Health workers attend to a Covid-19 patient in an ICU at Mulago National Referral Hospital early 2021. PHOTO/ PROMISE TWINAMUKYE

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Have Ugandans learnt to live with Covid-19?

What you need to know:

  • The latest data from the Ministry of Health indicates a downward trend in Covid-19 infections after the full reopening.

More than two years of confronting Covid-19 and enduring accompanying restrictions have left Ugandans exhausted and craving an end to the pandemic.

Now top scientists in the country are giving a mix of hope and uncertainty about the possibility of a pandemic —which has [as of Thursday] killed 3,567 from 162,492 infections—ending if/when the virus becomes endemic.
Uganda detected its index case of Covid-19 infection on March 21, 2020, and since then, everything changed. 

Following the spike in infections, people living in Uganda suffered two nationwide lockdowns. 
There has also been a trail of destruction, including several hospitalisations and thousands of deaths.

The slight relief from the January full reopening of the economy has augmented hope in the citizens. 
But the restoration of the pandemic- induced disruption of livelihood and impacts on education and economic growth will take time, according to experts.

Prof Samuel Majalija, a microbiologist at Makerere University, believes Covid-19 will over time become like a normal/common flu. He says if this happens, it could be the end of Covid-19 as a public health threat.

“By evolution, [viruses] come when they are very severe and they mutate into weaker versions that we can live with,” he says.

Prof Majalija hastens to add that this highly awaited end of the pandemic will take time as the virus and the immune system of the human body “negotiate and accept to lay down weapons of attack against each other.”

“Over the next few years, we are still going to see coronavirus variants that cause severe disease coming up and then they will go down,” he says.  

He adds: “This will continue until the virus and human body strikes a balance and they coexist over the years. It will become like normal flu.”

Making waves
When the Omicron variant emerged a few months ago—after the Delta variant had reared its ugly head—many experts in the country, including Prof Pontiano Kaleebu of Uganda Virus Research Institute (UVRI) and Dr Misaki Wayengera, the head of the government scientific advisory committee on Covid-19, started cautiously reinforcing part of their belief that the pandemic may end one day.

Dr Wayengera notes that Omicron also gives a way out for a developing country like Uganda that is channeling its limited resources towards fighting a pandemic instead of focusing on national development.

“Clearly, the cost of maintaining a proactive epidemic-mode response across the world has been high, and this, coupled with the negative socio-economic impact of the public health and social measures, it becomes necessary that we revisit the guidelines towards less stringent ones,” Dr Wayengera reasons.

He adds: “Omicron has in part enabled us to achieve that [balance] due to its connoted ‘mild presentation’ much as the same is only relatively factual and Omicron has proven deadly among many elderly and those with comorbidities.”

On the likely end of the pandemic, he says: “It is difficult to say, especially when we don’t know how possibly the virus will evolve…into a less fit variant and self-extinction, or a more deadly form.”

Due to the mix of hope and uncertainty around the end of the pandemic, the virologist warns that “it would be wise to maintain a more fluid strategy dependent on the level of threat rather than imagine that we can wish away the ‘epidemic response mode’ for an endemic status.”

The deadlier Delta variant triggered the second wave of the pandemic in the country. 
It saw the country lose a higher number of people compared to the first wave of the pandemic. 

By the time the Ministry of Health announced the second wave on May 5, 2021, the country had registered 346 deaths out of 42,224 infections. This was after 15 months of the pandemic in the country.

But when the same ministry was announcing the onset of the third wave (end of second wave)—around January 7 this year—the cumulative number of Covid-19 deaths stood at 3,339 and infections were at 153,762. This means the second wave had lasted around nine months, causing a ninefold increase in deaths and a threefold increase in infections.

This second wave stretched the health system to its limit, leaving Ugandans helpless as Covid-19 claimed patients in ambulances due to lack of space in hospitals. 

The intense suffering would continue until August when the wave started ebbing away with a notable reduction in infections and deaths.
But by the end of December 2021, Dr Henry Kyobe, the national incident commander for Covid-19, revealed to this newspaper that Omicron—a more transmissible new variant of Covid-19—was taking over.

The influx of the Omicron variant, which was said to have been imported into the country like the Delta variant, would trigger a third wave of the pandemic after causing a sharp spike in infections. But cases of infection with Omicron have generally been mild.

The total lifting of the lockdown on January 10 had caused fear among some experts that infections and deaths would spike to a disastrous level. And President Museveni had on December 31—while announcing the January full reopening of the economy—also warned that he would not hesitate to reinstate the restrictions if hospitals became overwhelmed by patients. 

But the latest data from the Ministry of Health indicates a downward trend in Covid-19 infections after the full reopening.

Between January 10 and February 6 (the last 28 days) after reopening the economy, 6,329 infections and 193 deaths were registered. This is lower than the 27,164 infections registered in the last 28 days (between December 13 and January 9) before the reopening. But deaths were lower during the period at 92.

“This corona, like flu, comes in waves and our bodies understand it and fight it better and then it goes down. But when it goes down, it doesn’t disappear. It mutates and then comes back to attack us again,” Dr Mukuzi Muhereza, a clinician in western Uganda, says. He is also the former secretary-general of the Uganda Medical Association (UMA).

“As a clinician, who sees patients on a daily basis, I would test you when there are some alarm bells. Few people are coming with symptoms and these [reported] numbers are depictive of what is happening in communities. Even the positivity rate is down,” Dr Muhereza also the former secretary general of the Uganda Medical Association (UMA), adds.

Living with Covid-19
Dr Wayengera reasons: “Clearly, even within the later refinements, when the situation evolves from epidemic to pandemic mode, countries have to be ready to respond to protect their most vulnerable. Thus, we need a robust surveillance strategy….and of course a plan and budget for rapid redeployment in case of a resurgence of the epidemic (pandemic).”

He adds that the country and the world will also need more affordable, equitably accessible biomedical interventions, drugs and vaccines that are easy to use and rapid to yield results.

“This is in the context of all technologies from testing, isolation, referral, treatment and follow up. We need real-time data access and resolution only possible via deploying advanced artificial intelligence,” he notes.
Prof Freddie Ssengooba, a specialist in health policy and health economics at Makerere University, says the government should ensure there is a clear balance between response to the pandemic and livelihood or national growth.

“The country needs to continue to be careful about those areas where we could get new variants to spread. But the concern is that the government has to see what more it has to do for the economy to pick up because Uganda is not the only country affected by Covid-19,” he says.

Prof Pontiano Kaleebu says maintaining observance of “Covid-19 preventive measures and vaccination” are important as the economy reopens fully.

“But it is mainly vaccination because maintaining some of these preventive measures such as masking and social distancing is hard, especially in schools. But mutation may come in and then we may need booster doses,” he says. 

The Covid-19 vaccine has been proven to be effective in preventing severe disease and death from Covid-19, according to the immunologist.

The Ministry of Health’s head of public health, Dr Daniel Kyabayinze, says since the country started vaccination in March 2021, the vaccination coverage has increased significantly.

“Fifty-eight percent of the targeted 22 million people are partially vaccinated, while 29 percent of the same targeted population is fully vaccinated,” he says, adding that the country is yet to acquire more Covid-19 vaccine doses in addition to the 36 million doses received over time.