Audit of lockdown reveals no exit plan

The government justified that the lockdown, which has greatly affected livelihoods and social wellbeing of Ugandans, was meant to minimise the devastating effects of the second wave on the health of the population and the economy.
Dr Jane Aceng, the Health minister, said the seven objectives of imposing the lockdown included interruption of Covid-19 transmission among health workers and the population, enhancing risk communication, and strengthening home-based care.

The other objectives were to increase capacity of health facilities to handle the pandemic, vaccinate more people, improve access to emergency medical services and sustain continuity of essential health services.
Our analysis of statistics from the ministry, compared to 21 days before the lockdown on June 18, reveal a gradual decline in new infections was manifest during the lockdown, although the number of samples tested per day was correspondingly falling.
On the day the lockdown was imposed on June 18, the country had registered 1,367 new cases of infections after testing 9,066 samples.

But what triggered the second shutdown appeared to be a spike on June 10 and June 11 when daily infections soared to 1,735 and 1,727, respectively, the highest ever single-day cases registered in the country since the March 2020 index case.
This was preceded with daily deaths of 25-49 between May 24-30, the highest fatalities in 16 months since the pandemic struck the country as overwhelmed hospitals reported oxygen and drug stockout and began turning away critically-ill Covid patients.
After the disease appeared to relent, Covid killed anywhere from 29 to 53 people per day between June 18 and July, although the highest single-day deaths from the disease was registered in the country on July 20.

For context, on the second day of the full lockdown, which followed a week of partial lockdown, daily infections dropped for the first time in 13 days to below 1,000 and staggered in between until a steady a fall from July 1.
By last Sunday, July 25, daily infections dropped for the first time in more than a month to double digits, corresponding with about 83 per cent Covid bed capacity becoming vacant following fewer admissions.
The start of this month was significant in Uganda’s Covid reporting as the Ministry of Health revised the Covid deaths, increasing it by about 800 to 1,910, citing a change in its criteria for determining Covid deaths to include PCR or Antigen Rapid Diagnostic Test (AgRDT) confirmed or probable cases.

“The Ministry of Health, working with Covid-19 Scientific Advisory Committee, has finalised a clinical diagnostic criterion for suspected Covid-19 deaths, but with no PCR or AgRDT result or negative result, but with a clinical picture similar to Covid-19,” Dr Aceng said while announcing the revision.
Earlier in June, the ministry noted public concerns and anxiety about inordinately delayed reporting of Covid-19 infections and deaths, with some sections of the population alleging that the government was underreporting both cases.

Commenting on the current pandemic situation in the country, both Dr Aceng and Dr David Sserwadda, the head of scientists advising government on vaccine access and deployment, attributed the decline in new infections to the lockdown measures and increased adherence to preventive measures.
“These numbers [of Covid-19 infections] began to reduce on June 30, following the lockdown until now where we are recording an average of 295 confirmed cases per day,” Dr Aceng said in a televised address to the country on Tuesday.

Dr Sserwadda, on the other hand, said the decline in infections may not be attributed to vaccination, considering that only 1.1 million of the targeted 21.9 million people have been inoculated, with one-fifth receiving the recommended double Oxford-AstraZeneca shots per person.
“Much of the reduction in transmission is possibly because people are following standard operating procedures (SOPs), reduced crowding which [reduce] the spread of the infection and handwashing. This [observing SOPs] will remain critical even when we have high vaccination rate,” he said.

From the day the second full lockdown was imposed on June 18, only a total of 313,377 doses of vaccines were administered against a target of 22 million.
Although government planned ramped up mass vaccination during the lockdown, the Ministry of Health --- which had announced an elaborate blueprint to bypass lockdown limitations --- said it could not meet the target due to scarcity of vaccines.
Despite this admission, the ministry forked out up to 2,000 doses for discretional use by businessman Hamis Kiggundu, better known as Ham, after he, on July 2, donated Shs530 million to bolster the government’s pandemic response.

