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Inside the COVID resurgence

 

Mulago doctors and nurses brief health officialsafter they released a batch of patients March last year. COVID-19 is back and Uganda’s health system has been stretched.

 Why government needs to think differently about where it needs to invest in order to effectively contain the pandemic

THE LAST WORD | Andrew M. Mwenda | COVID has returned with a vengeance and is now ravaging Uganda. In March and April, the virus seemed to disappear. Out of an average of about 2,000 people being tested daily, only 12 (0.7%) were positive. Today, out of 8,000 tests daily, an average of 1,500 (17%) are testing positive. Last year, Mulago Hospital had set aside 500 beds to handle COVID patients. At the height of the pandemic in late November and early December last year, Mulago ran out of COVID beds – it had 490 patients at any one time.

Yet at the beginning of April 2021, Mulago had only two COVID patients whom it transferred to Entebbe Grade B Hospital. When I called the head of Entebbe Grade B in the second week of April, he told me they had only four patients. Yet in November and December last year they were totally full with 160 patients at any one time. In April COVID was raving Kenya, with average positive tests of 900 daily. So, Uganda seemed to have said kwaheri to the virus. Yet today, all hospitals, public and private have run out of beds for COVID patients. In fact, the situation is much worse.

Last year, it was mandatory that anyone who tested COVID positive be admitted to hospital. Except for a few who could afford private self-isolation, government insisted on hospitalising everyone with a positive PCR test. According to doctors I spoke to at the time, 80% of Ugandans who tested positive were asymptomatic. I was one such Ugandan in January this year. During my 13 days of isolation, I did not exhibit any symptoms and was running 10km daily. Secondly of the 20% who were symptomatic, 80% had mild symptoms and therefore did not need to be hospitalised.

So essentially government was spending a lot of public resources to hospitalise individuals it did not need to. Of course, this mistake is understandable.  COVID was new. Everywhere in the world its effects had been exaggerated. For poor countries with young populations, the fear was out of proportion to the risk. The initial strain of COVID largely affected the elderly and people with pre-existing conditions, largely lifestyle diseases such as diabetes, high blood pressure etc. Many of these diseases are much more common in rich countries than poor ones. Therefore, the scare in Africa with a young population and less of these lifestyle diseases (except for the middle class) was exaggerated.

Yet even with the benefit of hindsight, I think government acted correctly.  It was afraid that if it left people with a positive COVID test to go home they would spread it to their family members and the wider community. Forced hospitalisations of people testing positive but without symptoms had this logic behind it.

But today the situation is different. Government is hospitalising only those who are in critical condition. Those who are asymptomatic or have mild symptoms are sent home to self-isolate, although they are given medication for free. This partly explains why the virus is spreading like wildfire across the country.

Nonetheless what has happened that has led to the explosion of the virus with vengeance? One reason is that the virus in this new wave is a new strain with a much higher infection rate and is more lethal, even affecting young people. The other is that the low infection rates of the first strain plus its mild or no symptoms made many Ugandans complacent. To make matters worse, the almost disappearance of COVID in March and April made citizens and public officials drop the guard. People stopped following COVID SOPs and mass gatherings resumed.

However, I think the biggest problem was that government did not invest in the areas where it has an advantage – a strict enforcement of COVID SOPs in public spaces. Instead, when I watched President Yoweri Museveni speak on television last week, he emphasised government investment in improving the medical infrastructure to handle COVID – number of hospital beds, Intensive Care Units and High Dependency Units, amount of oxygen produced, medicines imported etc.

I have always believed and argued in these pages that Africa’s health policies tend to focus unnecessarily on medical treatment which out poor countries cannot afford. We pay less attention to investment in preventive health interventions which we can afford – sanitation, public and personal hygiene, nutrition, vector control, vaccinations, access to lead water, better housing, etc.

In the case of COVID, the best and most effective interventions are not in medical activities but in preventive measures that can be enforced by nonmedical staff such as police and other security officials.

As we have seen from the experience of rich countries, no country can afford to handle all COVID patients regardless of the amount of money and medical personnel it throws at the problem.

Last year, the richest country in the world, the USA, also the country with the highest health spending per capita in the world, ran out of hospital beds, medical staff and equipment to handle COVID patients. The USA spends 19% of her GDP on health, the highest in the world. Given a GDP of $21.43 trillion, that is $4.07 trillion or $11,764 per person. On the other hand, Uganda spends about $11 per person.

I know money is not everything. But if a country with the money America spends on health can lose 640,000 people to COVID in 18 months, Uganda should not look to her hospitals for a solution. There we have the least financial, technological and manpower capacity. Our capacity is in preventative measures. Yet even here, Uganda needs to be careful that the health measures taken to contain the virus do not cause a degree of economic damage that harms more than the health benefits sought.

Again, listening to Museveni, I get the sense that he is too obsessed with scientific control of the virus to near blindness of the economic and even health and medical costs of the measures taken to contain COVID.

Ultimately if we are to manage COVID, we need more communication to let people take care of their lives by wearing masks, ensuring social distancing and sanitising.

During the lockdown last year, I drove through many villages in Kabarole District and was impressed by how many ordinary citizens had taken government advice on COVID. Even in the most rural villages, ordinary peasants had cans of water with soap tied to trees in front of their homes. It became clear to me that Ugandans actually trust the advice of the state. This is where most government investment should go – to advise and inform citizens to take care of their own lives.

