Fight or Flight — Facing the Marburg Outbreak in Rwanda

This firsthand account documents the clinical and ethical decision-making of a critical care physician during Rwanda’s first Marburg virus disease (MVD) outbreak in September–October 2024. The narrative recounts the diagnostic challenges in two young patients with unexplained fevers, seizures, respiratory failure, and mucosal bleeding, ultimately attributed to Marburg virus. Despite intense pressure from families to evacuate the patients abroad, the physician insisted on containment and local care, reflecting training in high-consequence infectious diseases and the national risks of premature transfer. After confirmation of MVD, Rwanda initiated rapid containment, case isolation, contact tracing, and experimental therapeutics including remdesivir, monoclonal antibodies, and a Marburg vaccine. The outbreak claimed lives of multiple health workers, including ICU staff. The piece emphasizes leadership, preparedness, and clinical courage under uncertainty, detailing both emotional burden and system-wide response innovations that helped arrest viral transmission.

This firsthand account documents the clinical and ethical decision-making of a critical care physician during Rwanda’s first Marburg virus disease (MVD) outbreak in September–October 2024. The narrative recounts the diagnostic challenges in two young patients with unexplained fevers, seizures, respiratory failure, and mucosal bleeding, ultimately attributed to Marburg virus. Despite intense pressure from families to evacuate the patients abroad, the physician insisted on containment and local care, reflecting training in high-consequence infectious diseases and the national risks of premature transfer. After confirmation of MVD, Rwanda initiated rapid containment, case isolation, contact tracing, and experimental therapeutics including remdesivir, monoclonal antibodies, and a Marburg vaccine. The outbreak claimed lives of multiple health workers, including ICU staff. The piece emphasizes leadership, preparedness, and clinical courage under uncertainty, detailing both emotional burden and system-wide response innovations that helped arrest viral transmission.