We are ready for coronavirus - health experts in Uganda

How prepared is Uganda to respond to the coronavirus threat? What do we have and what don’t we have and what is needed?

Dr Richard Idro (president of Uganda Medical Association): We are examining methods and so far, we have done very well in preventing this disease from coming to Uganda. But in case it reaches Uganda, we are looking at our trial systems. When a person presents with a problem, do we increase the numbers? We are assessing these regional hospitals and few other selected hospitals which may be near border points. We have 19 regional referral hospitals and few other border point hospitals which are going to be our entry points for developing capacities. We are developing a trial system, referral system and high dependency system and I hope by the end of the week, we would have a clear picture of what we need in terms of numbers so that appropriate people are trained.

What is the level of preparation among the private hospitals in the country?

Dr Denis Kimalyo (chairperson of Uganda Association of Private Hospitals): For now, we have decided to adopt the Ministry of Health guidelines in as far as preventing coronavirus is concerned. As private hospitals, there is a big constraint on issues of resources both human and financial to prepare for coronavirus.

How will you handle this when you lack the basic facilities?

If the ministry establishes a centre that will handle it, we shall refer the patients there if they come to our facilities. We have been in touch with the ministry to ensure diagnostic services are provided to us because you cannot know where the virus can attack from. It may be detected at the private facilities. Right now, the ministry has not provided anything. However, they have committed to train our staff and to provide testing kits and help us with other services like evacuation of patients.

How sufficient is oxygen supply in the country?
We have always had reliable and enough supply of oxygen. Many private entities are supplying and of recent, government also started a supply chain and they are willing to supply private hospitals as well.

How many Intensive Care Unit beds do we have in the country?

Dr Allan Muruta (Commissioner for Epidemiology and Surveillance at the Ministry of Health): We have about six in Entebbe, 69 at Mulago National Specialised Hospital together with Mulago Women Specialised Hospital. We are getting equipment for regional referrals and each regional referral will get like ten, so about over 100.
For every 100 sick people of coronavirus you can only have five per cent who need critical care. That means we shall get those capacities when we have roughly about 2,000 cases and this we don’t hope to get that scenario. When we get there it will be a different game, but we are elastic. We have the funds to procure more equipment and the facilities are there where we can put the equipment. If the worst comes to the worst we shall go to district hospitals, so we are elastic we can create more ICUs provided the equipment is there.

Dr Richard Idro: We know how many ICU beds are in the country. We have been having 55 functional ICU beds in the country, but there are a number of others that have not been working. There is that one in Jinja, in Lira and then the new Mulago hospital and three have just been placed at Entebbe. In a short period, many of these that have not been working will be activated.

Emmanuel Ainebyoona (senior public relations officer at Ministry of Health): We have slightly above 90 ICU beds; Mulago has 27 state of the art ICU beds for adults and 15 for children. The Women’s hospital has 35 ICU beds. Jinja Hospital has six ICU beds, Uganda Heart Institute has about 10. Cancer has about eight ICU beds. All are functional.

ICUs at Mulago Specialised Hospital have everything that a patient needs, including a temporary lung and heart machine. The ICU sections are ready to receive any patient but not every patient will need an ICU bed.
What about the oxygen plants, are they enough?
Regional referral hospitals have enough oxygen plants. Oxygen is got from air, you filter the air, remove other gases and leave oxygen.
How many doctors are in Uganda?

Dr Ekwaro Obuku (former chairperson of Uganda Medical Association): “We have about 7,000 doctors now [and] about 3,000 to 4,000 doctors practise in Uganda.
We have doctors who have been trained already and we as the medical association are going to train more. We also have to train nurses and clinical officers because doctors don’t work alone. As you know, for this COVID-19, there is no cure.
Uganda exported over 20 doctors to West Africa to be team leaders to manage the Ebola epidemic. We have doctors who have been trained already and we as the medical association are going to train at least 50 experts in this business
Dr Allan Muruta (Commissioner for Epidemiology and Surveillance at the Ministry of Health): Government is recruiting doctors on contract to contain the pandemic in case it hits Uganda.
We have what we call surge capacity and we have listed a number of health workers for recruitment on short term contracts; more than 200 to help us and it is not only doctors, but also epidemiologists, communicators. It is a cross section of health workers.

When and how can one get tested?

Dr Julius Lutwama (deputy director of Uganda Virus Research Institute (UVRI)): The tests are free of charge to those who have met criteria for being tested.
If anyone feels they have symptoms of the disease, they should go to nearby health facilities. At the facility, the doctor will assess you. If the symptoms are matching that of coronavirus, the patient information will be sent to the coronavirus Incidence Commander at the Ministry of Health, who will respond by sending field epidemiologists.
The patient will then be quarantined and samples will be taken and brought to UVRI.

What samples are required?

Dr Julius Lutwama (deputy director of Uganda Virus Research Institute (UVRI)): The type of sample taken depends on the state of the patient. The sample taken can be mouth or nose swabs as coronavirus is a respiratory disease. A blood sample may also be taken. The epidemiologists will deliver the samples to UVRI and in three hours, the results will be out. The machine is efficient, it can do up to 700 tests at ago.
A swab is an adsorbent material such as cotton, used to pick specimens from body parts for laboratory or other medical examination.
How many test kits do we have in the country?
Dr Julius Lutwama (deputy director of Uganda Virus Research Institute (UVRI)): The machine for testing coronavirus is only one in the country. It is a very expensive machine that costs around $30,000 (Shs111m).
We have enough kits for 500 reactions and government is procuring more kits.

How will insurance work?

Hellen Mbabazi, (Internal Air Ambulance (IAA) spokesperson): We only meet costs entailed in the emergencies and then advise our 200 service providers across the country to refer suspects to government gazetted facilities.
There are government protocols already in place. What we have agreed on as an insurance company is that we manage emergencies.
Our first step is to manage someone out of danger and we get in touch with the hospital covering the person and we clear that bill.
We have asked our service providers across the country to provide basics like containing one’s temperature and also provide pain killers to contain acute pain.
In case someone loses breath and needs oxygen or a breathalyser to get them out of danger, we have asked hospitals to provide them.
What do we have at the border points to ensure people who are infected do not sneak into the country using our porous borders?

Dr Diana Atwine (permanent secretary at the Ministry of Health): The porous borders remain a challenge in the fight to keep the virus out as people continue to enter the country without any screening. If we get to know, the people who crossed will be screened. If they come stealthily, some people will be missed definitely. I cannot say we can man all borders. This is a well-known challenge for our country. We are aware of the other points where people enter the country.
At the moment, we wanted to consolidate where we are able but in some places, you find these are relatives who are staying together and they just cross over and there is no clear demarcation. You just encourage people to follow the regulations and pass in designated places. It is not possible to cover all places where people are passing.

However, there are screening points at the designated border points in Kabale, Kisoro, Kanungu, Kasese, Mpondwe, Nimule, Malaba, Gula, Busia, and Arua.
The ministry is also engaging districts to be more vigilant since they are on the ground and ensure that they encourage as many people not to cross.
Allan Muruta (Commissioner for Epidemiology and Surveillance): We are working with security agencies to direct people to go through the designated entry points.