Covid-19: How Uganda good fight went wrong

By Frank Kisakye & Carolyne Nakazibwe, KAMPALA Uganda

Praised by the World Health Organisation (WHO) as a model country in the fight against the spread of the novel coronavirus, Uganda is now seemingly headed into the same trajectory as other badly-hit countries, if events of the last few weeks are any indicator.

Interviews with Covid-19 patients, their relatives and medical experts, help explain how the country’s rather good fight got off its rails. From March 18, when President Yoweri Museveni announced a total lockdown, all appeared to be going well. Cases were few, recoveries impressively high and the country began to open up.

Compliance with standard operating procedures (SOPs) especially washing hands and social distancing was religiously adhered to. The fear of contracting the disease stood between 70 and 80 per cent between March and May, according to survey results from the ministry of Health.

In June, that figure dropped to between 30 and 40 per cent and could be lower today. At the end of July, WHO regional director for Africa Dr Matshidiso Moeti praised Uganda, Seychelles and Mauritius for effectively managing to control the spread of the pandemic on the continent.

Ministry of Health permanent secretary Dr Diana Atwine even chastised Tanzania’s seeming laxity in fighting Covid-19, adding that the entire world was looking up to Uganda’s exemplary and success story.

On June 25, when the country had 848 cumulative cases, 780 recoveries and no deaths, the president of the Society of Uganda Private Medical Practitioners Dr Lulume Bayiga told a press conference that it was going to be an uphill task to convince Ugandans that the health impact of Covid-19 was as big as projected.

Lulume urged Uganda to emulate Tanzania and Burundi that had not locked down their countries but had kept their economies running amidst the pandemic, in hope for herd immunity (a form of indirect protection from an infectious disease that occurs when a sufficient percentage of the population has become immune either through vaccination or previous infections).

In response, Atwine told Uganda Radio Network (URN) that the perceived normality in Tanzania and Burundi was farfetched because their people were dying, according to intelligence shared between health experts in the region.

“What is there to learn [from Tanzania and Burundi]? Do you know thousands of people who have died just because they don’t share with you? Do you know how many thousands, thousands, we’re not talking about hundreds but thousands of people who have died?” she challenged. “Look at those countries that relaxed, they bought even extra land for graves. Is that what we want?”

But going by the recent trajectory, Uganda is headed for difficult times; hospital beds in Kampala are filling fast, with just 2,600 confirmed cases. SOPs have generally been dropped, and one only has to venture into downtown Kampala’s Kikuubo Lane or Luwum Street, to understand why Kampala Metropolitan is the latest hotspot for the virus.

While taxis were ordered by the president to ferry only eight passengers for social distancing purposes, passengers report that the case is different once the matatus get to the crowded suburbs.

“The taxi conductors are very strict on masks, but when I asked to use the sanitizer at the door, one conductor quipped: ‘eno ya ba traffic! Kozesa eyiyo (this one is kept for traffic checks; use your own)’,” one regular passenger told The Observer.

No wonder the city is seeing an explosion in cases. A patient hospitalized in Mulago with Covid-19 symptoms said on condition of anonymity, that four floors of the newly-refurbished New Mulago complex are operating at full bed capacity.

Cubicles meant for six beds are now reportedly accommodating between eight and 12 patients. Another patient in Entebbe Grade B hospital said some patients are starting to occupy space in corridors. Also, the recovery rate has dwindled, as symptomatic community cases start reporting to health facilities, unlike the asymptomatic truck drivers who previously recorded themselves dancing in wards.

The Uganda Medical Association proposed that the ministry stops admitting every patient who tests positive, to decongest hospitals, and admit only those with severe symptoms. But Health Minister Jane Ruth Aceng said with the complacency exhibited by Ugandans, it is unlikely that Covid-19 positive Ugandans with mild symptoms can self-isolate for 14 days without interacting with other members of the public.

