Why govt abandoned contact tracing, quarantine centres

When Uganda registered her first Covid-19 case in March last year, one of the key interventions undertaken by the government was to trace, test and isolate the people who had been in contact with a probable or a positive case.

Government also put in place mandatory institutional quarantine for persons entering the country and confirmed cases, all in a bid to stop the spread of the virus.

Sources indicate this went on until around August 2020. 

The interventions, along with other stringent measures, including a total lockdown, earned the country global recognition in combating the spread of infection. 

In the period between March and June 2020, the country registered only 870 cases and no deaths. The first death would occur in July.

With the easing of the first lockdown, however, many Ugandans abandoned preventive measures, just as government phased out quarantine centres, focusing on selling of adherence to standard operating procedures (SOPs), and the elusive hope for wide scale vaccination. 

Scientists warned that due to complacency, a resurgence would devastate the country.  
But even with the announcement of a second wave in early May, government did not pick up on contact tracing and quarantine.

Travellers from countries cited as high risk were only required to present a negative PCR result conducted in 120 hours.  Days later, the country confirmed more aggressive variants like the one from India. 

As of April 30, more than a year after the index case, cumulative cases stood at 41,973 with 33 hospital admissions and 342 deaths. These have since doubled in less than two months, with total cases reaching 75,537 as of June 22. More than 400 people have succumbed to the virus in the past two months, while 997 are admitted in the now overstretched hospitals. Many more patients are under home management.   

Although contact tracing and institutional quarantine played a role in slowing the pandemic, experts say the approaches are unfeasible at this stage of the pandemic. 

Lt Col Henry Kyobe, the Covid-19 Incident commander, says the interventions in the fight against pandemics are informed by different factors, including the phase of the pandemic.

“In different phases, we do different things. There are phases of containment and of mitigation. Each phase defines the epidemiology, but also defines the set of interventions to be implemented. We are in the mitigation phase, you hear about phase four, that is immensely mitigation where you have multiple cases of transmission,” Dr Kyobe says.

He adds: “In the containment phase, that is where you want to contain and make it not spread. But if it spreads like it happened, you may have to switch interventions and that is where we are. In phase four, there is limited contact tracing and quarantine. The background is that the disease is almost everywhere”.

Dr Misaki Wayengera, the head of the ministerial advisory committee, says government did implement the measures up to a point they were no longer practical.

“We did a lot of it.  How many people complained that they were being locked up? It did happen and at the right time. There are different strategies for different stages. When the cases spread community wide, it was impossible to do … How do you do contact tracing and quarantine given the numbers of [infected] people?” Dr Wayengera wonders.

He adds: “That strategy works early in the transmission. We have the phase of imported cases, a few sporadic cases and then those grow into communities and finally become widespread community infections. In the early stages, it [tracing and quarantine] does work, but now it does not work”. 

Dr Wayengera also says the resources required would be enormous for the government. 
Dr Andrew Kambugu, the director of Infectious Disease Institute at Makerere University, says such measures are used to buy time for governments to prepare for the interventions required to deal with widespread community transmission, including equipping hospitals for case management. 

“In a resource-constrained environment, the approach of contact tracing may not be pragmatic. Governments must anticipate that when widespread community transmission occur, they should have developed capacity to do case management and home-based care, which is the current approach,” he says.

Dr Kambugu, however, says governments can leverage technology, for example the use of mobile phones to trace persons who could have been in contact.