By Giulia Paravicini, Clement Bonnerot and Fiston Mahamba
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.
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 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 investigators seeking to map the spread of Ebola, with Makundi's the earliest suspected case, according to the report. The disease, it said, might have smoldered undetected in Mongbwalu for months.
Congo's health ministry said on June 9 that at least 40 people were confirmed to have died of Ebola in Mongbwalu. Aid workers warned the official figures may be incomplete due to limited testing.
RUMORS OF COFFIN SET ABLAZE SOW CHAOS
As tragedy rippled through the community, frightened residents searched for answers. Some turned not to clinics or laboratories, but to the events surrounding Pastor Makundi's burial.
As prayers ended and families drifted away from the cemetery in the warm evening, word spread that the damaged coffin had been set ablaze.
None of the six relatives and locals interviewed said they witnessed the fire, though all reported seeing the coffin's burnt remains. Pastor Makundi's father and uncle blamed a group of intoxicated youths but had no further details. The whole family was left stunned and struggling to understand what had happened, they added.
Among residents, the burned coffin was viewed as an affront to ancestors, community leader Katuwene said.
The unease had deepened after the burial of Tsongo Kenda Kenda, Makundi's younger brother, when local police intervened during a dispute between relatives over the opening of the coffin, according to the May 16 situation report at the provincial authority.
Katuwene said family members had argued over where the pre-burial wake should be held and that a relative removed the coffin lid in protest before putting it back on. Such meddling is viewed by many as disrespectful to the dead, Katuwene added.
For some residents, neighborhood chief administrator Joseph Payi Mute said, the subsequent deaths were interpreted not as the work of a virus but a punishment from ancestors angered by what had occurred around the two brothers' burials.
Jeremy Rayan Tamelegu, who was working as a mining-geology consultant in the same neighborhood as the pastor's family, said the unexplained surge in sickness and death fed into the curse narrative. He saw people in the neighborhood suddenly become ill and die within days.
Soon the story took on a life of its own on social media across Mongbwalu and the surrounding area. Gallows humor prevailed among the nervous population, even prompting a local music group to record a song about the rumors.
One lyric: "We hear a coffin is wandering Mongbwalu, leaving devastation in its wake."
The tune helped ignite a TikTok craze across eastern Congo, with users posting videos of coffins appearing to move by themselves along dirt roads or float above terrified residents.
'THEY VANDALIZED MY SON'S COFFIN AND BLAMED ME'
By the time provincial health investigators from the patient-zero inquiry arrived in Mongbwalu in early May, curse rumors spread and some residents had grown hostile towards health workers and officials, one investigator said.
The mistrust has turned violent, much as in previous Ebola outbreaks, when many locals have blamed the plague on modern medicine.
On May 22, an unspecified number of youths in the nearby village of Mabilindey attacked a response team gathering information about a confirmed Ebola case, according to the epidemiologist on the patient zero inquiry. A day later, assailants set fire to an isolation tent erected by aid workers at Mongbwalu General Hospital.
It's not just medics being blamed.
Pastor Makundi's father, Paka Kibali, said his family has been unjustly accused by some locals of starting the outbreak because of the events around the two burials.
"They vandalized my son's coffin and blamed me for the deaths that followed," he said in tears. "Yet I am the victim – it was my son's coffin that was desecrated."
(Reporting by Giulia Paravicini, Clement Bonnerot and Fiston Mahamba; Additional reporting by Erikas Mwisi, Benoit Nyemba and Gradel Muyisa in Bunia, Silvia Aloisi in Nairobi and Jennifer Rigby in London; Editing by Pravin Char)
