Can Uganda Contain Its COVID-19 Infection Spike? Reflections Of An Emergency Room Doctor Inside View 26/08/2020 • Samson Wamani Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Part of a series of stories about how the coronavirus lockdowns and relaxations are playing out in different parts of Africa. For more on this, see our stories on South Africa and Ibadan, Nigeria. Crowed market scene in Kampala – some wear masks and others do not. Kampala, Uganda – As Uganda’s coronavirus cases double in only two weeks, the Ministry of Health is considering a second lockdown to control the SARS-CoV2 virus spread. But will another lockdown really curb the number of cases? Does the healthcare system have the capacity to handle the next wave? And what will be the cost in lives of both health workers and the general public? Reflections from an emergency room doctor in Kampala: Since I am not one of the scientists that advises the President on public health measures like lockdowns, let me leave it to the experts to decide whether a second lockdown would be effective. We know, however, from many countries – such as the USA, Mexico, and Italy, among others – that full-blown lockdowns may not halt transmission of the coronavirus – and it won’t prevent deaths from the disease either. So far, the death toll in our country has been exceedingly modest, compared to countries in Europe, Asia and the Americas as well as countries on our continent, such as South Africa. Since the first case of the coronavirus was reported in Uganda on March 19, the virus has claimed a little more than twenty lives. However, the situation now is rapidly changing. Over the past weeks, Uganda’s number of Covid 19 cases has doubled, with its highest number of new cases in just 1 day being 318. Mask distribution in a village in Uganda. Our President, Yoweri Kaguta Museveni, has repeatedly appealed to Ugandans to follow the Standard Operating Procedures (SOPs) that his government has put into place. Based on WHO recommendations, they focus on: physical distancing, universal mask-wearing on public transport and in public spaces, as well as basic hand hygiene. In hospitals and clinics, WHO guidelines call for the continuation of basic health services, while strictly separating COVID-19 cases from others seeking health care. At the same time, health workers need extra protection, so that they don’t become ill and risk infecting others. Regrettably, even as we now face a serious uptick in new infections – we are falling short both in the public sphere and in our hospitals. Ugandans seem to be either indifferent or unable to follow the president’s directives. And this threatens our entire effort to keep people safe and healthy – including health workers. Deadly Lockdown Guidelines Empty road in Kampala, Uganda, during the first lockdown in March – June. Admittedly we hardly had any COVID-19 cases when the police and other security organs enforced a a strict lockdown between March and June. But that was also a crude tool with often cruel consequences. At a time when all transport was shut down, I received a call from a pregnant woman in labour, who was trying desperately to reach a hospital as her baby was in a breech position – which meant she really needed a cesarean. I knew this because I had examined her myself only a couple of weeks earlier while visiting my hometown in eastern Uganda. ‘’I am 8-months pregnant and bleeding for 2 days now,” the woman lamented over the phone. According to the lockdown guidelines, however, anyone traveling to the hospital had to first get permission from the Resident District Commissioner’s (RDC’s) office in-person. And the RDC office was too far for her to walk, bleeding alone. I was working at my hospital in Kampala and thus unable to provide immediate help. She told me that she would try to reach a traditional birth attendant (TBA). When I eventually spoke with her again two days later, she told me she had walked to the neighboring village, and was being cared for by a TBA. ‘’The bleeding has increased and I’m becoming weaker and weaker, I doubt that I will make it this time.’’ My heart sank as she spoke to me in her the voice of someone who was dying. I looked for ways to reach the RDC directly myself, to request an ambulance to save the mother and her child. Luckily enough, I finally got through to him, and knowing me, he offered us an ambulance. The driver rushed her to Mbale Regional Referral Hospital, where I was already making arrangements so that a team of health workers would be ready to receive her. The doctors performed a successful cesarean, but her baby had died in the womb by the time it was performed. I’m glad that my efforts at least helped save the mother – because we would have probably lost both mother and infant had we not reached the hospital. I can only imagine the pain she went through. But if we face another lockdown now, will the same scenes be repeated elsewhere? Does Uganda’s Healthcare System Have The Capacity To Handle The Next Wave? Unprotected medical workers lean over the bed of a sick patient in a Uganda hospital – some of whom may be infected with COVID-19. To cut a long story short, sadly NOT. That’s because very little has changed since the first wave – which was contained by a public lockdown. The alternative to a lockdown this time around would be strict public adherence to mask, hygiene and social distancing measures as well as a nimble health system response. But the public remains lax and the health system is still under-funded. We still face the same shortages in human resources, supplies, and crucial infrastructure that would allow for the effective and timely testing, tracing and isolation of COVID-19 cases. We can’t follow the WHO guidelines for proper management of COVID cases. Not Enough PPE – Suspected COVID-19 Cases Mixed With Regular Patients Here’s an example from one recent shift in the emergency room of the hospital where I am working now. A restless, 52 year-old business man with known hypertension came through our doors late one night. He had been suffering with a cough for the past two days, had difficulty breathing, and also had hypoxia, or low blood-oxygen levels – all signs of the SARS-CoV-2 virus. The internist on night duty, a friend and colleague of mine, contacted the designated COVID-team, which did not hurry to examine him – initially telling him to first rule out other causes of the symptoms. Finally, he admitted the man, with a diagnosis of suspected community-acquired pneumonia. The COVID-team, fully gowned with extensive personal protective equipment, came to the emergency ward, collected a nasal sample, and left within 20 minutes. The following day, with the COVID test still being processed, the patient was moved to a general ward, in close proximity to the other patients who were being treated for other, unrelated conditions. Except for the fully protected members of the COVID-19 team who took the nasal sample, the other medical staff who saw him over the following hours – from senior