Why Coronavirus won’t devastate Uganda

This may seem like a bold statement with the probable pandemic peeking over the horizon but even based only on reason 1  (spoiler alert), I’m happy to make it. Uganda has multiple factors in its favour when it comes to Coronavirus.

Here are 3 reasons coronavirus is unlikely to be as bad in Uganda as in other countries, 3 reasons why Uganda might struggle with the virus, and 3 actions Uganda should take to mitigate the risk.

The BIGGEST REASON why coronavirus will not devastate Uganda

Ugandans are SUPER young

 It’s hard to fathom how young Uganda  is. Half  the population is under 15. Only 2% of Ugandans are over 65 years old and 9 out of 10 are under 50.

To compare this with other affected countries, China and Italy have over 10% of their population over 65.

Coronavirus mainly kills older people. The contrast between the mortality rates of the old and the young is staggering. If you are over 70, coronavirus is very dangerous – you have more than a 1 in 10 chance of dying from the disease, if you are under 50, it’s only 1 in 500.

Death rate coronavirus

So even if the virus becomes widespread here, few people would get severe disease, and far, far fewer people would die compared with current countries ravaged by the virus. Based on Uganda’s demographics, 0.5%, less than 1 in every 200 infected people would die from the virus.

Reason 2: Previous pandemics have spared Sub-Saharan Africa

Africa was the least affected continent (besides Antarctica) in the two most recent viral pandemics, SARS and H1N1 swine flu. We don’t know why exactly, but one factor is that diseases spread by droplets don’t do well in hot, dry conditions. Perhaps the relative lack of international travel here also means less virus is imported. Although coronavirus a different disease, it has a similar mode of transmission to SARS and H1N1 so worldwide spread may to some extent follow past trends.

H1N1 pandemic map

Ref: Swine flu and the current (H1N1) pandemic in humans: A review. Pwaiya et al.

SARS map

Black indicates countries with confirmed death, red countries with confirmed cases.        Created by Maximillian Dorrbecker, using WHO data.

Don’t get me wrong, coronavirus will reach Uganda and will most likely cause a major public health problem, but if this virus follows past trends we may get off lightly compared to countries from other parts of the world

 

 


No. 3 Most people still live in the village

 Uganda is 70% rural. Many people are still in remote villages, and only have sporadic contact with people from town. Yes people move around and there is connections  through market days and visitors from town, but most people in Uganda aren’t packed into busy cities where the virus can easily spread. This means that the virus may spread more slowly, and may be easier control. This factor is weaker than the previous two, and is based on logic and intuition rather than evidence.


Reasons why Uganda might not manage the virus well

1. Lack of government ability to implement plans

It’s ironic that although Uganda has suffered under 35 years of a one-man dictatorship, the Ugandan government struggles to implement their most basic plans. This impotence is caused by understaffed government departments, disorganized bureaucracy and (obviously) corruption. Last year the government threatened to cut phone lines off if people didn’t register their sim-cards. People didn’t take the order seriously for a long time. The deadline for registration was extended 3 times, before the government finally started cutting of some lines.

In China, when the government ordered people to stay at home because of the virus, people stayed at home. If Museveni tells Ugandans to stay at home, it might take weeks for it to actually happen. If roads are blocked to prevent virus spread, “important” people will bribe their way through. If medical supplies are needed in remote regions, corruption and poor supply chain systems will cause huge delays. Government orders and the law aren’t taken seriously, which doesn’t bode well when managing an epidemic


2. The health system (obviously), especially the lack of oxygen

It goes without saying that the Ugandan health system is poorly equipped to cope with current health problems, let alone a new viral epidemic.

One major problem could be the lack of beds with oxygen. Coronavirus kills through respiratory infection. To grossly oversimplify, the virus damages the lungs until they can’t supply enough oxygen to the body. Supplying extra oxygen to the lungs is a crucial part of supportive care in severe coronavirus cases, buying time while the body fights off the disease. Towns of 200,000 people like Lira currently have under 20 hospital beds which can supply Oxygen, nowhere near enough.

3. Co-infection with malaria

Unfortunately if coronavirus does hit Uganda hard it may well be between May and August, the heart of malaria season. We don’t’ know how malaria interacts with coronavirus, but we do know that when pneumonia and malaria combine it can be a deadly combination. Coronavirus both causes a pneumonia like syndrome, and leaves the lungs vulnerable to secondary bacterial pneumonia infections. With over 50% of the population contracting malaria up North here in a bad year, there will be a ton of Covid Co-infection and it could turn ugly.

 

Actions Uganda should take

 1. Don’t waste Money and human resources testing for the virus

There will be the temptation to try and roll out expensive Coronavirus testing facilities across the country. Testing may have some value in the early “containment” phase to track where the virus initially spreads, but after the virus starts to move around the country it will be an exercise in futility to test everyone with a runny nose. Uganda doesn’t have the money, expertise, or infrastructure to track the virus real-time around the country in the same way as countries like England or China.

This global pandemic isn’t like an Ebola outbreak, where experts from around the world and tens of millions of dollars descend on the affected country to track and manage the virus. As the whole planet is affected at the same time, Uganda will have to manage this largely alone, and they should focus their efforts on fundamental public health measures and treating sick patients rather than virus testing. Unfortunately I doubt this will happen, and a lot of money and human resource is likely to be wasted on futile efforts to test for the virus and track the spread.


2.
Supply More Oxygen to hospitals

Oxygen is a key resource to support patients who are critically ill with the virus and Uganda doesn’t have enough for their current illness burden, let alone for coronavirus patients as well. If the virus does take hold, Uganda is going to need more beds with oxygen. There may only be a few weeks to prepare now, so we should start buying now. Every empty cylinder in Uganda should be filled, and other oxygen production devices like concentrators should also be purchased. Uganda needs to stock up in a big way, and start transporting the extra oxygen to rural hospitals as well. Ugandan hospitals need more oxygen anyway so even if the virus doesn’t hit in a big way, it’s not like the money will have been wasted.


3.
Break connections between “town” and the “village”

70% of Ugandans live rurally, in clusters of households on subsistence farms. Many of these people could be protected by minimizing the movement of people between towns and villages. Simple measures could be taken. Only allowing food and commodity supply vehicles to travel on main roads, while cutting off public transport would be one simple way to slow virus spread. Uganda has a huge advantage in that most people are largely self-sufficient and produce their own food, so cutting off the town from the village for a month or two wouldn’t be dangerous.

All things considered, coronavirus may not devastate Uganda to the same degree it will other countries. Feel free to share you own views and questions!

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5 Responses to Why Coronavirus won’t devastate Uganda

  1. Sara says:

    Nick, I read an article on BBC Swahili (I don’t know if the article is on the English version too) which said some drugs are being tested against this coronavirus, including chloroquine. Maybe that will be a solution to co-infection with malaria – treat both at once with the same drug?

    • ntlaing says:

      Hey Sara wouldn’t that be amazing! Although there’s some early lab work showing chloroquine activity against coronavirus, it’s a long long way from becoming a treatment. Unfortunately here in Uganda malaria is resistant to chloroquine so it wouldn’t work as a dual treatment. Imagine if it could be though!

      • Sara Sytsma says:

        Bummer! Maybe it will be doubly helpful in some other country. I also just finished a book on the Influenza pandemic of 1918 and apparently some desperate people tried treating it with quinine, to no avail.

  2. Pingback: Uganda closes schools – before Case no.1! | Ugandapanda

  3. Pingback: A Sub-Saharan African Miracle? | Ugandapanda

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