For months, Kenya built its wall against one of the world’s deadliest viral diseases: hundreds of thousands of travelers screened, nearly 5,000 health workers trained for the day Ebola might arrive. Then Ebola arrived — not over a bush path in the night but through the front door, on a scheduled flight into the capital and past every guard posted there, CNN reports.
The man had been ill for weeks when he left the eastern Democratic Republic of Congo, where he had lived for seven years. On October 2 he traveled by road through Beni, in North Kivu province, to Kampala, Uganda’s capital; the next day he flew to Nairobi, passing airport health screening in both countries without being flagged. In about two days he moved through three countries. What screening, if any, he underwent at the DRC-Uganda land border, authorities have not said.
A relative and a friend drove him straight from the airport to the Nairobi Hospital, a private facility in the Kenyan capital. By his arrival on October 3 he had a fever, chills, severe fatigue, muscle pain and bleeding beneath his skin, according to Kenya’s Ministry of Health. Doctors isolated him, and tests confirmed Bundibugyo virus, a form of Ebola. He died days later, on Monday — Kenya’s first Ebola death — and health officials have been working to identify anyone who may have been exposed.
The Largest Outbreak Congo Has Known
The outbreak he traveled out of is now the largest ever recorded in the DRC. As of Wednesday, the World Health Organization had counted 8,728 confirmed cases and 4,205 deaths, across seven provinces — a toll officials fear may still be underreported. Transmission remains intense, the WHO says, and it assesses the risk to countries sharing land borders with the DRC as high.
The DRC is not alone. Uganda recorded 20 cases before its health ministry declared the country Ebola-free on July 28; France recorded a travel-related case with no further spread. Kenya is now the fourth country to confirm Bundibugyo virus.
When in the journey he became ill with Ebola at all remains unknown. The WHO says it is unclear when his symptoms developed; his month-long illness suggests he was probably sick with something else at first and possibly contracted the virus later, perhaps while seeking care. Uganda had already restricted non-essential travel across its border with the DRC after most of its cases proved to have been imported from there.
A Goalpost Net for a Mosquito
Uganda’s health ministry says the man spent fewer than 24 hours in the country and had a normal temperature when screened before departing Entebbe International Airport; it says it is now intensifying cross-border surveillance and information sharing. In Nairobi, the health ministry says he underwent “normal public health screening” at Jomo Kenyatta International Airport and was not flagged as a suspected case. The Kenya Airports Authority notes that Port Health Services, part of the Ministry of Health, handles passenger screening. CNN has asked authorities in both countries what checks he actually faced, and whether his recent travel from the DRC should have prompted further assessment.
The deeper weakness lies off the highways. The International Organization for Migration told CNN that movement between Ebola-affected parts of eastern DRC and neighboring countries remains high — people crossing for work, trade and family — and not all of it passes through official posts. Some use informal routes that are far harder to monitor, the IOM said, so airport and land-border screening will never catch every infected traveler, especially before symptoms appear. Countries must also watch for cases in their communities, test quickly, trace contacts and share information across borders, so an imported case is found early and contained.
Oyewale Tomori, a former WHO regional virologist for Africa, takes a cold view of the checkpoints. “Africa is an open field divided into countries by poorly manned porous borders,” he told CNN. “The Kenya case is a warning of more cases in the future.” Border screening alone, he said, is like “using a football goalpost net to catch a mosquito.”
Christian Happi, a professor of molecular biology and genomics at Redeemer’s University in Nigeria, whose laboratory helped confirm Nigeria’s first Ebola case in 2014, explains why the net has holes: a temperature check misses the infected traveler who happens not to be feverish at that hour. “If you don’t have a fever at the time you are passing the health post at the airport, how is the health care worker going to detect it?” he asked. The WHO’s guidance for the DRC calls for exit screening at airports, ports and ground crossings — at least a questionnaire about possible exposure plus a temperature check — and says suspected, probable and confirmed cases, along with contacts assessed as exposed, should not travel internationally except for medical evacuation. Happi would go further: no one should leave the DRC by air without a negative Ebola test. “Anybody without a negative Ebola test should not board a flight,” he said, arguing that countries also need the capacity to test travelers far more quickly at airports. His proposal goes beyond WHO guidance, which does not call for universal testing and advises against broader travel or trade restrictions on affected countries.
So the response cannot stop at the border; when screening misses a case, speed becomes everything. Kenyan health officials are now tracing anyone who may have been exposed and have intensified screening at Jomo Kenyatta airport. Preliminary tests on a separate 20-year-old patient who had traveled from the DRC through Uganda came back negative on Thursday, Kenyan authorities said. There is no licensed vaccine or approved specific treatment for this form of Ebola, though possible vaccines and treatments are being tested. CNN has asked the WHO and the Africa Centres for Disease Control and Prevention how likely further cross-border spread is and what countries should do.
Happi points instead to Lagos, 2014: one imported case in one of Africa’s largest cities, 20 infections and eight deaths, and then the line held. Rapid detection and close coordination were what stopped it, he said — the lesson, he believes, for every country now watching the DRC. “It won’t be easy to detect everybody crossing borders,” he said. “It is how quickly countries detect and then how quickly they can contain imported cases.”