doctors to internists like myself, nurses, and administrative staff – have access only to a surgical mask and disposable gloves. Including myself. These are the people who must collect patient history, conduct routine exams, connect oxygen, provide treatment, and remain within close proximity of the patients for more than 12 hours a day. The man died as a team struggled to administer him oxygen – his test results later confirmed that he had COVID-19. Following that, we all had to be tested – and those among the medical staff who tested positive are now under quarantine. I was among the lucky ones who tested negative. This was particularly reassuring for me. As a diabetic, I am also at higher risk from COVID-19. But the reprise is only temporary. In fact, day after day, virtually all the staff in our wards, and in the whole hospital, are at constant risk of exposure to suspected COVID-19 cases, and thus at risk of exposing other patients, as well as outpatients, to a potentially deadly virus. And all of the medical staff also return home to their families everyday – or in my case, on the occasional weekend when I manage to make the journey back to my hometown in eastern Uganda. So what happens when the next patient arrives at our emergency room, with a suspected COVID-19 case? The COVID team says it lacks the capacity to quarantine and treat suspected COVID patients – even if they are very ill – until a test-confirms their diagnosis. Meanwhile, health workers remain exposed, and are thus exposing everyone around them. This is the case in most regional referral hospitals. This is where we are as a country. What is the fate of health workers? Health workers deaths due to COVID-19 in Africa, Asia and Europe. As of 13 July, over 3,000 health workers in some 79 countries have died from the coronavirus, according to Amnesty International. And healthcare workers in almost 63 countries have reported serious shortages in PPE. Like other hospitals in Uganda and many other countries elsewhere, our fate as health workers is uncertain. On the one hand, vigorous campaigns are underway in the community to introduce Ugandans to masks and reinforce handwashing and hygiene measures. Health workers demonstrate handwashing to villagers in eastern Uganda – to prevent COVID infection. But in the hospitals, the basic preventive measures we could take are weak. We can only pray that patients we manage everyday for community-acquired pneumonia do not have actually have COVID-19. And if they do, which has already happened in past months, we shall all be quarantined. As case numbers increase, more of us, depending on the degree of exposure, will contract the coronavirus – and many will die. The senior medical staff who decided to neglect us will be forced to emerge from their administrative offices to treat many of us – while also managing malaria, hypertension and women in labour – COVID or not. Many will be called heroes. Heroes who were left to die. Heroes who were sent out as sacrifices with no protection. Heroes who had no choice but to work in unsafe environments set out for them. Countering The Pandemic Samson Wamani wearing a non-medical mask that he uses when not on duty. Still, I refuse to be only a complainer. We can be part of the solution that addresses the issues our country is facing. All we really need to do is to put the lofty rhetoric issued at the top policy echelons into real action in our hospitals and wards. “Africa can only counter this pandemic through robust policy responses in every single country on our continent, with additional support from our partners around the globe, declared Charles Leyeka Lufumpa, vice president for economic governments at the African Development Bank Group, in an editorial this week. “In the short-term, African countries should prioritize health care spending to supply us with essential personal protective equipment (PPE) and to accelerate local production of vital healthcare products – including PPE, vaccine and other medicines,” he added. Health workers and management must unite and acknowledge existing shortcomings. Let us set out on a journey to solve the problems of the system once and for all. We must stand our ground on the numerous shortfalls in human resources, PPE supply, and health infrastructure. The Government must invest in the system with appropriate funding, facilities, supplies and human resources. Just yesterday, ministers and officials from over 40 different Member States across WHO’s Africa region met virtually for the WHO Regional Committee for Africa, and agreed that the pandemic has been a tragic reminder that we must invest more in our health systems. “The coronavirus pandemic has proven once again the importance of investing in health systems, enhancing equitable access to care and improving readiness to prevent and control outbreaks,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “Recovering from this pandemic will be incomplete without strong measures to bolster health systems. We must seize the opportunity and make the leap for a better tomorrow.” Let us stop pretending that things are okay. That we are ready to die only due to reckless circumstances. That we are more patriotic than leaders who have paid a deaf ear and blind eye to the obvious problems we’re all facing. Let us decide to protect ourselves, our patients, our families and country at large by not being part of the system that spreads a disease that’s actually preventable through evidence-based public health measures. There is still time to save Uganda from a larger wave that’s flooded other countries on the continent, such as South Africa. This war can be won if we stop talking and start doing. The time is now! Postscript: 9 September – Two Ugandan doctors have since died due to corona-related complications, in Lira and Mbarra regional hospitals. The COVID Treatment Unit (CTU) in my hospital is full to capacity. But suspected cases are still being mixed into the general wards unless and until their infection is confirmed by a test. The government is planning to open schools beginning September 20th – but there are no practical measures put in place to control the spread of the virus. We are bracing for huge numbers – we only hope that we shall not get many with severe disease. ________________________________________ The above are my personal opinions. Dr Samson Wamani is “examined” by one of his young patients – just weeks before the pandemic began. Samson Wamani, is currently working as a frontline medical doctor in a COVID-19 referral hospital in Kampala, Uganda. He is also the Executive Director of RAIN Uganda, an NGO that offers HIV education and testing in the Mbale area. He previously headed a health centre in eastern Uganda, as well as serving as the health and development officer for the NGO, Innovation Africa. He has a passion for maternal and child health.. Image Credits: Samson Wamani , Samson Wamani, Ndahiro derrick, Amnesty International, Sasmson Wamani . Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.