The apparent quid pro quo transaction sparked public uproar, prompting the Health ministry to defend the decision it said was informed by Kampala Capital City Authority returning its allocation after failing to find people to vaccinate even as tens were turned away over stockout.
It has emerged that the government has accelerated its scouting for vaccines, scanning from China’s Sinovac and Sinopharm and Russia’s Sputnik in the east to Pfizer, Johnson & Johnson and Moderna stocks in the United States in the West without taking its eyes off India-made Oxford-AstraZeneca.

In the Tuesday address, Dr Aceng said they had concluded legal requirements for an order of nine million doses of AstraZeneca vaccine through COVAX facility and made $3m (Shs10.5 billion) down payment through African Union to procure two million doses of Johnson & Johnson.
Until now, Uganda has depended on donated vaccines, and the country expects to receive 286,080 additional AstraZeneca vaccines donated by Norway through Covax and 300,000 doses of Sinovac donated by the Chinese government tomorrow and Saturday, respectively.

In the Health ministry statistics, the total number of tests done per day significantly declined from July 1 to July 25. For instance, on July 1, the country conducted 7,084 tests and 770 cases were confirmed, but this is several times higher than the 1,614 tests conducted on July 25 where only 71 new cases were detected.

Hospitalisation

Owing to the high numbers of infections before lockdown and in the early days of the second lockdown, the average number of patients in hospitals stagnated at around 1000.
But from July 9, about 21 days after the lockdown, the cases admitted to hospitals dropped to around 900 as the daily number of new infections declined. And from July 22 to July 25, the number of hospitalised Covid patients declined to an average of 670.

In June, a number of hospitals were full to capacity, accompanied with shortage of necessities needed in Covid fight such has Personal Protective Equipment (PPEs), oxygen, with fatigued health workers, among others. A number of health workers were infected in line of duty and a number of them died.
Dr Aceng said the daily admissions declined from an average 204 to 52.

“On average, 34,247 cases were registered between June 10 and July 26. The highest number of daily hospital admissions for severe and critically ill patients registered was 204 on June 20, with a daily average of 142 patients between June 10 and June 30, when the number of confirmed cases started declining. Since then, the average daily admissions stand at 50 patients,” she said.
This reporting, which chronicles largely feats, appears framed only in the narrow prism of health yet the lockdown imposed diverse disruptions to lives and livelihoods and does not also detail the deaths and recoveries from other diseases that were already killings hundreds a day before attention and resources were diverted to tackle the pandemic.

Dr Ivan Kisuule, the head of the Namboole Covid Treatment Centre, said they plan to double the bed capacity to 2,000 should cases increase. By press time yesterday, the unit had 20 moderate Covid patients.
“We have enough oxygen cylinders, they have now increased to 300 and those are enough to look after 300 patients at one time,” Dr Kisuule said.
Dr Rosemary Byanyima, the deputy director Mulago National Referral Hospital, said apart from increasing the oxygen capacity, the cylinder capacity has also been increased from 80 to 250 to supplement the 3,600 litres produced by the plant per minute.

In preparation in the event of a third wave, Mulago has recruited more contract staff through its parent Health ministry and the World Health Organisation, alongside refresher training of nurse on critical acre.
Mr Muhammed Mubiru, the administrator at Entebbe Grade B Hospital, said given the decline in the number of patients, some of the staff are resting and recuperating and will return in case need arises.
“We are trying to open further services that we had closed. We had some oxygen challenges in the middle of the pandemic, but we eventually got some donors to transport oxygen from Namanve [in Mukono District]. Currently, what the plant produces can cater for the patients we have… 43 cylinders in 24 hours (capacity of plant),” Mr Mubiru said.

The hospital is also expanding space capacity and training, as well health workers on top of those being recruited by government.
Separately, Dr Byanyima said upsurges are unpredictable and sometimes overwhelm plans as was the case with their preparations for the second wave.
Majority Covid-19 patients (about 80 per cent) are asymptomatic or have mild infection and these cases are treated from home, according to the Health ministry. The average number of people undergoing home-based care at any one point in the country has staggered at 20,000.

As of July 25, only around 13,749 people were under home care, according to government statistics.
Minister Aceng on Tuesday said: “During the lockdown, the government oriented the district taskforces to coordinate and supervise home-based care and supported training of Village Health Teams and community health workers on community-based disease surveillance and home-based care.”