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amwenda@independent.co.ug

 

 

 

 

6 comments

  1. This time round we do not wish to just copy the proportion of the dead from developed countries and paste (when government did you called it an over reaction!)

    Every life matters

    Some money should be spent on community mobilization , increase awareness and even enforce compliance

    A lot of money should be invested in life support

    A patient who has become breathless needs oxygen in the ambulance that transports him to the health center; these should be many enough

    He should be received as fast as possible (at health center), his oxygen demands may vary between two, five 10 and 20 liters, this necessitates a good health care worker to patient ratio all the time

    He needs constant review and investigations
    The health care workers have got to be committed, effectively protected and get adequate time to rest

    The patient should stay long enough to a point when he is able to breath by himself

    The population should not be paying for diagnostic tests, the time taken to receive results becomes shorter, when you have more centers

    There should be Health care workers able to visit the students and determine if their condition necessitates transfer to hospital as opposed to moving when they are gasping

    Let us refrain from down playing the need for life support, all people are equal, even when they do not agree with your ideology

    The individuals who are in areas that have not been disrupted by the Ugandan adventures have retained the intact systems and indeed people comply because of preserved life style

    There are areas where life has been so disrupted; displaced, orphaned , denied meaningful rehabilitation, abandoned to fate; survivors from such system are not only hardened but may have no leadership that commands enough authority to have a uniform impact.

    Why would a society loose confidence in the guidance of those meant to protect them?

    Last but not least have you taken count of burials from upcountry? cause of death being difficult in breathing?

    I have listened to stories of whose loved ones missed opportunity of life support, i am also grateful that i was enabled to benefit from life support

    • I think you miss the important point that Mwenda has raised. That is; We are better off focusing on prevention than on treatment.

      By the way; most of the COVID-19 patients who died in the developed countries received the best care. They died while on oxygen, ventilators, and other life supporting equipment. They still died…..

      We will still register very many deaths even if we have ICUs for all COVID-19 patients who need them; but, we will have much fewer deaths if prevent SARS-COV-2 infection. That is; we do not need to get to the point where people are infected with coronavirus and need ICUs which may not actually save them. That to me is where Mwenda’s point lies and he is 100% correct.

      • “We will still register very many deaths even if we have ICUs for all COVID-19 patients who need them”

        -yes this happens, but in presence of such beds, some survive

        ” but, we will have much fewer deaths if prevent SARS-COV-2 infection”.
        -Indeed , several Ugandans started on this process last year, we organised water points, educated individuals on proper washing of hands, availed soap in the communities of those who seemed to be wanting

        at one point members of village health teams in a certain district were reported to have run out of logistics, initiated by themselves

        we have continued begging the community to comply, with minimal success

        How do you change knowledge attitude and practices?

        we are not begging you to say that we are correct (we are above such)

        in being 100% correct, one expects the right measures for the right people in the right place

        So we shall agree with the high score when the implementation is in such a way that it achieves a sustainable change in the way society views prevention of disease

        Looking forward to action with no conflict of interest

        Man shall be judged by his works

  2. He has always been correct

    The only problem is that there was very little to talk about in terms of care and support, this has to be attended to [several complied with SOPs but got contaminated by the heavy bio burden around them]; patients from developed countries still died but an attempt had been made to save them. [do not extrapolate that fact to this setting, those who fail to access care could have survived]

    This advice was actually highly desirable during round one and the activity should have continued, by now the situation may have looked different

    Let him advise on the best way to educate the masses, just help us who seem not to understand health despite walking the corridors where it is mentioned for decades, the messages on television and radios as aired since last year, how much did they impact the community?

    How best do you effect compliance in a setting like the one we are dealing with?

    How far is the spread of SARS-COV-2 infection ?

    What happened to the structures meant to implement preventive measures?

    Well the last time i checked prevention is at three levels, two of these may belong to the type that I consider at 0% correctness (yes some money goes to break the chain of transmission-i mention that,communities attempted this last year-remember? how much is some? you are better placed to determine )

    Some responses are based on priming, being correct 100% does not cloud the glaring gaps in facilitating the standard of care [or we must believe that all is well?]

    identify problems and address them so that they do not occur again

  3. 1.Its just by chance that someone can dodge contracting Covid;I beleive that there is a terrorist who is maliciously spreading this disease.FBI should carry out a thorough investigation.
    2.Ugandans complain alot there is no rich person in Uganda who is complaining about the high charges by Private Hospitals .
    3.The elite were convinced that some people in government wanted to steal money. Its so absurd that when things are now getting out of control thats when they now believe that government meant well.

  4. As we focus on prevention of transmission, how much does it cost to transport empty oxygen cylinders from Fort portal hospital(Buhinga) to Mbarara Regional Hospital and back?

    Hospital in Masaka and Mbale suffered a similar fate!

    Soroti is stuck

    In Hoima an individual has volunteered to educate others, some are already promising behaviour change

    But the repair of the Oxygen source in Fort portal is pending

    Even when the majority are kept away, those not lucky enough, get to hospital and find the units that you

    think should have minimal support

    Rethink the budget idea (the score remains as allocated)

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