Rwanda: Is a Lockdown Possible? Eight Key Questions About the Marburg Virus Answered

As Rwanda continues to strengthen measures to tame the Marburg Virus Disease (MVD) outbreak, several questions about the deadly Viral Haemorrhagic Fever (VHF) remain on the minds of many -considering that it is a relatively new disease.

Some are linking it to the Covid-19 pandemic, while others are already anticipating a lockdown as it happened during the previous pandemic.

The Ministry of Health has reiterated the importance of the general public remaining vigilant, and following the preventive measures put in place by the government, and partners to prevent more infections and possible death.

A highly feared disease, which has a fatality rate of above 88 per cent, and being relatively new to many Rwandans – Marburg virus is one that is most likely to take a major toll on the psychological wellbeing of people, with many grappling with excessive information and at the same time unanswered questions.

ALSO READ: Rwanda confirms Marburg outbreak, steps up preventive measures

With an outbreak of such a fatal epidemic, it becomes easy for people to go into panic mode, but as the Minister of Health has emphasised, life must continue normally, with preventive measures in place.

Similarly, the Ministry of Education on Wednesday, October 02, issued safety guidelines for schools to follow, complementing those already put in place by the Ministry of Health, as the country continues to combat a possible spread of the disease.

As of October 02, 36 cases had been confirmed, with seven new cases reported the highest since the outbreak, and one more death – bringing the number of deaths to 11.

ALSO READ: Marburg virus:11 fatalities reported as seven new cases are confirmed

Dr. Sabin Nsanzimana, Minister of Health, has ruled out the possibility of a lockdown – pointing out that it is too early to speak of one, answering those who are wondering if the country will be thrown into another lockdown as it was with the Covid-19 pandemic.

“Every day we are tracking numbers. We are tracing the contacts to see where the problem is, and we are learning a lot every single day and that is reassuring in a way because we don’t see indications of taking extra measures or measures that will lock people’s activities,” Dr. Nsanzimana said on Rwanda Television (RTV), adding that such a move would have even more impact on people’s lives and health than the epidemic itself.

Nsanzimana explained that a lockdown is the worst-case scenario, and would only happen if there is a community transmission, for example, when there are cases everywhere and you don’t know where they are coming from, which means that you’ve lost track of contacts, which is phase 4; the last phase of an outbreak control, and it is not the case in Rwanda.

“We are still at Phase One. By the time we get to Phase Two, and I hope we’re not, we will be able to see how we evolve,” he noted, adding, however, that at this point there is no cause for concern that a lockdown can be enforced.

Below are some of the frequently asked questions about the Marburg virus, according to the World Health Organisation (WHO), and the African Centre for Disease Control (Africa CDC), which are working closely with the Government of Rwanda, to deal with the Marburg outbreak.

How long does it take to develop symptoms of Marburg virus disease?

The interval from infection to onset of symptoms varies from 2 to 21 days. Some patients will experience bleeding between 5 and 7 days, and fatal cases usually have some form of bleeding, often from multiple areas. Blood in vomit and/or faeces is often accompanied by bleeding from the nose, gums, and vagina.

According to the Africa CDC, transmission does not occur during the incubation period which is normally between 2 to 9 days. At the same time transmission of the virus from person to person requires extremely close contact with a patient.

High virus concentration is found in body fluids including faeces, vomitus, urine, saliva, and respiratory secretions. It is more contagious when these fluids contain blood. Transmission via infected semen can occur up to seven weeks after clinical recovery.

Death can occur rapidly among Marburg victims, and is usually caused by viral sepsis, multi-organ failure and bleeding.

How do you protect yourself and others from Marburg when it is suspected to be in your community?

As the Ministry of Health has emphasised, the best way to prevent MVD is to avoid contact with infected individuals or animals, and to practice good hygiene and follow other preventive measures recommended by the government and stakeholders like WHO.

It is advised that if you live in or are travelling to an area where MVD has been reported, even if you do not have symptoms and you are not a contact, follow all recommended national and local preventive measures such as, including seeking care if you have MVD symptoms, washing your hands regularly with soap or with alcohol-based hand sanitizers.

