A mysterious disease in the Democratic Republic of Congo (DRC) has infected over 400 people and killed dozens in the past couple of weeks. According to some reports, the real number is much higher. The disease has symptoms like fever, headache, and body aches, somewhat similar to severe flu, but appears to be a different disease. The disease seems to be more severe for children under 5, but a 50-year-old man from Italy was hospitalized after being exposed to the disease.

It’s another “Disease X.”

How it started

Disease X is a placeholder name. It’s what the World Health Organization uses to denote priority diseases that represent an unknown pathogen that may start a future epidemic.

It all started on October 24, when the first patient fell ill with an unidentified sickness in the Kwango province in the DRC. Soon enough, others started following. The first recorded fatality happened on November 10, and only after that, central authorities were notified.

The WHO reported 406 cases from October 24 – December 5, the vast majority being children.

“The clinical presentation of patients includes symptoms such as fever (96.5%), cough (87.9%), fatigue (60.9%) and a running nose (57.8%),” according to the WHO.

“The area experienced deterioration in food insecurity in recent months, has low vaccination coverage and very limited access to diagnostics and quality case management,” the organization added.

Another important clue is that severe cases were malnourished, but this doesn’t shed light on what the disease actually is.

For now, it’s not 100% clear that this is even a new disease. Acute pneumonia, COVID-19, measles, and malaria could be contributing to this disease. At this stage, it’s not clear whether it’s one disease contributing to this or multiple. And given the logistics of the DRC it will be difficult to determine and trace the source.

Why is it so difficult to get at the bottom of this?

The outbreak of the disease seems to be in Panzi, in the Kwango province. This province is more than 400 miles from the capital Kinshasa.

There are no laboratories in the province that can adequately test and diagnose samples — such testing infrastructure needs to be transported by road. However, it can take 48 hours to drive from Kinshasa to Kwango. Kwango itself has several scattered communities, and it’s hard to assess if and how the cases are related. This was also part of why it took so long for national authorities to be alerted.

The challenges of accessibility have hampered efforts to assess the risk properly. For now, this is something should be monitored closely, but there's no reason for panic. In fact, "situations like this occur probably several times a year around the world," says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who has been tracking the DRC outbreak.

But many questions still loom.

"Is it an infectious disease? Is it a non-infectious disease? If we talk about infectious diseases, is this a viral infection? Is it a bacterial infection? Is it a fungal infection? Is it a parasitic infection? There are so many things we don't know," says Dr. Jean Kaseya, director general of Africa CDC. "We want to know very quickly, what is this disease? The world is wondering," Kaseya added.

We shouldn't let our guard down

The emergence of Disease X serves as a stark reminder of the unpredictability of infectious threats. While threats appear constantly and they often don't cause any large-scale problems, we've seen in the COVID-19 pandemic just how costly a lack of inaction can be.

To accelerate the investigation, Africa CDC has deployed a team of experts, including epidemiologists, laboratory scientists, and infection prevention specialists. This team is working alongside national and international partners, such as the WHO, to enhance diagnostic testing and implement effective control measures.

The organization has supplied advanced molecular diagnostic tools, automated liquid handlers, and bioinformatics servers to speed up pathogen identification. These new resources are designed to enhance the country’s ability to detect and respond to outbreaks swiftly. Although doctors in the region have become well-versed in working with limited resources, we need to support them more if we want to reduce the risk of another pandemic emerging.

The epicenter in the Panzi Health Zone also underscores the urgent need for decentralized laboratory infrastructure. This doesn't only concern the Democratic Republic of Congo or Africa — diseases have no borders and can affect everyone.