47,000 Ugandans died in 34 Days

By Francis Otucu

47,498 patients died during the first 34 days of covid-19 lockdown, The Second Opinion can exclusively report.

The shocking revelation is entailed in a report that was authored by the Cvid-19 Pandemic Rapid Evidence Synthesis Group (CoVPRES) that’s allied to the Uganda Medical Association (UMA).

According to the report, these patients succumbed as a result of difficulties occasioned onto the country by the covid-19 disease and its related lockdown.

Despite the fact that Uganda had reported just two Covid-19 deaths by press time; after about four months of the lockdown, thousands of patients succumbed to other diseases for various reasons but which are related to the Covid-19 lockdown.

“Some died after they failed to access medical care due to lockdown restrictions on mobility. In some instances, patients failed to find assistance as medical personnel did not make it to work over lack of transport. To others, they failed to raise funds for treatment due to loss of income as the lockdown limited people’s ability to pay for services,” the report shows in part. For some people, the failure to seek medical care was due to concern about being exposed to COVID-19; although they ended up dying anyway.

2000 DAILY DEATHS

The report further shows that as a result of these challenges, in the first 34 days of the lockdown, Uganda recorded nearly 2,000 deaths per day. The number is estimated to be even higher. Of these, 105 mothers (3.1%) died per day, 405 died of Non-Communicable Diseases (NCDs) representing 11.9% per day. 207 died of anemia (6.1% per day), 265 died as a result of pneumonia (7.8% per day) while malaria killed 418 people per day, an equivalent of 12.3%. For 34 days, these are 47,498 deaths. This report is expected to be launched between September and October 2020, according to Uganda Medical Association.

When contacted, Emmanuel Ainebyona, the Ministry of Health spokesperson said he was not yet privy to the report but will read it and react once he accesses it.

However, a previous Ministry of Health report portrayed Uganda’s annual health sector performance as severe. The report showed that severe malaria, severe pneumonia and severe anemia claimed over 10,000 lives in the year 2018/2019. There were also 1,135 maternal deaths during that period.

A quick review of the same 2018/19 Ministry of Health report suggests that of the above deaths, Uganda lost an average of 12.3% Ugandans per day from malaria, 7.8% from pneumonia, 6.1% from anemia and 3.1% pregnant mothers during childbirth.

In March 2020, 327 deaths due to malaria were reported. In 2019, the monthly average number of reported deaths due to malaria was 448. This is a figure higher than the one reported in March 2020, though higher than the one reported in March 2019 (240 deaths due to malaria).

Data we have obtained shows that in the last two years, the monthly average number of reported deaths due to pneumonia was 261 while Uganda reported 103 maternal deaths in March 2020, down from 135 deaths reported the month before. According to the report, the number of maternal deaths reported is consistent with the number observed since September 2019. Meanwhile, trends in monthly newborn deaths continue to be in the range of 500 to 600 deaths. No significant changes have been observed from the past two years. 64 neonatal deaths were registered in March 2020. The previous month (February) had 89. According to the report, the increase in neonatal deaths between October and February seems consistent. However, whereas Uganda has recorded thousands of cases with hundreds of thousands of COVID-19 tests, only one death related to the deadly virus has been reported in recorded in Uganda, particularly the 34-year-old female in Namisindwa district.

While commenting on these findings, former Uganda Medical Association President, Dr. Ekwaro Obuku attributed the lockdown deaths to new problems that usually come with every policy intervention.

“Every policy intervention creates new policy problems. What are our blind spots? Are we covering all our bases in this COVID-19 fight? What has happened to the killer diseases prevalent before March 18th when Mr. Museveni declared 13 measures against COVID-19?” Obuku said.

He noted, however, that Uganda would have been better off focusing on other diseases alongside Covid-19 since it is already known to have a good track record when it comes to fighting epidemics.

“Even before the COVID-19 pandemic, Uganda made significant achievements in key health outcomes over the 3 decades of President Museveni’s regime. The life expectancy at birth is now above 60 years, up from below 45 years due to the wrath of HIV/AIDS; maternal deaths have reduced from above 500 to less than 350 per 100,000 live births, which is still unacceptably high. And there has been simultaneous reductions in child mortality and Malaria in the recent past. Conquering epidemics is therefore not new to President Museveni; and Uganda’s medals range from victory +over the deadly “kill-me-quick” Ebola to the chronic HIV/AIDS that we have positively learned to live with.”

