Whisper it quietly, but the Marburg Virus Disease (MVD) outbreak in Rwanda, may be nearing its end, thanks to a much praised response, that included a number of firsts in the treatment of the disease. Any sense of complacency however, would undermine the extraordinary work done to contain the virus, and should be avoided like the proverbial plague, or indeed a virus.
In a weekly press conference, this week held jointly, as the Rwanda’s Minister of Health, Dr Sabin Nsanzimana, was joined by World Health Organisation (WHO) Director-General, Dr Tedros Adhom Ghebreyesus, who is on a visit to Rwanda, the words, good news, best practice, cropped up a number of times, an unmistakable hint of light at the end of a tunnel.
The fifteen people lost to the virus, most of them healthworkers, is fifteen too many, but it is nevertheless, to date, the lowest number of deaths in any Marburg outbreak.
The number of confirmed cases remain at 62, with no new infections, three people are still in isolation undergoing treatment, close to 5,000 tested, and fourty-two have recovered. That number of the recovered is expected to rise by at least two.
Two patients, who were on intubation have now been extubated, and confidence about their recovery is high. When as expected they are added to the number of those who have recovered, it will be another first. Never before on the African continent, will an intubated MVD patient have gone on to be extubated, and treated to recovery.
That this is possible, has been entirely due to the speed and nature of the medical intervention, from the moment the virus was identified, to now, three weeks down the line, when optimism that the end of the outbreak is in sight, can be fully justified by the figures. The epidemilogical weekly trend of confirmed cases, show the virus having decreased by 92%. This is a dramatic rate of decrease that owes to the effectiveness of the response.
While the scientific community has learnt a lot about MVD, much remains to be understood, in particular, the treatment of those who are infected. Rwanda’s response will almost certainly add to this understanding. From the start of the outbreak, when healthcare workers had yet to identify what was killing their colleagues, a time that with characteristic medical understatement, Dr Nsanzimana, described as “very difficult first days,” much has been learned.
Speed and teamwork, have been of the utmost importance. Speed in medical intervention, speed in tracing, and testing people who may have come into contact with infected persons, speed in understanding what treatments were most effective. As might be expected, Dr Nsanzimana is full of praise for the healthcare workers, who put their lives on the line to treat others.
He also stressed the importance of teamwork and organisation. From his first press conference, announcing the outbreak of the virus, the minister also expressed gratitude to global partners, who have supported and continue to support Rwanda. This he said, was the answer to the question of how Rwanda has managed to keep an unusually low fatality rate.
At 24%, the fatality rate is the lowest ever, in a Marburg outbreak. This, in spite of the fact that an outbreak in a city, created particularly difficult challenges, for the response teams.
“I would really want to pause here to thank all heathworkers, especially the teams that worked in treatment centres to have managed to keep this case fatality rate, at a very low level, twenty-four per cent, the answer to this, is teamwork.”
Different efforts contributed to this low rate, he said, ranging from providing anti-virals, different therapeutics, some of which are still under trial…supportive treatments, critical care, including intensive care units (ICU) specialists, among others, have made the low fatality rate possible.
A particular reason for celebration, he noted, was the two patients who were extubated.
“We got great news…Yesterday, I was with Dr Tedros [Tedros Adhanom Ghebreyesus], visiting the treatment centre, seeing that the two patients, who had been on intubation for more than ten days, have been extubated. It’s the best news you can expect in any hospital, when someone has been on intubation for a long time…it was great celebration that these two people are also going to get out of this virus and go back to work…”
“I would also like to acknowledge other tools we’ve acquired, including vaccination, which came very quickly…rapid access and deployment of this vaccine, that is one of the factors for rapid containment of the virus…we’ve reached more than a thousand people receiving this vaccination, and we thank all our partners, who have contributed to this effort…”
Foremost among the partners who have been part of Rwanda’s effort in containing the MVD outbreak, has been WHO. The organisation’s director-general was both reassured and reassuring, after seeing the response for himself, meeting not only the healthcare workers and leadership, but the leadership of the nation, including President Kagame.
He and his team, he said, were impressed with the level of critical care for patients, which has not been used before in Africa, to treat a viral haemorrhagic fever.
“Two of the patients we met had experienced all of the symptoms of Marburg, including multiple organ failure…they were put on life support, they were successfully intubated and extubated and are now recovering. We believe, this is the first time patients with Marburg virus, have been extubated in Africa. Tese patients would have died in previous outbreaks.”
“This reflects the work Rwanda has done over many years, to strengthen its health system, to develop capacities for critical care and life support, that can be deployed both in regular hospital care and in emergencies. And I have heard this not only from local doctors, but also from nationals, who are serving in the treatment centre, and other facilities in Rwanda. They are very happy with the level of standard in Rwanda.”
While there are still no approved vaccines and therapeutics for MVD, he congratulated Rwanda, on the speed with which trials of vaccines and therapeutics were initiated. The trials he hoped will now help to generate the data to support approval of the vaccines and therapeutics, that have proved so effective in Rwanda.
Dr Ghebreyesus echoed not only Dr Nsanzimana, but also the Director-General of CDC Africa, Dr Jean Kaseya, in their observation of the teamwork, beyond the medical, which has contributed to the containment of the virus.
“Yesterday, we also visited the National Command Centre, and we were impressed with the way technology is being used, to provide real time information for action, and enhance operational efficiency. Borrowing the words of President Kagame, I saw ‘smart Rwanda’ in action…”
The Director-General underscored the importance of leadership in combating epidemics.
“I also had the opportunity to meet with his Excellency, President Kagame, and it’s clear that he’s closely engaged in the response to the virus outbreak. Leadership from the highest levels of government is essential in any outbreak response. And that’s what we see here, in Rwanda.”
The oft asked question of how and where the outbreak started, is now also known, within a small margin of error. After exhaustive research, including sequensing, epidemiological diagnostic research, clinical information, it was determined that the virus had a zoonotic origin, from bats, to a twenty-seven-year old male, who contracted the virus in a cave. He was treated at one of the major hospitals.
With all the uplifting news, however, as he had done at every weekly press conference, Dr Nsanzimana, emphasized that the work continues, and the country was not yet out of the woods. Efforts to contain the virus within Rwanda continue, with vigilance at the Kigali internation airport, remaining high, to ensure that both arrivals and departures, are free of the virus.
And anyone feeling the symptoms of the disease, high fever, severe headaches, vomitting, is urged to call 114, and seek immediate medical help, as is anyone who may have come in contact with an infected person.
