bucked violently, showering dust over the potholes, rocks and gullies carved into the red earth.
By the time the truck reached Mongbwalu, the coffin was cracked, after collapsing under the weight of those sitting on it.
Investigators Search for Patient Zero
These are among events being examined by investigators hunting for the "patient zero", or earliest infection, of the Ebola epidemic raging in the war-torn Democratic Republic of Congo, according to four experts on the team conducting the health ministry inquiry.
The investigators said the casket's rocky journey preceded one of the earliest suspected super-spreader events: the February 4 funeral of the man inside the coffin, Pastor Paluku Makundi Denis.
Health authorities are struggling to catch up with the mushrooming epidemic of a rare Ebola strain that kills 30% to 50% of those infected and has no vaccine or cure. The outbreak has caused about 635 confirmed infections and at least 127 deaths in eastern Congo, according to the country's health ministry. The true toll could be much higher, officials warn.
A surveillance epidemiologist on the inquiry estimated the strain, Bundibugyo, had been circulating for four to six months before Congo's official outbreak confirmation on May 15. He stressed more work is needed to determine whether Pastor Makundi, who was never tested for Ebola, was infected and to identify the outbreak's origin — a key step to understanding its scale and preventing further epidemics.
Congo's health ministry and Ituri's health authority didn't respond to comment requests. WHO chief Tedros Adhanom Ghebreyesus declined to comment on Makundi's case and said many outbreak scenarios are being investigated.
Reuters pieced together the events surrounding the pastor's funeral in the remote gold-mining town of Mongbwalu through interviews with doctors, local officials and victims' relatives and a review of hospital, burial and government records.
The Funeral Journey and Its Consequences
The broken coffin was only the beginning.
The corpse was transferred into a new casket by residents who touched the remains before community members converged for the funeral – a perilous move if Makundi had Ebola because victims' bodies are highly infectious.
Within weeks, dozens of deaths were recorded in the locale.
The original cracked coffin was meanwhile set ablaze in mysterious circumstances, helping spawn rumors that a curse caused the spreading sickness.
The Pastor's Death and a New Coffin
A Bunia hospital had diagnosed Makundi with peritonitis, a severe abdominal infection, on February 3, according to three doctors and a nurse there.
No samples were taken for Ebola testing, they said, because Congolese officials were unaware of any outbreak.
David Heymann, an infectious-disease professor at the London School of Hygiene and Tropical Medicine, said peritonitis is one manifestation of a severe Ebola infection but it was impossible to confirm the cause of Makundi's death without testing.
The broken coffin carrying the pastor arrived the afternoon of February 4 in Mongbwalu, a town of about 130,000 people, many of them transient.
Dozens of mourners had gathered at a family compound. Silence fell as the pastor's father, Pascal Kibali, known as Paka, inspected the broken box in the fading light.
Before moving to Bunia to become a clergyman, Makundi - better known as Paluku - had been a pillar of Mongbwalu's ethnic Nande community and a founder of the local charcoal cooperative, the 70-year-old Kibali said.
He recalled thinking: "My eldest son cannot be buried in such a coffin."
Relatives hurried to buy a new casket from a local coffin maker.
The body was transferred before sunset, and a wake was held at the family compound before a cemetery burial. At traditional Congolese wakes, mourners often touch and kiss the body. It remains unclear whether the tradition was followed in this case.
The Funeral and Its Deadly Aftermath
More than 80 relatives, friends and neighbors assembled at the local cemetery at dusk, according to Edmond Kambale Katuwene, the leader of the town's Nande community. A priest led prayers, urging mourners to reflect on the fragility of life and prepare for their own end, Katuwene said.
In the following days, several community members began falling ill, Mongbwalu's Mayor Sesereki Mandro Israel said. Nearly 50 deaths were recorded within two weeks of the burial, he said, with many presenting symptoms of Ebola: fever, vomiting, bleeding.
Pastor Makundi's brother Idi was among the first. The 36-year-old miner died on February 16 from suspected appendicitis, according to a May 16 situation report by the provincial health authority. Within weeks, another brother and a relative died, from suspected hemorrhoids and tuberculosis, respectively, according to the bulletin, which flagged the deaths as needing further investigation.
The relatives' deaths preceded at least 108 deaths in Mongbwalu between April and May, according to the same report by the Ituri authority, an arm of the national health ministry. Patients in family clusters collapsed with fever, vomiting, diarrhea and in some cases hemorrhaging symptoms, it said.
The deaths are among those being examined by investigato
