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Rwanda’s fragile health care system could become overwhelmed by the deadly Marburg virus, doctors fear, because most of those currently infected are medical professionals, and some have already died.
Since the first outbreak in the country last month, at least 30 medical workers have been infected, and at least four have died. Among the infected are two of the country’s scarce anesthesiologists. More medical staff members are isolated in hospital wards in the capital, Kigali. The health care system, with approximately 1,500 doctors and fewer than 40 anesthesiologists for a nation of just over 13 million people, could face significant strain.
Rwanda’s health minister, Dr. Sabin Nsanzimana, has said the country is seeking experimental vaccines and treatments, and hopes to address the outbreak with candidate drugs and shots — those in preclinical or clinical trial phases.
“We are determined to halt this outbreak before it spreads to other areas within the country, the region or beyond,” he told reporters on Thursday.
The outbreak that began in late September was the East African country’s first known encounter with the virus, which has a high death rate. As of Friday, the Health Ministry had reported 42 cases and 13 deaths, with 80 percent of the infected identified as health care professionals. Those numbers are rising daily.
Marburg, first identified in Africa in the 1970s, is related to Ebola. Outbreaks can be started by contact with Egyptian fruit bats or their caves. Once infected, people can spread the virus to others through contact with bodily fluids such as blood or sweat.
Marburg has caused small, episodic outbreaks since first being identified, most recently last year in Tanzania and Ghana. It is one of the deadliest known viruses, with no approved vaccines or specific treatments.
In Rwanda, one health care provider at the University Teaching Hospital of Kigali described via audio and text messages how he had learned he was infected. He spoke from quarantine in a hospital ward and under the condition of anonymity because staff members were prohibited from talking to the news media.
“It started on Monday with just a minor headache and some kind of weakness,” he said. “I told my colleagues I felt sick, but they thought I was just tired.”
The situation quickly worsened. After it became clear that one of the first people in Rwanda to become infected and die had sought treatment at the hospital, the entire intensive-care staff was screened.
The health care worker had gone home, thinking he might have some form of malaria, and tried to manage his symptoms with paracetamol, a painkiller. “But by that night, the headache became severe and the fever got worse,” he said. “I realized it was very serious.”
The next day, Oct. 1, he was taken into isolation, and by Wednesday, his test confirmed he had the Marburg virus.
Concerns about global spread heightened last month, when a medical student in Germany fell ill after working in Rwanda and having contact with an infected patient. Neither the student nor the person he was traveling with later proved to be infected.
The outbreak in Rwanda is believed to have started, according to the Africa Centers for Disease Control and Prevention, when a man in his early 40s infected several of his relatives. At least one of them later died. The man is believed to have transmitted the virus to a doctor at the country’s biggest health care center, King Faisal Hospital, during treatment.
The virus spread within the hospital, which now has the highest number of infected staff members, officials said. Details remain murky.
“Since we realized we have an outbreak of the virus, the ball started rolling in terms of trying to understand the source,” said Dr. John Baptist Nkuranga, the president of the Rwanda Medical Association.
Malaria, which is prevalent in Rwanda, and the Marburg disease share similar initial symptoms, like fever and body aches. While both can be fatal, Marburg’s later stages are characterized by severe internal bleeding, unlike malaria.
“Initially, patients were admitted and treated as severe and complicated malaria, until seven days ago, when the first case was confirmed,” Dr. Jean Kaseya, the director of the Africa C.D.C., said of the outbreak at King Faisal Hospital.
Dr. Kaseya said that because the outbreak was first detected in the hospital, the majority of those with the virus are health care workers.
A document from the Africa C.D.C. reviewed by The New York Times said that as of Thursday, 19 health care professionals at King Faisal Hospital had been infected by Marburg, with three confirmed deaths.
But according to a health care worker who works there and also spoke on the condition of anonymity because he was not authorized to speak about the outbreak to the news media, the number of infected staff members has since risen, with two anesthesiologists newly confirmed as infected. The worker also confirmed the deaths of three colleagues from the virus.
A spokesman for King Faisal Hospital declined to comment on Friday.
At the University Teaching Hospital of Kigali, a smaller group of medical professionals is infected by the Marburg virus. The health care provider who became infected said he had been given Remdesivir, an antiviral medication used in the treatment of infections like Covid-19. He said that one of his colleagues had died from the Marburg virus earlier in the week, but he remained hopeful for his own recovery.
“I’m getting better,” he said. “They are really taking care of us. For the first time now, since last night, I haven’t experienced fever. So far, everything is going well.”
Scientists say that they have seen an increase in Marburg cases in recent years.
“People are coming into closer contact with wildlife everywhere in the world,” said Dr. Amira A. Roess, a professor of global health and epidemiology at George Mason University. “Wildlife is adapting to contact with humans. It is worrisome.”
The lack of vaccines and treatments for Marburg poses significant challenges, yet outbreaks present opportunities for testing solutions. Potential Marburg vaccines are undergoing early-stage human trials, but they have not yet been approved, nor are they available for widespread use.
“There are plans for the vaccine trial to launch within days, in line with the national protocol and expert advice,” Dr. Kaseya said.
Stephanie Nolen contributed reporting.
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