Is Uganda losing war on corona?

President Museveni on Thursday evening raised the stakes on chances of another lockdown following rapidly increasing cases and deaths from Covid-19 in Kampala and across the country.

Mr Museveni, who interrupted his televised address to the ruling NRM party Central Executive Committee (CEC) at State House Entebbe last night, warned that Ugandans are joking with the deadly viral disease, were not listening, and not helping the country’s scientists keep off the virus from attacking and killing Ugandans.

The President, who sounded angry, warned: “We’ve been begging, and some of the idiots say there’s no corona; they’re telling lies.”

Mr Museveni, who said he will address the nation on the way forward on Covid-19 next week, added: “You’re now going to see real problems. From what I am hearing, now 1,750 have been infected, 1,194 healed, and 537 active cases in hospital, with 323 case in Kampala alone; with 71 of the 94 single-day infections occurring in Kampala yesterday [Thursday].”

As of yesterday, the community infections had risen from eight cases on May 6, to 887 cases of the total cumulative number of 1,750.

Also in less than 30 days, 16 deaths have been recorded between July 23 and August 19. At least 48 districts have reported cases of the coronavirus disease
President Museveni said had Ugandans listened to his and scientists’ earlier warnings, the country would’ve done things in a smarter way.

“We’ll have to take very drastic measures against the idiots [who tell lies on coronavirus disease]! We will meet in a taskforce and agree on how to deal with these people,” he warned.

The President had previously said government would make an important decision before September on whether to lift the lockdown, and, or even open schools for final year students and candidate classes, depending on how the country manages the coronavirus disease.

But with the situation continually growing uncertain, many players, including the President and his ministers, have sounded dejected lately, lamenting that Ugandans have ignored or deliberately refused to comply with guidelines and preventive measures to stop Covid-19.

Speaking separately to the media on Thursday, Health minister Jane Ruth Aceng, who equally sounded dejected, warned that there are only two options for coronavirus; coming out alive and damaged or dying.

“If you are admitted to Intensive Care Unit, you either exit the way you came or exit the other way round,” she said.
Dr Charles Olaro, the director of curative services at the Ministry of Health, said another lockdown is one of the possibilities to curb the spread but only in circumstances where the situation is out of hand.

These recent events and dark moods from the country’s leaders begs the question whether Uganda is losing the fight against Covid-19.

This grim picture contrasts sharply with the earlier days in March and April, when the nation was full of hope and the Health ministry was being hailed for brilliant tactics that curbed Covid-19 infections and prevented deaths.

The Health ministry had spearheaded critical steps that closed borders and the country’s airport. The ministry also ensured tracing and putting in quarantine, people who had entered the country from abroad where Covid-19 was highly endemic.

Although the truck drivers emerged as key propellers of the infection, measures were also quickly instituted to minimise their interaction with communities.

The public too was adhering to prevention measures, honouring the difficult curfew time and staying indoors, as prescribed by the scientists and enforced by government.

False steps, belated arrest
But now, experts say despite the early efforts, Covid-19 had already sneaked into the country and by late April, the country had started experiencing cases of local transmission as community infections rose but remained unreported due to limited testing.

As of yesterday, the community infections had climbed from eight cases on May 6 to 887 cases of the total cumulative number of 1,750.

And in less than 30 days, 16 deaths have been recorded between July 23 and August 19. At least 59 districts have registered cases, with at least 48 registering community cases.

Dr Misaki Wayengera, the head of scientists advising the government on Covid-19, told Saturday Monitor that mistakes that sparked the community infections were made right from the beginning of the response.

“In the beginning, when the globalised neighbourhood was unaffected, we were content with only screening travellers. When cases in the neighbourhood grew, we moved to close our borders,” he said.

“Little did we know that a gross misfortune would befall us, whereby a cluster of returning travellers would bypass the infra-red thermometers as asymptomatic cases, yet with risk for infection. It took one suspect picked up with a fever to test positive, for us to act,” added Dr Misaki.

The chief of scientists also said misinformation about the contagious virus was spreading and causing more people to defy prevention measures, thus driving local transmission.

“That [local transmission] was made worse, when information continued to flow in suggesting that this [Covid-19] is just like any flu illness, and that measures so far instituted were unwarranted,” he added.

