Is Africa prepared for Covid-19 pandemic?

Dear Tingasiga;
Many virus infections have found great partnership with commercial air travel. A sneeze and a sniffle (what President Yoweri Museveni calls “sneezing in”) in China are quickly felt in far off lands.
Since the first reported case of Covid-19 on our continent in early February 2020, the number of identified cases, which has already exceeded 1,000, continues to climb quickly. Uganda reported her first case on March 21.

Is Africa prepared for tackling the Covid-19 pandemic? The long Editorial of the April 1, 2020 issue of the International Journal of Infectious Diseases asks this very question.

After reviewing the lessons from past outbreaks and ongoing pan-African public health efforts, the distinguished panel of authors answer the question in the affirmative.

“Africa is better prepared than ever before,” they write. “Substantial progress has been made since the 2014–16 Ebola outbreak, with lessons learned from previous and ongoing outbreaks, followed by significant investments into surveillance and preparedness.”

“Thus, African countries have been on heightened alert to detect and isolate any imported cases of Covid-19. There has been rapid response to the Covid-19 epidemic from Africa’s public health systems, well before any cases of Covid-19 had been reported from Africa.”

The combined efforts of the WHO, the African Union Commission and the Africa Centre for Disease Control, have already expedited the diagnostic capacities of African countries in a very short period. At the beginning of February, only two African countries had the capacity to diagnose Covid-19. Today, more than 40 countries do so.

Watching the reassuring confidence and professionalism displayed by Dr Jane Ruth Aceng, Uganda’s Minister of Health and by Dr Joyce Moriku Kaducu, the Minister of State for Primary Healthcare, one quickly recognised that the country’s response to Covid-19 was in the hands of competent and well-prepared leaders. I salute those two ladies.

President Museveni has shown good leadership in this fight. Like his ministers of Health, he has been very open and forthright in reporting about the situation in the country. The team has taken decisive actions that will positively enhance Uganda’s chances of containing this potentially deadly virus, though they will undoubtedly have a negative impact on the economy.
It is a small price to pay. The Ugandan leaders’ bold response has been in contrast to the lies that were told by the Chinese and the Iranians, and the denials, obfuscations and unbelievably ignorant claims by the American president and his fawning media supporters.

Whereas Donald Trump, who initially declared the pandemic to be a hoax by the Democrats and the fake news media, is still busy injecting misinformed claims about a disease he clearly knows little about, the Ugandan ruler has been very open about it and has reassuringly deferred to his team of professionals.

To watch President Museveni respectfully addressing his questions and comments to the professionals who are in charge of the fight against this virus was very energising.

Clearly, more needs to be done. Ideally, Uganda should simply be “shut down,” including banning all public transportation and closing the large markets. However, this is easier said than done.

Such measures, already in place in some parts of the world, are easily implemented in high-income countries, the majority of whose citizens have the personal and national financial cushions to see them through a period away from income-generating work.

In Canada, for example, millions of people are continuing to do their regular jobs from home.
Medical doctors are “seeing” patients using well-developed internet communication systems, complete with the patients’ electronic medical records and the ability to write prescriptions and electronically forward them to pharmacies.

On the other hand, the Ugandan leaders must grapple with the reality that millions of citizens, most of them young and struggling to survive, depend on jobs like riding boda bodas, washing cars, hawking goods on the streets or selling fresh produce in order to put food on their tables.

To ban such endeavours without compensation could trigger an explosive response from the affected workers.

At a minimum, individuals might turn to illegal methods of tapping into the wealth of the economically advantaged. The security and social consequences of such outcomes must be very carefully weighed against the risks that go with continuing with business-as-usual.
Furthermore, how does forcing people from the markets and the main streets and buildings of the central business districts help, when all they do is return to their overcrowded slums with limited water supplies? These are some of the questions that need open dialogue and engagement of all stakeholders in the hope of finding tailor-made solutions for Uganda.

Given that the majority of Uganda’s citizens are in the very young age group that appears to suffer a milder form of the disease, one has reason to hope that we shall not see a very high need for intensive care in our hospitals.

However, there are enough people with high risk factors – the senior citizens and those with pre-existing diseases – to force our attention to the state of our critical care services.

This is one area where Uganda, like most African countries, falls very short. An excellent study by Drs Patience Atumanya, Cornelius Sendagire, Peter K Agaba and their colleagues, published in the February 2020 issue of the Journal of Critical Care, found that out of Uganda’s 14 intensive care units (ICU), 12 were functional. The other two (in Jinja and Lira, respectively) were dormant because of lack of the human resource.
Of the 12 functional ICUs, 10 (83 per cent) were in Kampala. The two functional ones outside Kampala were in Mburara and Gulu, respectively. The total number of ICU beds in Uganda, a country of 45 million people, was only 55, with the large bulk of them in Kampala. Half of these beds were in expensive private hospitals.

Major weaknesses in these ICUs include suboptimal patient care because of resource constraints, including lack of trained nurses and functioning equipment. Of the 171 nurses in these ICUs, only 13 (7.6 percent) have had training in critical care.

This serious shortage of adequate functional ICU beds should focus our minds on our priorities.
We must make a choice between luxury motor vehicles and our health care. Do we need extravagant celebrations of various things and a very expensive government, or a better health care system that meets the personal needs of the president and the peasant? Covid-19 ought to bring us back down to Earth.

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