Interviewed by the New Vision recently, Dr Monica Musenero, the senior presidential advisor on epidemics, said Uganda is fast moving to the stage of uncontrolled transmission, especially in Kampala.

“The bed capacity, especially in Kampala, has been outstripped and that is why we have close to 150 people, who tested positive, being treated at home,” she said.

However, even Aceng’s current admit-all, treat-all method is not foolproof. Two weeks ago, Bettina (name changed on request) took her husband to Lancet Laboratories for a Covid-19 test at Shs 345,000, because he had presented with all the symptoms – including chest pain, fever, loss of sense of smell/taste, headache and difficulty in breathing – for at least five days.

Five days during which the couple went to different hospitals in Kampala and could not secure a test or help. According to Bettina, the couple contacted KCCA for help and were referred to Mengo hospital only to be turned away because there were neither testing kits nor doctors designated for Covid-19, despite the hospital being identified as a testing centre at the time.

As her husband’s health deteriorated, they opted for the expensive private test.

“When he received a positive result the following day, through connections we secured an ambulance to transfer him to Mulago as our car was impounded for fumigation,” Bettina said.

“As soon as the technician gave us the results, he told us to go home and wait for a call from the ministry. Had we not used our connections to deliver my husband to Mulago, the ministry would probably never have called, because he has never received the said call since his positive test.”

“After his admission, I was told to self-isolate for 14 days, and also find my way to Kiswa health centre in Bugolobi for a test, because the Mulago sample collection centre had been closed and reserved for VIPs.”

“Meanwhile, they told me not to use public means to go to Kiswa, but there was no vehicle or ambulance to take me. How was I supposed to get there and go back home?” Bettina said.

That was August 20. By Monday August 31 when The Observer compiled this, Bettina was yet to receive her test results, despite repeated calls to Kiswa.

“One health worker told me on phone they were undergoing health training and there was no one to update me on the results,” she recounted.

Also, no contact tracer has been to Bettina’s neighbours/community, neither has she received a follow-up phone call from health workers as a primary contact to a Covid-19 patient. At Mulago too, her husband reports that no one has asked for his list of contacts!

She is ‘self-isolating’, but ironically has to deliver food and fruits to her husband, after the Mulago patients reportedly protested against the bad food and the administration allowed caretakers to drop off food daily between 10am and 1pm.

The hospital executive director, Dr Byarugaba Baterana told the Public Accounts Committee of Parliament on August 25, the hospital had budgetary shortfalls and needed funding from government to handle Covid-19, instead of dipping into the usual allocated budget.

He disclosed that the hospital was struggling to feed Covid-19 patients, whose appetites are not necessarily affected by Coronavirus. Many on the wards are asymptomatic. The hospital currently has close to 300 Covid-19 admissions and has registered at least four deaths.

Delays in release of the test results is one of the big setbacks in the Covid-19 fight. While Kiswa told Bettina she would get her results within four days, it had been 10 days and counting, when The Observer last checked; the facility had stopped taking her calls.

Other patients have reported similar delays, and with no strict quarantine measures for community cases, the spread is inevitable. The delay in releasing results could also be responsible for the hospital congestion, since a patient is not discharged until they have a negative result.

Minister Aceng has previously said each test takes about five hours to complete. But surprisingly in places like Ghana, the wait time for a Covid-19 PCR (polymerase chain reaction) test result is 30 minutes.

The ministry has religiously updated Ugandans on ‘new’ cases, recoveries and deaths daily, but unknown to most, the results announced daily are from past tests done over several days, announced as and when the laboratories eventually turn them in.

For community cases, Ugandans are trusted to stay in self-isolation until their results come in.

“This entire Covid thing is a mess. I was tested 10 days ago and it is only today that they called to bring me to Mulago. Do they know how many people I have infected? I believe I have actually healed between then and now if indeed I was positive,” a patient who had just been dropped at Mulago from Busia, said.

