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Marburg virus is notorious for its killing ability. In past outbreaks, as many as 9 out of 10 patients have died from the disease. And there are no approved vaccines or medications.

That was the grim situation in Rwanda just over a month ago, when officials made the announcement that nobody wants to make: The country was in the midst of its first Marburg outbreak. 

Now those same Rwandan officials have better news to share. Remarkably better.

“We are at a case fatality rate of 22.7% — probably among the lowest ever recorded [for a Marburg outbreak],” said Dr. Yvan Butera, the Rwandan Minister of State for Health at a press conference hosted by Africa Centers for Disease Control and Prevention on Thursday.

There’s more heartening news: Two of the Marburg patients, who experienced multiple organ failure and were put on life support, have now been extubated — had their breathing tubes successfully removed — and have recovered from the virus.

“We believe this is the first time patients with Marburg virus have been extubated in Africa,” says Tedros Adhanom Ghebreyesus, director general of the World Health Organization. “These patients would have died in previous outbreaks.”

The number of new cases in Rwanda has also dwindled dramatically, from several a day to just 4 reported in the last two weeks, bringing the total for this outbreak to 66 Marburg patients and 15 deaths.

“It’s not yet time to declare victory, but we think we are headed in a good direction,” says Butera. Public health experts are already using words like “remarkable,” “unprecedented” and “very, very encouraging” to characterize the response.

How did Rwanda — an African country of some 14 million — achieve this success? And what can other countries learn from Rwanda’s response?

Doing the basics really well

Rwanda is known for the horrific 1994 genocide — one of the worst in modern times. Since then, the country has charted a different path. In 20 years, life expectancy increased by 20 years from 47.5 years old in 2000 to 67.5 years old in 2021 — about double the gains seen across the continent. And Rwanda has spent decades building up a robust health-care system.

“The health infrastructure, the health-care providers in Rwanda — they’re really, really great,” says Dr. Craig Spencer, an emergency physician and professor at Brown University School of Public Health. Spencer specializes in global health issues and has been following the Rwandan outbreak closely.

There are well-run hospitals and well-trained nurses and doctors, he says. There are laboratories that can quickly do diagnostic testing. There is personal protective equipment for medical workers.

For this outbreak, there was the know-how and infrastructure to set up a separate Marburg treatment facility. That’s been a boon for other patients and medical staff, preventing exposure to the virus — which crosses over from bats to humans and can be transmitted through bodily fluids like blood, sweat and diarrhea.

And even though there aren’t approved medications to treat Marburg, patients in Rwanda have received good supportive care for all their symptoms — like the IV fluids critical for symptoms like high fevers, nausea, vomiting and diarrhea.

This stands in stark contrast to the response in past Marburg scenarios. For example, the Democratic Republic of Congo — next door to Rwanda — had an outbreak between 1998 and 2000. Dr. Daniel Bausch, now a professor at the London School of Hygiene and Tropical Medicine and an expert in tropical diseases like Marburg, provided care in that outbreak. He says what the country’s health centers were able to offer patients was rudimentary at best.

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