Dr Misaki said it was absurd that even important institutions such as the World Bank and others went ahead to castigate African countries such as Uganda that had taken drastic measures to flatten their curves.

Covid-19 fight

The head of scientists, Dr Misaki, said the new strategy they adopted is to trace and isolate (for treatment if positive), contacts of Covid-19 patients.

“We have to move the fight to the community and have everyone actively play a role not only in keeping safe by following the stipulated infection prevention guidelines but also, be on watch out for Covid-19-like illness,” he said.

Dr Mukuzi Muhereza, the UMA secretary general, asked the government to provide adequate masks to health workers in both public and private health facilities.

“We are seeing people dying even in private facilities. I don’t want the government to concentrate only on public health facilities,” he said.

Dr Henry Kajumbula, the chairperson of Infection Prevention and Control Committee in the team of scientists advising the government on Covid-19, said they will increase the training of health workers to boost their confidence for a more effective Covid-19 response.

“We did train the health workers at the start of the pandemic but I think we need to increase the training of both the health workers in private and public health facilities,” he said.

Dr Tegegn asked Ugandans to take personal responsibility if they are to escape Covid-19 deaths.
“The population should take personal responsibility and that action will determine how many of us get sick and those who die,” he said.

“People shouldn’t just wear any mask, the mask should have three layers. If the masks have few layers, it protects you less. Keep at least two-metre distance and you have to avoid large gatherings. Hand hygiene is also very important,” he added.

Another lockdown looming?
Although the government has not come clear on whether they are planning to impose another lockdown, there have been warnings from the ministers of Health, Works and Transport and that of Kampala City, sounding alarms of another lockdown.

The ministers are citing widespread violation of Covid-19 measures and more cases of community infections being reported as sufficient grounds for another lockdown.

By close of week, reports from officials from some hospitals indicated that their medical officers have been asked by the government to get stickers for vehicles as it happened during the first lockdown.

The stickers are to allow free movement for vehicles of the essential workers during the lockdown.
None of the officials was ready to be quoted on the claims.

But Dr Tegegn, who has been central in the steps the government took, including the lockdown, told this newspaper that lockdown is not meant to hurt but protect people from death.

“The country should take risk assessment on the effect of the lockdown on basic things like survival. It [government] should strike a balance between curbing the infection and ensuring the survival goes on,” he said.

As the country anxiously awaits the presidential address on Covid-19, a statement from Dr Charles Olaro, the director of curative services at the Ministry of Health, would be informative.

Dr Olaro on Saturday said another lockdown is one of the possibilities to curb the spread, but only in circumstances where the situation is out of hand.

Are we losing the fight?

Dr Yonas Tegegn, the World Health Organisation (WHO) Uganda representative, who has been at the centre of designing Covid-19 response strategies, told this newspaper that the plan developed by scientists to curb the pandemic has not failed.

Dr Tegegn said whereas it is impossible to stop community infections for a contagious virus like Covid-19, the country still has a high capacity to prevent extreme scenarios.

“The Covid-19 response strategy has not failed, we can’t guarantee 100 per cent prevention of the [Covid-19] infection in the country, but it is a matter of containing it,” he said.

“You can prevent Covid-19 by blocking all the borders but can you live without importing basic things like food? The whole agenda of lockdown is not something that can last forever, it is meant to allow the country chance to build capacity to respond better,” he added.

Dr Tegegn said Uganda still has the capacity to manage its cases and prevent infections.
“We need to put strategies to manage the increase but not to stop the increase, it is impossible to stop it. The facilities have to increase their capacity to handle cases or prevent infections. That is what we call success in the response strategy,” he added.

But Dr Misaki Wayengera, the head of scientists advising the government on Covid-19, said the strategy developed to curb the infection was to keep out imported cases as long as possible, and that it has worked well.
He said the strategy was destined to be replaced depending on changing environment where it is being applied.

Circumstances of Covid-19 deaths
Dr Bruce Kirenga, the head of Makerere University Lung Institute, said most people who died were diagnosed after a very late stage of their illnesses or after they had died.

Of the 16 deaths the country has registered, the youngest was 27 years old and the oldest 80 years old, according to data from the Ministry of Health.

