Unconfirmed suspects awaiting laboratory results occupied between 55% and 64% of every Ebola isolation bed in DR Congo through the week to 27 July, Africa CDC found1. Most of the country's isolation capacity is therefore holding people whose infection status nobody yet knows.
Isolation exists because Ebola spreads through contact with the sick, so anyone presenting with fever, vomiting or bleeding in an affected health zone has to be separated until a polymerase chain reaction test returns a verdict. Where samples move quickly, the ward turns over: negatives go home in a day or two, positives move into treatment. Where samples queue for transport to a distant laboratory, both groups stay put. WHO granted the first Bundibugyo-specific diagnostic an Emergency Use Listing on 2 July, which fixed the question of whether a validated test existed. It did not fix the distance between a health post in Ituri and the machine that runs the assay.
A confirmed patient turned away from a full ward is a patient WHO goes home infectious, and the person occupying the bed they needed may well test negative the following morning. Every hour of laboratory delay converts directly into isolation capacity that treats nobody, which is why decentralised testing, the two mobile laboratories placed at the border among them, buys more ward space than any comparable amount of construction.
