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.