Counting the cost of COVID-19 in health

Nov 15, 2020

Health experts say the number of health workers who have succumbed to COVID-19 in Uganda may be more than what is recorded.

In five months, Uganda has lost 143 people to COVID-19.

The number is an equivalent of 10 commuter taxis full of people. Among the dead are nine health workers, while globally, more than 3,000 health workers have died of the pandemic.

By November 10, at least 1,070 health workers in Uganda were confirmed to have contracted the virus.

Health workers are the first line of defence in the fight against the pandemic, but there is concern that the country is losing grip on this front.

Experts warn that if the first line of defence is further compromised by the pandemic, the country will be headed to a disastrous phase in which thousands of people could die.

A report from Amnesty International has linked the increased global deaths of health workers to unsafe working conditions, low pay, long working hours and violence against medics.

Numbers in Uganda could be more

Health experts say the number of health workers who have succumbed to COVID-19 in Uganda may be more than what is recorded.

This, therefore, raises the question of why Uganda continues to lose health workers at a time when the country needs more medics to deal with the increasing number of COVID-19 cases, now at 15,217.

The commissioner in charge of curative services at the health ministry, Dr Charles Olaro, says health workers are naturally more at risk because of their interaction with patients.

It is also complicated further if a medic has underlying comorbidities, such as asthma, diabetes and hypertension.

"Having comorbidities puts them at risk. They may have all the knowledge about the disease, but if their bodies are weak, they become vulnerable if exposed," Olaro notes.

The executive director of the Uganda Healthcare Federation, Grace Kiwanuka, says the complacency of the general public also contributes to the problem.

Complacency has led to a spike in the infection cases, which means the health workers are overstretched and this increases their risk of contracting the virus.

"Many patients come with signs and symptoms, but some health workers take long to suspect COVID-19, especially those who are asymptomatic. Some are not properly sensitised on issues of infection protection and control, so they do not take precaution," Kiwanuka notes.

Dr Anthony Ekwaro Obuku, the former head of the Medical Association of Uganda, says COVID-19 found the country with a weak health system and this could be another reason why more medics are succumbing to the virus.

Obuku adds that healthcare professionals work in areas of high concentration of people with respiratory diseases and that the pandemic has increased their workload.

Even when they are given protective equipment, they falter along the way because they are being overworked.

"Just being tired can make the health workers falter with the SOPs and a problem sets in," he notes.

Obuku's views are corroborated by an ongoing survey conducted by the health ministry with support from the World Health Organisation to understand the magnitude of COVID-19 infection among health workers.

The survey findings indicate that work burn-out and lack of adequate Personal Protection Equipment (PPEs) are the major risk factors.

"The health workers are few and they work so hard. Consequently, they end up compromising on the SOPs," explains Dr Jane Byakika, the principle investigator.

Kiwanuka agrees with Byakika, explaining that in a bid to cut costs, some private health facilities reduced their staffing because they could not afford to keep them on the job.

As such, health workers are working longer hours. Some health workers cannot afford PPEs, they keep recycling, putting themselves at risk of infection.

It gets worse for the duo practice — health workers serving in both private and public health facilities and have to move back and forth.

Obuku also blames the spike in infections and the deaths to the poor quality of PPEs. Some protective gear, for example, masks, are of poor quality.

When used for a long time, or if one begins to sweat, they start to fall off. This, according to Obuku, raises concern about the quality of protective gear supplied to health workers, which he thinks may be originating from poor procurement processes.

In a report on the Overview of COVID-19, dated November 9, the health minister, Jane Ruth Aceng, said a significant number of health workers got infected through their interactions with the communities and not necessarily in the line of duty.

"I would like to appeal to our health workers to wear Personal Protective Equipment and follow Infection, Prevention and Control (IPC) measures at all times," Aceng said.

Solutions

There are standards for personal protective equipment, so the Uganda National Bureau of Standards should be able to pronounce itself on the quality of PPEs and also do impromptu quality checks, Obuku notes.

"We need to employ and deploy about 500 doctors in all health facilities. For every doctor, we need to employ three nurses and two midwives. This will translate to about 1,500 nurses and more 1,000 midwives," he says.

Even with health workers equipped with knowledge on the signs and symptoms of COVID 19, some may be asymptomatic, hence failing to manage the disease in time, Dr Patrick Kadama, the director of policy and strategy at the Africa Centre for Global Health and Social Transformation (ACHEST), says.

COVID-19 is a condition that we should proactively manage.

If we wait for patients to present with symptoms, we shall get into a dire situation similar to that of Italy, Kadama warns. He says medical care professionals should have a lot more than just face masks. As such, all frontline health workers should be wearing face shields to offer extra protection.

Olaro calls for capacity-building and training before the health workers are deployed, in addition to continuous training while on the job.

Equipping them with infection protection and control guidelines is vital, he notes. Health workers with comorbidities should not be allowed to work in COVID-19 treatment centres or units with highly infectious diseases.

Health workers should be regularly screened (after two weeks) in order to capture the infection early before it progresses to severe form, Olaro notes.

Kiwanuka says protecting health workers not only starts with sensitising the public to have a high index of suspicion, but also to be compliant.

Statistics According to data from the health ministry updates on the COVID-19 situation in the country, by November 11, the cumulative confirmed cases stood at 15,217, with 224 new cases.

The total cumulative recoveries are 7,985, while the cumulative deaths stand at 143. The total COVID-19 samples so far tested are 579,443.

Who are the fallen medics?

On July 21, Uganda registered the first COVID-19 death.

This was a 34-year-old woman, a village health team worker in Namisindwa district. Upon admission at Joy Hospice in Mbale, she presented with COVID-19-related symptoms, including fever, headache and difficulty in breathing.

She died the night following her admission. Dr Peter Mugisha, a specialist at Mbarara Hospital, was the second health worker to succumb to COVID-19.

His death was confirmed by the hospital director, Dr Celestine Barigye and Lt. Col. James Mwesigye, the Mbarara resident district commissioner, who is also head of the district COVID-19 task force. Dr Patrick Odongo, a senior medical officer at Lira Hospital, also succumbed to COVID-19.

Odongo was taken to Lira Hospital when he was ill. He was then tested and results indicated he was COVID-19 positive. Odongo, who owned Megwa Clinic, had other underlying medical conditions.

David Katuntu, a Ugandan senior epidemiologist, also succumbed to COVID-19 on September 1.

William Mule, who was the Mukono district laboratory technician, succumbed to COVID-19 on October 27 at Kiruddu Hospital.

Mule developed body weakness three weeks prior to his death and started himself on self-medication, thinking he was treating malaria.

A day before his death, Mule contacted one of his colleagues at Mukono General Hospital laboratory department and told her that he was seriously ill.

Arrangements were made and he was taken to the hospital, where a COVID-19 swab sample was taken, before he was referred to Kiruddu Hospital.

Sadly, results confirming that he was COVID-19 positive were released on the morning of the day he died.

On November 5, Dr Yasin Kiyemba, the medical superintendent of Rakai Hospital, succumbed to COVID-19 after being admitted to Mulago Hospital's intensive care unit.

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