As the number of samples and occasional shortage of reagents overwhelm laboratories, Covid-19 is spreading from the crowded downtown Kampala to upmarket air-conditioned ministry offices (Ministry of Finance, Planning and Economic Development registered 21 cases), banking halls (Dfcu Lugogo branch), newsrooms (so far, New Vision, NTV, NBS, UBC and Radio Pacis), hospitals, supermarkets, among others. 

“I feel Coronavirus results are only important if they are released within 24 hours or 48 hours. That is when they are important. Apart from that, you’re going to create a trail of contacts that you can’t handle. Maybe the government is enjoying having enough numbers of Covid-19 patients,” said a laboratory technician from one of the Covid-19 contracted labs, in a voice note sent to The Observer on July 29.

Recently the ministry of Health spokesperson Emmanuel Ainebyoona told The Observer that it takes only 48 hours to know one’s results. The facts on the ground state differently. Even Ministry of Finance, Planning and Economic Development staff who were tested between August 19 and 21, received results on August 24. And that was considered fast.

“Sometimes when the results delay, it is due to the running out of reagents or sometimes traffic jam affects movements of medical officers from sample collection centers to testing laboratories,” Ainebyoona told The Observer.

He also said there is a planned rapid assessment that will occur in greater Kampala Metropolitan, Wakiso and Mukono districts like what happened in other high-risk districts.

“We shall be selecting a number of people scattered across in these districts and test them. We shall also do risk basic testing; for example, if premise X has a case, then we test all the occupants and their contacts there,” he says.

Meanwhile, a patient at Mulago said in a phone interview that patients are neither sensitised about proper hygiene, nor supplied with sanitizers. They, however, get one surgical mask per day.

“Patients are also cleaning the washrooms, because most of the cleaners who were doing the job reportedly contracted the disease. Unfortunately, there is no liquid soap or other detergents to help. If patients don’t volunteer to clean the washrooms, they remain dirty all day,” he said.

Perhaps the ministry of Health’s major battle now is against public complacency and skepticism over the seriousness of the pandemic. After reported misuse and theft of Covid-19 funds in some African countries including Kenya, a section of Ugandans still believe there is no pandemic and government is only using the term to collect donations.

Not even public figures such as AIGP Asan Kasingye, businessman Isaac Rucibigango (he was discharged on August 27 after a negative result), Makerere University lecturer Amanda Ngabirano and others, talking about their personal struggles with Covid-19 made much impact.

One Twitter user even responded to Kasingye’s Covid-19 infection announcement that he (the tweep) would not believe Covid-19 exists unless the Police Chief Political Commissar succumbs to the disease, to Kasingye’s chagrin!

The ministry of Health’s fight was dealt further blows when Aceng was captured in an unfortunate video mingling with masses in Lira, without a mask. Several other ministers and politicians have also flouted the SOPs as the election season kicks into high gear, further disenfranchising the doubting Thomases.

It did not help matters when on July 19 the ministry released its daily update that showed more Covid-19 recoveries (1,071) than confirmed cases (1,069). In their explanation on social media that was missed by many, the ministry said the recoveries included Ugandans, non-Ugandans, as well as refugees.

However, foreign confirmed cases had earlier been expunged from the country’s totals on the orders of President Museveni, a development that even led to mini friction with WHO, who said it was against international pandemic practices.

In addition, when the country started recording Covid-19 deaths, affected families took to social media to dispute the ministry’s findings that their people had died of the disease. This only fueled social media allegations of ‘scaremongering’.

Even The Observer, which has consistently been making daily updates on our online platforms on the status of Coronavirus in the country, was falsely accused of colluding with the ministry to steal Covid money.

As cases spike and the country continues to open up with SOPs, the ministry remains faced with the challenge of upholding an image it boasted of earlier this year, which even made Aceng, Atwine, Dr Monica Musenero and other taskforce members adored celebrities. For a short while. - The Observer