Covid-19: No cure yet, follow guidelines

You head the Uganda Virus Research Institute (UVRI), which does the testing for Covid-19. What is the situation in the country?
I think for now, Africa has not yet had many cases compared to Europe and Middle East. The source was China of course, and the interventions maybe started late.But in Africa, the confirmed cases are mostly connected to travels from either Asia or Europe. The cases are beginning to rise in Africa, especially in South Africa.

The only worry is that unlike other viruses, the coronavirus is easily transmissible. There were other viruses that we saw in the early 2000s but this is more transmissible. The good thing is that the mortality rate is low, except among those who are elderly or very sick. Everyone is working to see that we don’t reach the epidemic level as it was in China and currently in Europe.
We haven’t seen many cases here in Uganda but that doesn’t rule out the fact that there could be those that are positive but have not yet been tested.

There has been a debate among scientist and epidemiologists, what is the best approach to follow, do we intervene aggressively at the start or do you follow the epidemic and intervene accordingly? I am on the side of telling people not to get too scared, but follow the guidelines as we have been directed by the government.

How prepared are we to handle this disease that has put the world on hold?
The good thing is that we have had epidemics before in Uganda; cholera, Marburg, Crimean Congo, Ebola, yellow fever and all that, and the Ministry of Health, together with other partners, have set up emergency operating centres to track these epidemics and that has helped our preparation.

But also quite important is our role as UVRI; we have been in these emerging infections, viral haemorrhagic fever infections, other viruses and so on, so our laboratories have the equipment and the trained staff to handle this coronavirus.

The government has also taken it seriously because it is very important to take this from the top leadership. But in spite of all this, there are gaps that need to be fixed. For instance, at the airport, there has been screening even before this outbreak but there are reported gaps in terms of equipment, following the right procedure and personnel.

There are gaps even in referrals and the isolation centres, how you follow them up and ensure that there are no leakages.

These are things we had not prepared for and the government is trying to fill these gaps. Although Uganda has succeeded in other outbreaks, this Covid-19, like in many countries, caught us a little bit unawares.
But it took over a month after the outbreak for Uganda to register her first case...
In that one month, we prepared the population and told them to wash hands, keep a distance and all that. But what many, including the President, have said could have been done earlier is restrictions on people coming into the country. But it is a hard decision to make so quickly.
But there were debates of people arguing, why close now when we don’t have a case? So there are quite many difficult decisions to make. So in some ways we prepared but not 100 per cent.

How different is Covid-19 from all the other outbreaks?
There are many things that are different. All those outbreaks kill, but they are more localised. They have been mostly in African states and transmitted through contact with body fluids of those infected and all that. The way Covid-19 is being transmitted, it does not see country borders, it does not see class, you just move and touch somewhere and you get it.
The presidents, kings are all potential victims, such people will not get Ebola. It has no boundaries because of travel and easily transmissible but most importantly, it is new. The mortality could increase because many people do not know how to handle it and it has affected economies of many countries.

Why does coronavirus affect older people more severely?
It has a big effect on those whose immune system is compromised, and it is true the elderly are in this category. But it also has a huge effect on those who have other illnesses even if they are younger, so it is about how your immune system responds.

Some say Covid-19 is flu in an advanced form?
There is a common cold which we mostly get caused by other viruses including other human coronaviruses, and then flu caused by influenza virus. Sometimes there is confusion when we talk about flu.

The common cold we get many people recover from it. For flu caused by influenza, again old people and young children suffer more but the good thing we have vaccines, though not commonly used here in Uganda.

For Covid-19, we are seeing the death rate going to 15 per cent in Spain, 10 per cent in Italy and this is higher than the four and three per cent that we had experienced before in China. I think Covid-19 will become just like any other flu or common cold with time.

Is Covid-19 a natural virus or manmade?
From the literature that we are reading, it is a natural virus that has crossed from other species.
A related virus is found in bats and then also found in the pangolin. The people who know evolution of viruses that when you look at the way this virus is made or its genetic composition, it could be from these other species into the human being. There is no proof that these viruses could have been manmade.

When do you think the ban on public gatherings and transport should end?
I hope that we can have more scientists, epidemiologists and people who understand modelling who can come out and explain to us these interventions we are now implementing and how they will affect the pandemic.

We will need to have very good systems of identifying new cases very quickly, isolate them and treat them so that the spread does not continue.
This means we have to increase our efficiency in terms of testing and isolating those infected because if there are weakness there then we shall have a very big challenge.
You spoke about herd immunity and the healing process, could you take us through this process.
Yes. There are a few scientists who think we could have left the virus to spread among healthy young people like you but protect the elderly people and those who are vulnerable, and allow more people in the community get exposed and get the immunity to fight the disease naturally.

If you get the population of about 70 per cent who are immune, the spread of the disease will be very low because majority of people will be protected naturally, then there will be little transmission, that even those with no immunity will be protected. What we are doing right now, hiding from the virus may not be sustainable unless if we get a vaccine or a cure eventually.

How did it go wrong for countries like Italy? What can Uganda learn?
I have heard that Italy got many people coming in from other countries which had the infection who they should have denied entrance. They then went to different places in Italy spreading the infection. People are learning from those mistakes, and here we have closed all the borders and the airport, which is what Italy would have done.

We have heard of remedies such as taking lemon in warm water. What else can help improve chances of preventing or fighting coronavirus?
Lemon and vitamins are not antiviral. We were taught in primary school to have a balanced diet, get vitamins which is good for our body and immunity. These help to boost your immunity. But we need to protect ourselves. This is not a vaccine or a prophylaxis.

Sometimes we over blow nutrition and people get confused. There has been a period when selling supplements has become fashionable and a real market, and their benefit exaggerated.

So what should be done?
It is what they are telling you. Wash your hands, isolate yourself and keep the social distance. Avoid touching mucosal surfaces which may lead to more infections.

What about the treatment of Covid-19?
At the moment there is no cure but there is a lot of research that is going on to find a solution including this one of chloroquine, lopinavir which is used for HIV, and there is another drug called Remdesivir which was used for Ebola but the initial studies have indicated that they may not be effective.
The trials are still ongoing but I think after (US President Donald) Trump saw some of these studies showing some positivity, he jumped to conclude. But there is a lot of research still ongoing and the Food and Drug Administration has not yet confirmed their benefit, until the trials are over.
Virology studies have shown even before Covid-19 that chloroquine can block virus replication on coronaviruses and other viruses. It has an effect on the change in the PH from acidity to alkaline and preventing its release into the cell.