ALSO READ: Preventive measures rolled out in public spaces in wake of Marburg outbreak

By all means, avoid contact with body fluids of people with MVD symptoms and the body of someone who died with symptoms of MVD. When entering buildings or crossing borders, stop at official check points and adhere to any preventive measures in place. Among other things, agree to have your temperature screened.

It is advised that people complete health declaration forms when available at public entry points, especially in hospitals, markets, churches, sports places, public offices, banks, airports, seaports and land borders, among other places.

What do you do if you have been in contact with someone with MVD?

If you have been in contact with someone who has fallen ill with MVD or if you experience similar symptoms, you may be at risk of developing the disease yourself, especially if you have been in close contact with a patient, whether sick or deceased.

For instance, if you have lived or stayed in the same household or room with a Marburg patient or if you were admitted to a health facility where there was a MVD patient, you are required to report immediately.

Similarly, if you have shared objects or touched the same surfaces that may have been contaminated by body fluids of an MVD patient, such as surfaces in the gym, shops, doors and more, chances of being infected are very high.

If you have been identified as a contact of someone with MVD symptoms, you will be monitored by health authorities for 21 days after exposure.

Health authorities will come to visit you at least twice a day to check on your health.

Once you are identified as a contact, you are obliged to accept visits by Ministry of Health or Rwanda Biomedical Centre (RBC) representatives twice a day to monitor your health.

Comply and provide them with accurate information, answering all questions as accurately as you can, to get suitable help. You can also avoid travelling unless travel has been approved by your authorities. You are also required to report any symptoms immediately to your local health authority.

WHO says that if you have no symptoms 21 days after exposure, your health will no longer be monitored. If symptoms develop while being monitored by the health authorities, you will be advised to take a laboratory test.

The test results will guide the health professional on whether you should immediately be admitted to a treatment centre or not for care.

Can Marburg virus disease be treated?

There is currently no available treatment for MVD. This is why it is important for people showing Marburg-like symptoms to seek care early.

Supportive care, including providing adequate hydration, pain management and treatment of symptoms as they arise under professional care remains the safest and most effective way to manage MVD.

Treatment of co-infection such as malaria is also crucial for supportive care against MVD. Some candidate treatments have been prioritised by WHO for evaluation under randomised clinical trials.

Are treatment centres safe for patients?

The Ministry of Health, together with partners like WHO, ensure that treatment centres are safe, equipped with appropriate materials and managed by skilled and trained professionals who can provide safe and adequate care to all patients with respect to their dignity and humanity.

Once at a hospital or treatment centre, health professionals and support personnel will provide you with whatever help is needed for your recovery.

This includes room, toilets, safe water, medicines, food, and any assistance on how to manage contact with your loved ones. Seeking care early when you are sick will improve your chance of survival and limit the transmission of the disease to your loved ones.

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What you should know about someone recovering from Marburg virus disease?

When people recover from MVD, they need to be welcomed back into the community. To maintain the health and safety of survivors, they will need regular medical checks and care for possible remaining adverse effects such as eye problems and muscular pain.

Marburg survivors need love, inclusion and re-integration so that they do not feel excluded from the community.

A man recovering from MVD is advised to observe safe sex practices, including consistent use of condoms, until semen has been tested twice as negative for MVD, while breastfeeding women suffering from Marburg are advised to refrain from breastfeeding their babies, and, in that case, health authorities will support them with adequate milk replacement.

After recovering, nursing mums are required to comply with testing to know when they can resume breastfeeding safely. If pregnant at the time of MVD infection and have recovered with a viable pregnancy, seek and accept dedicated supportive care until after the baby is born.

Is there a vaccine that protects against Marburg virus disease?

There are no vaccines approved for MVD. However, there are some candidate vaccines currently under development. WHO identifies Marburg as a top priority disease for which a vaccine is urgently needed. Several evaluations have been made by the WHO Technical Advisory Group based on research done, but there is no vaccine as of now.

What should you know about animals and animal products during a Marburg virus disease outbreak?

During MVD outbreaks, all animal products, particularly blood and meat, should be safely managed, cleaned and cooked before consumption. It is important to correctly wash your hands before and after touching animals and related products.

During field activities, work, research activities or tourist visits in mines, forests or caves inhabited by fruit bats, it is advised to wear long clothing, gloves and other appropriate protective coverings.

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