Like HIV/AIDS treatment, poor adherence to ARVs confers zero benefits; as it was zero protection from poor use of condoms. The discomfort of wearing masks; compromised breathing and quality of speech, coupled with waning trust in our leaders weakens Ugandans resolve to use masks consistently
I salute the Ugandan talent for our early gains in the COVID-19 war. Our COVID-19 burden has remained relatively low and mostly asymptomatic. President Yoweri Museveni has done a commendable job. However, behind him has been a team of dedicated professionals.
For instance, Ugandans are now accustomed to the soft-spoken Dr Henry Mwebesa, the Director General Health Services. Dr Mwebesa signs-off Uganda's official test results daily.
Today we also celebrate Prof. Moses Joloba who elevated our national tuberculosis laboratory to a World Health Organisation regional centre of excellence just like Prof. Pontiano Kaleebu did for the Uganda Virus Research Institute.
As we relax the lockdown, which has been hinged on community-wide use of facemasks, it would be an injustice to ignore the excesses of the lockdown.
However, there were other unintended positives, such as family bonding, reduced crime and cleaner Kampala air. On the other hand diminished access to healthcare facilities may have impacted community deaths due to malaria, pneumonia, anaemia and tuberculosis.
Pregnant women suffered too and a countrywide maternal death audit is prudent. African countries implemented lockdowns earlier than the global north. Although lockdowns slowed early spread of COVID-19, in terms of years of life lost, their negative knock-on effects on treatment for Africa's "big three"; AIDS, TB and malaria could be similar to COVID-19, according to researchers from Imperial College London.
There is no doubt that COVID-19 is a deadly "flu". It is true that every year seasonal "flu" kills over half a million people worldwide and COVID-19 is catching up fast with nearly four hundred thousand dead. Equally true, the research evidence is weak about community-wide use of facemasks to curb the spread of flu-like illnesses, especially COVID-19.
Recent systematic reviews of randomised trials (the ‘gold standard' of scientific evidence) suggest medical masks may be effective in healthcare professionals in hospitals and high-risk populations with respiratory symptoms.
In the community, especially open air spaces, masks are less helpful where the burden is negligible. So why are we investing sh7b to distribute masks to Ugandan "wanainchi", and another sh35b to buy them?
The risk of recommendations not backed by robust scientific evidence lies in the opportunity cost. What is the next best intervention to spend Uganda's meagre resource envelope? In the "Tamiflu" scandal, countries invested billions of dollars stockpiling the drug, yet this was no better than using paracetamol for the 2009 "swine flu" pandemic (H1N1).
Perhaps the biggest problem in Uganda's fight today is the COVID-19 "cash cow" eclipsed public policy priorities. For example, those who need masks most, the frontline healthcare professionals lack basic protection (PPE). Unfortunately, recently two frontline healthcare soldiers caught the coronavirus.
When ruling party MPS were added sh40m each, on top of the initial sh20m that came from "bad planning", the political leadership gains early in the pandemic lockdown were eroded together with the people's trust.
To be fair, the absence of evidence is not evidence of absence. Recommending community-wide masks is on the balance of scientific opinion and precaution. Nonetheless, community masks would be cost-effective with at least three thousand confirmed cases of COVID-19.
Moreover, currently Uganda has spent over 200 tests to detect one case of COVID-19. From simple economic evaluation this translates to at least sh22m per person found to have COVID-19.
In sum, focusing on protecting those at highest risk of transmission with symptomatic flu-like illness or cough, and healthcare professionals is judicious.
Secondly, masks create a sense of false security so that other measures such as physical distancing and hand-hygiene are overlooked.
Thirdly, is the observed inappropriate use of masks. Like HIV/AIDS treatment, poor adherence to ARVs confers zero benefit; as it were zero protection from poor use of condoms. The discomfort of wearing masks, compromised breathing and quality of speech, coupled with waning trust in our leaders weakens Ugandans resolve to use masks consistently. Actually, a mask wearer may move closer to be better heard while speaking, compromising physical distancing. Air breathed out of masks may seep into the eyes, causing irritation and the urge to touch "soft parts" in the eye.
Therefore, mass masking should target the same high-risk population being targeted for COVID-19 testing: symptomatic with respiratory like-illnesses, truck drivers, contacts, and "at-risk vulnerable poor" unable to afford them.
The writer is a member of Uganda Medical Association