An Ebola treatment unit in Butembo, Democratic Republic of the Congo, is operating at maximum capacity as clinicians confront a rapidly moving outbreak. Dr. Rupa Narra, a U.S. pediatrician working for Doctors Without Borders, reports that all 30 beds in the facility are full, driven by a rapidity that never was the case.
Outbreak Scale and Pediatric Toll
The current epidemic in the Democratic Republic of the Congo has recorded at least 6,800 confirmed cases and more than 3,310 deaths since May, placing it on track to be the worst on record. Children have accounted for 1 in 4 confirmed cases and represent 1 in 3 overall deaths. Dr. Narra noted that her unit recently lost eight patients, all under the age of 5. For newborns, the virus is almost always fatal.
Clinical Realities of the Bundibugyo Strain
The outbreak is driven by the Bundibugyo strain of ebolavirus, which has no approved antiviral medication or vaccine. Without these medical options, approximately 30% of adults who are diagnosed with the virus die within two weeks, while the death rate is even higher for children, whose immune systems are less developed. Clinicians in Butembo provide supportive care, administering IV fluids, oxygen, blood transfusions, and treatments for fever, hypothermia, and secondary infections.
Due to the difficulty and risks of working in protective gear, medical staff are limited to about an hour at a time. The clinic is divided evenly with 15 beds for sick patients who are waiting on test results—as symptoms can often begin similar to malaria—and 15 beds for confirmed Ebola patients. Surging patient volumes have forced staff to utilize quarantine beds for confirmed cases as well.
Response Challenges and Patient Care
The absence of an approved vaccine complicates staffing within pediatric wards, as finding someone already immune to the virus, from a prior infection, who can watch over the smallest patients is hard. Dr. Narra recounted the case of a newborn whose mother died shortly after childbirth in the unit. Lacking exposed family members, an Ebola survivor stepped forward to care for the infant continuously until the child succumbed to the virus after 10 days.
Dr. Narra brings prior crisis experience from the 2014 West Africa Ebola outbreak, work as a pediatrician in an emergency department in Brooklyn when COVID-19 hit the United States, and work for Doctors Without Borders in Haiti. Despite this background, she stated, “I’ve never seen anything like this,” referring to the speed of transmission.
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