He further noted, “Uganda has done relatively well in the COVID-19 fight. Currently, Uganda is outshining its East African neighbors having maintained a significantly lower burden of COVID-19 despite a higher per capita testing.

Thus far, of the estimated 40,000 tests we have detected only 1000 cases of COVID-19 and over 50% have recovered from supportive treatment in Uganda.”

Obuku notes that the key success factors in Uganda’s fight against COVID-19 have been unassuming yet focused leadership from the top, community mobilization and cooperation, substantial monetary investment, trusting professionals in science and above all raising awareness about SARS-CoV-2. In all this, the heroic proletariat of professionals in medical care: nurses, doctors and midwives; the media and the armed forces have been leading at the frontline. He adds: “Mr. Museveni has provided clear direction, our Minister of Health Dr. Aceng has followed through hinged on a scientific approach and Rt. Hon. Kadaga appropriated the money timely, a no mean feat in

Uganda’s leadership resolve to conquer COVID-19.” He however says that whereas the earlier Shs10bn allocation by Parliamentarians soiled the trust in these leaders; they still remain steadfast.”

According to Obuku, the biggest question is whether there are excess deaths from severe malaria, severe pneumonia, severe anemia or pregnant mothers ever since we turned all our attention and resources to COVID-19. “In all his 13 Covid-19 national addresses, Mr. Museveni has been keen to point out each COVID-19 patient in such detail that

Medical ethicists would raise eyebrows; and with satisfaction concludes, “Uganda’s COVID19 curve is flat!” While no system is perfect, is the President receiving daily briefings on the non-COVID19 curve?” Obuku asks.

Obuku says that while the Permanent Secretary, Dr. Atwine often challenges the medical fraternity to provide solutions beyond merely complaining; the medics believe that defining the non-COVID-19 diseases problem is the point of entry in providing for alternative and comprehensive COVID19 interventions.

“As context is everything, we were at Day 34 of lockdown or community quarantine by the last Presidential address on May 4, 2020. How does this community quarantine affect the burden of non-COVID-19 deaths? How does this burden compare to the same period of March to May last year, 2019? We celebrate Sr. Okudinia, the nurse who wheeled a patient in need of emergency medical care for three kilometers from Ediofe HCIII to Arua Regional Hospital, soon after the lockdown was instituted. Such are the undesired events of the total lockdown. And what about the RDC who has to give permission to pregnant mothers to go and deliver? Does this introduce another point of delay to access quality medical care?” he ponders.

He, however, said the COVID-19 Scientific Advisory Committee can easily settle this question by reviewing the Ministry of Health’s management information systems monthly reports of 2020.

He also argues that there is the moral and ethical question as to whether these deaths are any less important than the COVID-19 deaths of which Uganda has just reported a single case.

“It is this last matter that Mr. Museveni and his team ought to address if indeed all

Ugandan lives matter! The solutions therefore lie in the hands of our leaders to whom we have entrusted our national treasury,” Obuku, known for academics and research, noted.

THE WARNING

The lockdown deaths come on the backdrop of an earlier warning by the Global Financing Facility. In their report titled “Preserving Essential Health Services”, the group warned on the possibility of the COVID-19 Pandemic diverting attention from other diseases. The report for instance warned that the COVID-19 pandemic threatens to disrupt the provision of essential services due to barriers to the supply and demand for services. Basing on Mathematical models, the group noted that large service disruptions in Uganda have the potential to leave 1,358,400 children without oral antibiotics for pneumonia, 1,862,700 children without DPT vaccinations, 301,300 women without access to facility-based deliveries, and 941,800 fewer women receiving family planning services. As a result of disruptions in all essential services, the message said, child mortality in Uganda could increase by 22 percent and maternal mortality by 21 percent over the next year. Global Financing Facility maintains, maintaining essential health services during the COVID-19 pandemic is critical to prevent these severe outcomes and protect the gains made over the past years in reducing maternal and child mortality.

As much as the virus is yet to cause death in Uganda, the COVID-19 pandemic is causing widespread disease and death elsewhere. In addition to mortality and morbidity directly attributed to COVID-19, the pandemic poses a significant risk of indirect morbidity and mortality from other preventable and treatable diseases if the provision of essential health services is disrupted.

