All around Uganda, people with asymptomatic and mild coronavirus are being locked up in “isolation facilities”, which achieves nothing and endangers the health of both those with coronavirus and the medical staff looking after them. This must stop now.
This is more than just a blog, it’s a plea to the WHO and Ugandan government to stop abusing the human rights of innocent people with coronavirus in isolation facilities around Uganda. People with no symptoms or mild symptoms should be immediately released from the forced isolation centers around the country. In particular the hazardous Namboole stadium which could hold over 1000 people inside should be immediately closed, and the poor people allowed to isolate safely at home
I’m calling out the WHO specifically, because they support the “institutional isolation” initiative both passively through their institutional isolation policy, and actively through membership on the Uganda National Task Force, the body which has instigated this policy in Uganda. The WHO should know better than this, and should not be supporting the policy but rather actively campaigning to stop it. There are at least two fairly obvious reasons why institutional isolation is such a disaster here.
First, the isolation centers are useless, because they don’t slow the spread of coronavirus in Uganda. Second, those with corona are put at higher risk of complications and death and Third, this policy unnecessarily burdens and endangers healthcare workers.
1. The Policy Is Useless
Call me captain obvious but any policy designed to reduce coronavirus spread, should meaningfully reduce coronavirus spread. Nowhere have I seen the flow of thought as to how this policy can help the coronavirus situation in Uganda. Perhaps the WHO and Ugandan government wants to appear like they are acting, even while said action is useless. At first thought, locking people up with corona seems like it should help stop the disease spread but it doesn’t take much investigation to reveal that nothing is achieved.
The reason institutional isolation achieves nothing in Uganda, is because the vast majority cases in Uganda are still out there in the community and never get tested. This is because the number of daily tests in Ugandda is only enough to capture a small percent of all coronavirus cases. Uganda averages around 3500 tests daily, which has barely changed in the last 2 months even as the outbreak has exponentially grown. it’s difficult to secure a test even for sick patients with typical symptoms. As a doctor I’ve failed twice to secure people tests, even while they were sick with typical symptoms. If anyone at home has typicalsymptoms and wants to test, there’s no pathway to a test unless you have lots of money.
Isolating a small minority of cases in quarantine is therefore a pointless endeavor, when most people with covid have never been tested. It’s impossible to accurately estimate the tiny percent of cases that actually test positive here, but I’m going to try. To estimate the proportion of those with covid who are actually testing positive, and being locked up we need to know the daily deaths and mortality rate of coronalvirus.
The ministry reports the number of daily deaths. This month in Uganda, we’ve had on average 1.3 deaths a day reported in Uganda. There will certainly be some covid deaths not picked up, but I’m going to be conservative and use the ministry’s official figures. The mortality rate however is harder to guess, so we’re going to have to rely on surrounding countries. Sub Saharan African countries have a super low Covid mortality rate, which has been estimated in these 3 countries below based on the percentage of the population which has covid antibodies when randomly tested. We haven’t yet had a similar study in Uganda.
|Country||Estimated cases||Mortality||Cases per death|
South Africa has high rates of obesity and demographics nothing like Uganda, so Malawi and Kenya are far better comparisons. These studies do have major flaw and in my opinion (for Kenya and Malawi at least) underestimate the mortality rate, but they are the best data we have. I’m going to be super conservative, and assume that the mortality rate here could be as high as 10 times that reported in Kenya, which means for every death we would expect 2000 cases. That means with 1.3 deaths per day, at minimum there are 2600 cases of coronavirus every day in Uganda. We currently test around 200 positive cases daily in Uganda, which means that over 90% of people who catch coronavirus in Uganda are never tested, and are out there in the community spreading the virus.
So under 10% of people with coronavirus are actually tested, the rest are out there spreading.
And that’s where Ugandas policy comes in – forcibly isolating under 10% of cases. This achieves close to nothing, as over 90% of the cases are still out there freely spreading the virus
I’ve represented this tragedy visually below.
So the entire purpose of the institutional isolation – to stop virus spread is futile. It’s bad enough sacrificing your time and freedom to help the country stop a virus spreading, but far worse that the sacrifice of the poor souls in isolation achieves nothing
It’s not like the Ugandan national taskforce doesn’t know this. Today Dr. Kobe, Ugandas Covid-19 “incident commander” estimated that 85% of coronavirus cases are never tested in the community, which is similar to my estimate of over 90%. Given that the MOH, WHO and Uganda coronavirus ask force know this, it’s bizzare and unconscionable that they continue to lock people up for no reason.
2. Isolated patients could catch worse illnesses
It’s bad enough that their sacrifice is for nothing, but putting a whole lot of patients who aren’t very sick with coronavirus in a room together is worse than useless – it’s harmful. Secondary infections like TB (not uncommon in Uganda) and pneumonia can spread from patient to patient, especially while their lungs may be more vulnerable while they have corona. There’s no question asymptomatic and mild corona cases would be safer at home then this room in Namboole stadium, Uganda’s largest isolation center
“Do no harm” is a fundamental part of our Hippocratic medical oath. Us medical professions should not for any reason harm further those who are sick. The Ugandan isolation centers violate this fundamental principle, and put those with asymptomatic or mild corona at higher risk of life threatening infections – collateral damage of a useless policy
3. Endangering Medical staff.
Not only are people with coronavirus put at risk of catching secondary infections, but medical staff all around Uganda are forced to babysit these people who aren’t sick, and therefore risk catching coronavirus as well. This has many negative consequences.
1. Medical workers catch corona. Already 4 medical workers who were associated with isolation facilities have died of coronavirus. Just yesterday, a nurse at Kapchorwa hospital died because they probably caught coronavirus from someone with corona who they isolated in the hospital. Medical staff are our most valuable health resource and putting them in harms way for no gain is both unfair on the staff and just plain stupid..
2. Health services suffer. After 50 staff tested positive and one nurse died at Kapchorwa Hosptal, they have closed the whole hospital. This closure makes no sense. If all hospital staff in Uganda were tested, some staff would test positive at most hospitals across the country. The risk of spreading coronavirus is nowhere near as high as the risk of closing the hospital and stopping lifesaving services. Even though a nurse has died, the healthcare fallout from closing the biggest hospital in a region where health services are already massively stretched will be enormous. More than 1 person will die because of the closure. This is just one example of health services crumbling under the weight of a nonsense policy
The end result? Human rights abuse
Forcing coronavirus patients into a harmful situation to achieve nothing, is human rights abuse. These poor people with corona who aren’t even sick are removed from their families and put into open wards with many patients, while their children and families receive zero support.
The WHO (and others) are supporting the Ministry of health to abuse the human rights of Ugandans.
And it needs to stop now. It needed to stop a long time ago
Ths Solution is easy. Do what the rest of the world is doing – isolate people at home. As I’ve already shown, isolating people with Covid doesn’t achieve meaningful results anyway, but if the WHO and MOH want to feel like they are doing something to “control” the virus, then they could regularly call people, or even visit people at home to make sure they were complying with isolation.
I’ts my plea to the WHO and Ministry of Health to stop this policy now, and halt this strange and unnecessary episode of human rights abuse. I’ll send this blog to organisations that are supporting MOH efforts, and you never know – someone might have a heart and respond.
NB anyone is keen to follow up with me (Nick) about this, I’d love to hear from you though the blog contact form.