The Ebola outbreak in Congo is creating new hot spots where there's little to no support for patients, responders and officials say, as health workers admit there could still be a long way to go in fighting the disease that has killed over 4,000 people.

More than 70% of new cases are still coming from outside of known contacts and at least 60% of deaths are outside of treatment centers, Africa CDC Director-General Dr. Jean Kaseya told The Associated Press. “There are so many other people who are becoming sick, who are not tested, treated, or listed,” said Kaseya on Tuesday.

The conflict-battered, remote North Kivu province, which has emerged as the new epicenter, now accounts for around 40% of all newly confirmed cases in Congo, compared with 24% at the end of August. But the response on the ground is “chaotic,” said Stephanie Hoffmann, a project coordinator with Doctors Without Borders (MSF). “There is a lack of coordination and organization, but there’s certainly a lack of actors present here,” Hoffmann told the AP.

Congo's deadliest Ebola outbreak — caused by the Bundibugyo virus, which has no approved vaccine or treatment — was declared in May under some of the most challenging conditions imaginable fueled by mass population movements, rebel violence, mistrust and poor welfare of front line workers.

Congo has recorded more than 8,500 cases in the outbreak, according to government data, making it the fastest-growing Ebola outbreak on record and the country’s deadliest. On Tuesday, Kenya reported its first Ebola case, a man who arrived from Congo and died while receiving treatment.

The biggest challenge to date is contact tracing, Dr. Kayesa said. Only 23% of expected contacts of Ebola patients have so far been traced. The disease is spreading in a region of Congo with intense population movements due to economic activities, conflict displacement and mining, and where there’s deep mistrust with the government and misinformation about the virus.

“I’m unable to tell you when we can stop this outbreak unless we implement the village-centered approach,” the Africa CDC chief said, calling for direct involvement of villages and local leaders in contact tracing, burials of deceased patients and isolation of cases.

Many Ebola treatment centers in North Kivu are struggling with shortages of health workers and supplies, contributing to more deaths among patients, the World Health Organization has said.

North Kivu’s case fatality rate of 58% is the highest among Congo’s seven affected provinces. The disease has spread to half of its 34 health zones. In nine of those 17 affected zones, more than half of patients with confirmed infections have died, according to Health Ministry data.

Desperate for care, patients in some parts of North Kivu have turned to regular health facilities, MSF said.

“Local healthcare workers are the ones feeling this the most because they have to make the decision between sending their community members home to potentially die by themselves or putting themselves at risk to help treat them in their health center,” said Hoffmann, coordinator of MSF’s Ebola treatment center in Butembo, North Kivu.

Nearly five months after the outbreak was declared, it has become harder to track in parts of North Kivu, where residents still have “a hard time believing the disease exists,” said Michel Ngimba of the National Institute of Biomedical Research in Butembo.

He described cases in which families were reluctant to report a death or allow a sample to be taken from someone who died with Ebola symptoms. In other cases, families “want to arrange the funeral quickly,” Ngimba said, potentially creating new chains of transmission because the bodies of people who die from Ebola are highly contagious.

“The situation has become more difficult to monitor (and) surveillance has to deal with situations that are highly fluid and sometimes difficult to document,” he said.

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AP writer Sebastien Kitsa Musayi in Beni, Congo contributed.

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