What is the cost of treating Covid-19 daily

Private hospitals in Kampala are charging anywhere between Shs3.5 million and Shs10 million per day for treating a critically-ill Covid-19 patient, according to a mini-survey by this newspaper.

Such billing for a week dwarfs the Shs22 million that Information minister Judith Nabakooba last week said the government spends on a coronavirus patient at a public hospital for the whole duration of treatment, upwards of a fortnight.  

Our inquiries show that at least two of the private hospitals in the city take between Shs5 million and Shs10 million in deposit before admitting a patient in either High Dependency Unit (HDU) or Intensive Care Unit (ICU).

These charges in a country where the percapita income is $777 (Shs2.7million) means that the cost of treating a critically-ill Covid-19 patient is beyond the affordability of most households.
For some, it has meant substantial borrowing while relatives of some of the patients said they have had to sell family and personal assets to raise money to meet hospital bills.

A man, who lost a relative to the pandemic, told Daily Monitor on Monday, that they shifted another Covid-19 positive from Mulago hospital, where she received free care, to a private hospital for better management.

“The patient was on wall oxygen at Mulago hospital, but started complaining that she was not getting enough oxygen,” the relative said, asking not to be named for fear of victimisation.
We could not independently verify this claim.

However, in an investigative story published on November 29, this newspaper unearthed gross mismanagement of care and treatment of Covid-19 patients at Mulago hospital, with some starved of oxygen due to plant or piping malfunction.

Mulago hospital management, however, disputed the allegations.
The relative of the latest patient, who moved away from Mulago hospital, on Monday, said they are overwhelmed by the Shs100 million, but are still rising bills at the private facility.  

“We have been borrowing from all corners … [and to] meet this huge bill will require us to sell some family assets,” the relative added.
The treatment for Covid-19 patients at public hospitals is supposed to be free but patients may be asked to buy medication required that are out of stock, Health ministry spokesperson Emmanuel Ainebyoona said yesterday. 
 He, however, declined to comment on what a patient should do if charged at a public health facility for Covid-19 treatment.

Dr Richard Lukandwa, a consultant physician and acting medical director at Medipal International Hospital in Kampala, said the cost of care is driven by a patient’s need for oxygen and treatment for comorbidities that are aggravated by the viral disease.

The treatment of a Covid-19 patient at the Medipal ICU costs Shs4.3 million per day. This covers attachment to the machine, PPEs, suction, physiotherapy, enteric feed and drugs. It does not, however, cover oxygen, Covid-19 drugs and investigations, according to Dr Lukandwa.

At Medipal, a Coronavirus patient with mild symptoms is charged Shs1 million per day for admission in to the general ward. This cost includes meals, care from doctors and PPE, but excludes drugs and investigations.

Dr Lukandwa said a patient admitted in the general ward could potentially spend an additional Shs600,000 per day if they suddenly require oxygen or other more expensive medicine.

The daily bill for a patient in ICU at Medipal Hospital can vary between Shs5 million and Shs7 million, Dr Lukandwa said, depending on the drugs administered and condition of the patient. He, however, said a patient with a kidney problem requiring dialysis is likely to pay an extra Shs1 million.

Mujahed Mustafa of the University of Bahri and others in a 2020 study points out that the most serious causes of failure of the liver and kidneys in Covid-19 patients is due to cytokine storm, an immune reaction that causes multiple inflammations and other abnormalities in the organs.

In the Monday interview, Dr Lukandwa said: “For our first (Covid-19) ICU patient, we charged Shs5 million per day, but on that day they [used] 19 cylinders of oxygen. We then added the cost of PPE and realised that the cost of care before you add any profit was more than Shs5m. So, we changed into a different package where we removed consumables such as oxygen.”

A source at Case Hospital, another private health facility, told Daily Monitor that the daily cost of treating a critical and mild Covid-19 patient is Shs3 million to Shs5 million and Shs1.5 million, respectively.

In a separate interview, Dr Charles Olaro, the director of clinical services (curative) in the Health ministry, said the cost drivers of treatment are oxygen demand, medication and specialised cadre of health professionals required to handle individual Covid-19 patients.

A single ICU and HDU bed are to have six and one round-the-clock nurses, respectively, he said.

This is in addition to support staff such as cleaners.
Other charges at public health facilities that the government meets include Shs80,000 and Shs15,000 daily risk and refreshment allowances.

“By the time the workers go in for four hours [to work in the units], they will have to put on disposal cover all which costs about $25 (about Shs90,700) per person per day,” Dr Olaro said.

He said the health workers will need to wear N95 which costs Shs20,000 and Shs25,000.

“Then those who have (blood) clotting problems will need to have a dose of anticoagulant which is at Shs50,000 per dose,” he added.
Ms Grace Ssali Kiwanuka, the executive director of Uganda Healthcare Federation (UHF), the umbrella body for private healthcare providers, described the billing for ICU services for Covid-19 patients as  “aggressive”.

“The market prices [of inputs for handling and treating Covid-19 patients] are hiked. You need a dedicated team that is not seeing other patients, you need extra full PPE all day, plus other infection prevention and control measures,” she said.

Cost of managing Covid-19 at home
Dr Dennis Kilama, the vice chancellor of African Renewal University, who recently recovered from Covid-19, said he had to buy temperature and oxygen monitors at Shs250,000.
He also used drugs like azithromycin, zinc and vitamin C tablets which are recommended for Covid-19 management.
In one of the pharmacies in Kampala, a full dose of azithromycin is sold at Shs6,000, zinc at Shs4,000 and vitamin C at Shs1,000.
In addition, one can make and take a cocktail drink of garlic, lemon, honey.
 

The cost

N95 mask costs Shs20,000 to Shs25,000.
Drugs for ICU
·         Remdesivir: Shs300,000 to Shs1 million per dosage depending on the brand.
·       Anticoagulant for blood clotting problem: Shs50,000 per dose.
For non-severe
·         Vitamin C: Shs3,000 full dose for adults for 5 days. 
·         Azithromycin: Shs14,000 full dose for adults for five days.
·         Zinc: A strip is Shs3,000 full dose for adults for five days.
·         Hydroxychloroquine: Shs14,000 full dose for adults for 5 days.
Oxygen 
·   70kgs cylinder: costs Shs1,035,000million, has 6,800 liters of oxygen. Refilling is Shs35,000. This can last 22 hours at a flow rate of 5 litres per minute. 
·   35kgs cylinder: costs more than Shs1 million, has round 4,100 litres. Refilling is Shs25,000. This can last around 13 hours. 
·  18kgs cylinder: costs Shs1, 020,000, has 1,360 litres. Refilling is Shs20, 000. This can last around four and a half hours.
Oxygen concentrator
·   Shs3.8 million for the one that produces 5 litres of 100 per cent oxygen per hour.
·   Shs4million for the one that produces 10 litres of 100 per cent oxygen per hour.