Such a disruption could come from both supply and demand-side factors. On the supply side, medical personnel normally providing essential health services could be diverted to respond to COVID-19 and large numbers of health care workers could become ill or die. Health facilities could be overwhelmed by large numbers of COVID-19 patients needing management and treatment. Finally, global supply chains for essential supplies and equipment may be disrupted due to production shifting to COVID-19 related supplies, declines in production due to disruptions in the availability of raw materials, and substantial delays in delivery times due to transport and movement restriction.

During the 2014-2015 Ebola outbreak, many vaccine programs were suspended, and in April 2020 the Global Polio Eradication Initiative announced a pause in polio immunizations worldwide to divert personnel and supplies toward the response to COVID-19. According to the message, there is already evidence that COVID-19 is causing high rates of morbidity and mortality among health care workers, leading to further staffing shortages. Many family planning clinics in Asia have reported shortages in modern contraceptives, and UNFPA has reported commodity production shutdowns, delays in procurement and increased prices.

On the demand side, people may use fewer essential services during the COVID-19 pandemic due to lockdowns or other mobility restrictions. Income lost due to lockdowns may limit people’s ability to pay for services and limit utilization. People may be less likely to seek care due to concern about being exposed to COVID-19. During the 2003

SARS epidemic, a 24 percent decline in outpatient services was observed and was largely attributed to people’s fears about the contagiousness of SARS, which made them afraid to seek health care. During the 2014-2015 Ebola outbreak average health care utilization declined by 18 percent, but declines were larger for maternal and child health services; for example, facility-based deliveries dropped by 28 percent. In past economic crises, household income declines resulted in decreases in the use of health care services, and these were more extreme for children as compared to adults. Preserving essential health care services is therefore especially important for protecting the health and well-being of mothers and children.

Modeling estimates using the Lives Saved Tool (LiST) model show that COVID-19-related disruptions could leave many women and children without access to essential services and result in increased maternal and child morbidity and mortality (see methods box). If declines in service utilization similar to those observed in other epidemics occur in Uganda, as many as 1,358,400 fewer children would receive oral antibiotics for pneumonia and 1,862,700 fewer would receive DPT vaccinations. There would also be 301,300 fewer facility-based deliveries and 941,800 fewer women would access family planning services.

If the coverage of all essential maternal and child health interventions in Uganda decreased in a similar way, the result would be a 22 percent increase in child mortality and a 21 percent increase in maternal mortality over the next year. Evidence also suggests that the breakdown in primary care service provision during an epidemic can lead to longer-term increases in indirect mortality. In West Africa, the Ebola epidemic has continued to have an effect on utilization of essential services, likely due to the lack of trust in the health care system.

The facility appealed, preserving essential health care services is critical to prevent avoidable losses of maternal and child lives during the COVID-19 pandemic and to protect progress in reducing maternal and child mortality achieved over recent years (see box for useful resources). “Therefore, strategies to maintain essential health services need to be part of Uganda’s response to the COVID-19 pandemic,” the message reads, in part.

It should be noted that even after the warning, Uganda did not heed to it. For instance, immunization dropped by 13%, according to Dr. Obuku.

MEDIC JOB LOSS, SALARY CUT & NON-PAYMENT

Already, city private hospitals have either cut salaries, sent workers on forced leave or are not paying workers.

Although we could not independently verify this, this publication understands that Norvik Hospital ‘downsized’ as a result of the lockdown against the increase of COVID-19 infections. Case Hospital, according to sources, cut salaries.

Some hospitals sent workers on an annual leave while others laid off workers. Grace Ssali Kiwanuka of the Uganda

Health Care Federation in an interview with publication said whereas she is unable to provide the figures, the impact of COVID-19 lockdown is there and that the problem of health workers is going to bite. “Truth is, we have a number who have been scaled down and these are senior health workers,” she said. She, however, explained that these could have been caused by either lay-offs, hospitals closing shops or lack of movements while others have experienced changes in shifts. “The situation is not permanent,” she said adding, “There is just going to be a delayed effect.” The biggest challenge, according to Ssali, will come when, now that countries like the United Kingdom have opened doors for medics to move and settle there. “We are waiting for an upswing. The challenge is that the UK has opened doors and when the demand returns, doctors will be no more after all these investments in the best brains,” she noted. Some of these issues, according to Ssali, can be addressed through a coordination between private facilities and the public.