How do truck drivers get COVID-19?

Denis (not real name) delivered cargo to a depot in Nakawa, a Kampala suburb, four days ago, from the port of Mombasa. However, by Friday, his truck had not been offloaded because there were several trucks ahead of him in the queue.

Denis started his journey at Mombasa last week. His first stopover was at a weighbridge, after driving for two hours, and the second was at Nyama-Choma.

"Nyama-Choma is a busy place. There are shops, bars and lodges. I spent a night in a lodge and left the next day. After driving for about seven hours, I needed to take a break," he said.

Dennis left at 8:00am, the following day, arriving in Nairobi at 2:00pm. He broke his journey at a place outside Nairobi called Longonot for a lunch break. He later drove through Naivasha arriving at Malaba — the Kenya-Uganda border — six hours later.

"I reached Malaba at night and decided to spend a night there because of the long queue of drivers waiting to be cleared. We also had to be tested for COVID-19," he added.

Dennis arrived in Kampala the next day after travelling a distance of over 1,100km.

SOCIAL LIFE

The 38-year-old Ugandan cargo truck driver and father of four, is single, having separated from the mother of his children. Dennis reveals that although truck drivers are thought to have a string of women in different places along their routes, he is different. "I can spend a year without a woman. People are of different characters," he explains.

But his colleague, Patrick also a Ugandan, said he has two wives. "You can even spend a month in Kampala waiting to be cleared to the next destination. I cannot go back to Kabale to see my first wife and then return to Kampala. I have two wives because I do not engage the services of sex workers," he added.

However, their Kenyan colleague, Thomas, does not have a wife in Kampala. He spends some nights in lodges.

Patrick said most of the sex workers and other women they encounter are only worried about conceiving, not contracting sexually transmitted diseases.

The trio reveals that truckers who earn between sh600,000 and sh900,000 in salaries per month cannot afford to pay for accommodation off their monthly earnings.

They supplement their pay by picking up travellers along the transport corridors for a fee.

Dennis said he spends the extra earnings on his family and beer, but Thomas said additional cash is a motivation to engage in some merrymaking.

"Most of the lodges where some of us spend nights double as nightclubs. We always find sex workers there and when you have money you may not avoid them," he added.

Patrick said most of the sex workers and other women they encounter are only worried about conceiving, but not contracting sexually transmitted diseases.

These, he added, consent to unprotected sex as long as a man promises to take care of the pregnancy or is willing to pay more money," he stated.

As they wait for the loading and offloading of cargo trucks and vehicles stuck for weeks because of bad roads, the drivers interact with several people, such as roadside vendors, revellers in entertainment places, restaurants and travellers.

WHY MANY TRUCKERS TEST POSITIVE

On June 27, of the 3,386 COVID-19 tests done, 10 tests that came back positive were foreign truck drivers, who have since been handed over to their respective countries of origin.

By June 22, a total of 373 of the confirmed 774 infections were among truckers.

President Yoweri Museveni, in his address on the same day, said 1,067 non-Ugandan truckers who tested positive had been handed back to their countries of origin.

On June 24, seven truckers from Kenya (4), Tanzania (2) and Burundi (1) tested positive and were handed back to their home countries at the border.

However, Uganda's case count rose to 821 on the same day. This is after five Ugandan truckers tested positive; four arriving from South Sudan and another returning from Kenya. There were 11 cases among the alerts and contacts of previously confirmed cases, including truckers; four in Kyotera, four in Amuru, one in Tororo, one in Kakumiro and one in Luwero.

According to the health ministry permanent secretary, Dr Diana Atwine, the highest number of infected Ugandan truckers travelled from SouthSudan.

"This does not mean the burden is bigger in South Sudan than other countries. It is because many Ugandan truckers carry merchandise to South Sudan," she added.

Atwine revealed that some of the neighboring countries now test their drivers and only allow those that are negative to proceed to Uganda. She said only about 20% of the confi rmed cases were among Ugandans who returned to the country from abroad. The rest, she added, are linked to truckers and their contracts.

TRUCKERS' TAKE ON COVID-19

We put several questions to a group of cargo truck drivers near a depot in Nakawa. They were eating mairungi, and blamed the positive test results on the drugs. "COVID-19 has never reached Africa. Health workers test our colleagues after they (drivers) have taken drugs. We use a lot of cannabis, mairungi and other drugs and these increase one's body temperature. They send us into quarantine because it is high," they said, adding, "they then give them vitamins and milk and they recover." Dennis, concurred with his colleagues.

He says many drivers entering Uganda through Malaba and Mutukula initially tested positive for COVID-19 because of drugs. "Positive cases reduced because drivers stopped taking drugs as they approached Malaba and Mutukula. But they took more drugs after leaving Uganda and test positive on their way back to Uganda from South Sudan," he says.

No doubt their perception of the disease has an effect on how they respond to measures to control COVID-19. None of them wore a mask and they did not enforce social distancing throughout the interviews.

LABORATORY TESTS

Dr.Monica Musenero, a presidential advisor on epidemics, dismissed the drivers' claims regarding drugs and blamed the high infection rate among them on their multiple contacts.

"We do not rely on temperature to confirm the virus. If your temperature is high, we do lab tests. There is no relationship between COVID-19 and high temperature as a result of drugs," she added.

Musenero said the source of infections, among drivers, is hard to establish because they travel to many countries and interact with people whose risk profiles are unknown by the Ugandan health experts. "Some truck drivers get infected as they wait for their results," she revealed.

Musenero also explained that drivers do not get crucial information on prevention since they are always in transit. "People need to listen to what experts are saying. We have COVID-19," she asserted.

But why are there more COVID-19 cases among truckers?

Dr Alex Ario, the director of the national institute of public health in the ministry, said  Tanzanians and Kenyans were the fi rst to be found with high infections, in the category of truckers, in the population because they were entering Uganda from COVID-19 epicentres.

"By the time we started testing them at Malaba and Mutukula, Tanzania and Kenya had community infections," he added. Ario explained that the large infection rate among truckers is also explained by their high mobility and multiple contacts  along the transport corridors.

THE SPREAD

"What determines if you get infected or not is the distance between you and the infection person. If you are one metre from the infected person and stay with the case for 15 minutes or more, you are likely to get infected,'' Dr Alex Ario, the director of the national institute of public health in the ministry, said.

‘‘However, others will not get it because of strong immunity," he added. With 60% of the cases being asymptomatic, Ario said, many pass it on without knowledge. The other factors that determine the level of infections, Ario said, include the level of testing and government control measures.

He also relies on the results from the recent random testing among high-risk populations in Uganda to prove that the truckers are a risk group.

A total of 24,000 samples were collected during random COVID-19 testing of the population; fishermen, sex workers, market vendors and immigration officers at entry points, as well as the Police, army, health workers, employees of schools and churches.

But only three samples tested positive. Ario was one of the investigators in the exercise.  "Even one of three positive cases was a truck driver," he added.

Besides the cases detected among Ugandans returning into the country, Ario said all other infections are linked to truckers. Infections from truckers, he explained, resulted in clusters (a number of cases in a certain location) in some communities.

Ario also revealed that there are more cases among the informal sector workers in Uganda. "These live from hand to mouth and they have to go out and get a daily income. They interact with many people in their bid to earn an income," he says.

INTERVENTION

The works ministry and private sector players have set up 20 seclusion and resting areas for truckers along the routes to minimise contact with the population.

According to the Inter Security Agency Task Force on COVID-19, these facilities will be maintained even after the disease has been defeated.