Uganda: COVID-19 death

Traders, salons, boda boda now part of major experiment

Kampala, Uganda | THE INDEPENDENT | President Yoweri Museveni, under pressure, recently re-opened arcades, beauty parlours (salons) and motor-cycle boda-boda taxi services. The question now is whether or not Museveni might soon regret re-opening the multi-storied buildings that each house hundreds of small shops under one roof.

The health community is anxious. The President announced the re-opening on July 21 and the next day, the Minister of Health, Jane Aceng flagged off teams to conduct the second Rapid Assessment Survey to determine the extent of community transmission of COVID-19 and possible risk groups in the 11 districts estimated to be at highest risk.

The targeted districts are Masaka, Kyotera, Adjumani, Rakai, Isingiro, Gulu, Buikwe, Ntungamo, Amuru, Kakumiro, and Kasese. And the main groups considered at highest risk are border workers (residents, URA staff, and traders), law enforcement officers, health workers, boda boda and bicycle riders, sex workers, slum dwellers, factory workers, and fishing communities. One of the main goals of the survey is to determine secondary attack rates of COVID-19 among contacts of confirmed cases.

Arcade trader, salon operators were not included in the survey, just as the districts where they have the highest concentration such as Kampala, Mukono, Wakiso, and Mbarara.

Then on July 23 the Ministry of Health confirmed the first COVID-19 death in Uganda; that of a 34-year old woman in Namisindwa District, eastern Uganda.

The woman was first admitted to a health facility on July 15 with severe pneumonia. Five days later, on July 20, her condition worsened and she was moved to another health facility. She died next day. She was a paramedic.

This case has raised numerous questions about the level of preparedness of Uganda’s health system for COVID-19. Why was this patient not immediately tested for COVID-19 either on July 15 when she first presented symptoms or before she died a week later?

This case exposes what critics of Uganda’s low confirmed COVID-19 infection cases have said all along; that Uganda is simply not doing enough tests and many people could be infected and dying unrecorded.

Since the pandemic broke out in March, Uganda had by July 23 tested only 247, 646 samples; that is an average of 2000 samples per day.  Rwanda has said it can test 4,000 to 5,000 samples per day. Kenya on July 22 tested 6,754 samples.

Uganda clearly needs to increase on COVID-19 testing, especially after re-opening of arcades, salons, and boda-bodas.

Secondly, why was she treated in a private health facility? Private facilities are excluded from the Ministry of Health’s response planning on COVID-19.

Namisindwa district where the death occurred is not listed among the high risk areas, despite being at the border with Kenya where the COVID-19 cases are rising exponentially at community level.

According to experts, there is a high likelihood that re-opening of arcades, salons and boda-boda could lead to a spike in community spread of COVID-19 in Uganda. They cite cases and studies from other regions that have re-opened.

COVID-19 danger indoors

In a study of 318 outbreaks in China, transmission in all cases except one occurred in indoor spaces. The outdoor events that have also been implicated in the spread of COVID-19, typically those associated with crowding such as celebrations and sports events.

In another study, a team of Finnish researchers used supercomputer simulations of how pathogens like COVID-19 spread in spaces like supermarkets.

They concluded that in an infected person (not wearing a face mask) coughs in a supermarket aisle, the cough particles spread substantially through the area, eventually diluting itself over the course of several minutes. Based on this, the researchers concluded that the airborne particles could infect other shoppers during those crucial minutes, well after the coughing person had walked away.

The researchers said it is not possible to disentangle in their reports the role of physical proximity and direct contact through handshaking, or indirect transmission through contaminated objects and surfaces or longer distance transmission through aerosols. However, they illustrate the risk of transmission in crowded indoor settings and the importance of bundled prevention measures.

Based on this, it appears the Ugandan traders and buyers in arcades, and users of salon and boda boda are now part of a major experiment.