Given the healthcare assets of Uganda, any scenario in which the corona virus causes a run on hospitals is a disaster. This much is a fact.
Treatment options for the virus ( outside experimental drugs being widely tested around the world) will be outside the scope of what can be reasonably offered to a large number of patients in Uganda. They require, for serious COVID cases, equipment and oxygen, and trained personnel for which the country has little to spare.
Thus in many ways the most viable option of slowing down the virus is the enforced social distancing that is the subject of much debate in country. But there is a gap. In Uganda, as in other countries, on the question of what testing data can do for policymakers.
So far aggressive testing in Uganda is limited ( still small less than 550 in total) has targeted the narrow set of recent travelers and those exposed to them. The black hole here is that without testing to confirm, isolate and attempt to treat each individual case, an country needs an intelligent estimate or working theory to support what is known about COVID-19 to health authorities around the world.
First, that most future COVID-19 patients are asymptomatic.
A long incubation period allows for COVID-19 to move far ahead of any response that health authorities can devise. Prolonged lockdowns around the world, in the absence of a vaccine or treatment, are for this reason the best scenario for countries with far greater assets than Uganda (and here we mean clinical assets) to deploy against scores that fall sick. Using this scenario, the current lockdown ,which is designed to slow down the virus so as not to overwhelm Uganda’s meagre clinical capacity, could last months.
This does not appear a path that Uganda can sustain.
It would be like if a recreational runner were caught up in a race to save his or her life that turned out to be a series of marathons whose end is not yet determined. Even the elite athletes in the field running to save their own lives are aware that their own energy is limited and will fail if the race is not called. This is how our healthcare system is set up against COVID-19 compared to its sisters in more wealthier parts of the world.
Given that Uganda is doing very little testing, it is also safer to assume that community infections are well advanced – and that only the lack of testing is preventing this from being known.
Aside from the debacle at the airport, in which several people evaded quarantine orders or where quarantine facilities were inadequate and exposed hotel workers and others, it is safe to assume that the blockade on borders was late ( infected patients esp from the busy UAE-Uganda route) were long streaming in) and that the dragnet did not extend to cover busy road travel. In just one case an expatriate who attended a meeting with several colleagues, and who later tested positive ( and whose colleagues also fell sick) could not get help until their symptoms were almost resolving without treatment. This happened after over a week of going to work in a busy organization with dozens upon dozens of Ugandans. This is a small measure of the leaks of COVID-19 into the overall population that surveillance and tracking cannot account for.
Moreover. Assuming in fact that people indeed started falling sick – it is unclear given Uganda’s assets what clinical strategy would be effective and sustainable over the long run. Uganda, however like other nations may have a way out that also involves testing. As a non-scientific opinion this option needs the voice of medical experts in the country about what is happening around the world with regard to the development of antibody tests that look for if someone already had COVID but survived it. If there is already community spread and infection, and it is safe to assume there is for the reasons given above, there may already be a significant portion of the Ugandan population that has survived the infection.
To establish how widespread such a net is Uganda needs a cheap anti-body test. Researchers in Germany are mulling such a plan – based on “immunity certificates” or anti-body tests that could potentially allow COVID survivors back into the economy and the workforce. It may be that Uganda works to bring early trials of such tests, many of which are being pursued around the world, to determine quickly and scientifically not who is sick but rather who has survived COVID.
Given Uganda’s youth demographic it is not out of the realm of things to expect that an immunity wall is operating against COVID-19. Such views however can be put to scientific evaluation. This path could present an earlier exist from extended lockdowns and quarantines and the associated issues with this policy. According to one physician involved with the national COVID-19 effort, some Asian countries do have anti-body tests but these have not been approved by the World Health Organization or other reputable regulators.
Should Uganda wait?
Can Uganda afford to wait?
Perhaps for now Ugandan scientists and medical teams could debate the merits of mapping of the population to separate groups by age, medical history, as well as potential exposure so that restrictions on work and mobility are gradually eased for the least vulnerable? Should an anti-body test be introduced this process can be done whilst maintaining in place the hygiene standards indefinitely at workplaces and public places as well as social distancing in general.
Keeping it real
For analysts, crisis such as World War worthy shock and awe of the COVID-19 one, are a good time to make evidence-based conclusions about a country’s systems. In ordinary times these tend to be shielded by political rhetoric, bureaucratic obscurantism and other sorts of distractions that are accommodated by the lack of demand for the organizational capabilities of sitting governments and their leaders.
As Uganda took measures to hold off widespread community infection many aspects of how the country is organized went public – the way one’s possessions are forcefully displayed after a storm or a forceful eviction due to non-payment of rent. In ordinary times blame for shortages of oxygen, ventilators and blood can be passed around between Ministries, departments and budget wars but in times of a pandemic, well a harsh audit of what is available is a stark reminder that we did not pay our dues and now possible death is the full reckoning with no other court to pass the buck.
It is brutally shocking as well as refreshing.
One of the first victims of pandemics is the Industry of Appearances that comprises politicians, journalists, influencers and other narrative warriors, thought leaders, religious leaders ( especially evangelical types sadly), corporate captains of industry and privileged civil servants who rely on selling success primarily (and deflecting blame for failures).
In a pandemic ( or other nature induced crisis such as the locust invasion before COVID-19 took over) the tools to control or create a narrative are quickly eroded. The ability to create or project a reality is replaced only by the capacity to respond. For the latter quality, only those who have prepared are rewarded and as it happens to be prepared requires patient investment in the health of public institutions.
We shall return here to admonish the neo-nationalists who are so sensitive to good headlines and carry around large buckets of white paint to throw at years of bad investments but suffice to say that before we pivot to the potential to defeat COVID19 – this pandemic has simulated what can happen in the case of a national crisis such as an invasion by a foreign power, a debilitating power vacuum at the top or an economic crisis that crushes production.
So far it is not pretty. The new pandemic has shown that one resource that is not money or political acumen that Uganda needs is administrative capacity. In any event getting over the forced lockdowns will require pretty harsh compromises. Hopefully we are right about the immunity wall and the potential for anti-body tests to work an exit magic.
In the meantime, stay home and stay safe.
Well argued Angelo, as always. We surely need to invest in admin capacity too. And no just science, science and more science.
It is possible that hundreds, if not thousands are infected and pulling through. Like another doctor mentioned – many may die with but not of Covid-19.