Cases within the age bracket of 46 to 65 years dominated with nine deaths. The age bracket of 66 years and above contributed four deaths and the youth, 25 to 35 years, registered three deaths.
“More Covid-19 deaths tend to occur among adults due to reduced immunity and higher chances of other underlying health complications,” Dr Kirenga said.

The risk factors for Covid-19 deaths include having conditions such as diabetes and hypertension, which is more prevalent among adults.

Sex factor
The males contributed 11 of the 16 deaths, while five women have died of Covid-19.
Dr Kirenga said there are more men (around 85 per cent) than women being admitted with severe Covid-19 disease.
Available scientific information indicate that men have a higher chance of contracting Covid-19 because they are more outgoing and this makes more men admitted to hospitals than women, and so the deaths rate will be higher among them.

Location of Covid-19 deaths
Kampala Metropolitan area contributed 12 of the 16 deaths.
Prof Freddie Ssengooba, a public health expert from Makerere University, said Covid-19 deaths occur more in urban areas due to overcrowding that increases exposure and infections.

More infections also mean several people will develop severe disease thus more deaths.

“The concept behind the deaths is the gathering. Covid-19 likes concentrated places and gatherings such as churches, prisons, where people are watching football matches, and other places where people are crowded,” he said.
“Cities have more people, more interactions and more chances of infection because one person can spread the infection to more people,” he added.

Prof Ssengooba projected that if the deaths are to happen, most of it will still be registered within Kampala and similar big urban areas.

The other districts, where deaths have been reported, include Kiryandongo and Hoima in western Uganda, contributing one death each. Namisindwa and Mbale in Eastern Uganda also contributed one death each.

Facilities where deaths occurred
Up to 12 of the 16 patients who died first sought care from private health facilities. It was from there that they passed away or they died at government hospitals where they were referred.

Three other patients, who passed on, first sought care from public health hospitals. But where the patient from Kiryandongo District, who passed on August 15, sought care were not specified by the ministry.

Some patients died on the road while on referral for better care. The 46-year-old female who was resident of Kibuli [in Kampala] “died on her way to Mulago [National Referral Hospital]”, according to the Health ministry.

“She presented on August 1 at Kibuli Muslim Hospital with signs of Covid-19. Upon suspecting, the hospital referred her to Mulago National Referral Hospital for further management the same day. Unfortunately, she died on her way to Mulago,” reads the Health ministry report.

Problem with quality of care?
Dr Kirenga, who also involved in Covid-19 case management at Mulago National Referral Hospital, said the quality of care being given is optimum.

“The problem is that most people are presenting at a very late stage of the disease. People should be close to the health workers if they have symptoms of Covid-19,” he said.

“We are doing studies to find out the type of people or which symptoms are predictive among Covid-19 patients that they may develop severe disease so that health workers can give such patients more attention,” he said.

Dr Kirenga also said the frontline team in case management are developing a superior treatment regimen that the ongoing trial has shown it very effective in rescuing patients in intensive care units (ICUs).
Some patients have also died in the ICUs while admitted.

The ministry on August 12, reported the death of a 55-year-old male who passed on while admitted at the ICU at Mulago.

More health workers infected
Dr Richard Idro, the Uganda Medical Association (UMA) president, said more health workers are testing positive for the contagious virus.

“Thirty nine health workers have been infected [so far]. In addition to the earlier 27 health workers [who were infected], the new ones have been from Namisindwa District, and Kampala Metropolitan Area,” he said.
The UMA president said although a wide range of health workers are being affected, private hospitals are contributing most of the cases.

“Infections are from workplaces, including private hospitals, which had not been included in the Ministry of Health’s earlier programmes [of training health workers on infection prevention and control]. Most of the health workers in these units were ill-prepared to suspect cases of Covid-19 presenting to them,” he said.

Ms Grace Ssali Kiwanuka, the executive director of the Uganda Healthcare Federation, which is the umbrella body for private health facilities, said although the government trained some of their health workers on infection prevention and control, it was for a very short time and very few health workers were trained.

The available statistics show that more than 50 per cent of Ugandans seek medical care from private health facilities. A number of Covid-19 deaths in the country were of patients who were seeking care at private facilities.