Volume 1, Nov. 2020

MAGAZINE PRESIDE

COVID-19 in Is the Science Working?

Volume 1, Nov. 2020 1 © PRESIDE Magazine A4 Magazine Ad.pdf 1 10/11/2020 17:04

CONTENTS We cannot Afford to Lag Behind in Science and Technology 6 Again

C COVID-19 IN UGANDA: Is the Science Working? M WRITERS: 8 Y • Dr. Monica M. Musenero Combatting COVID-19: Uganda’s race against the CM • Prof. 13 Clock MY • Dr. Sheila Balinda

CY • Prof. William Bazeyo Safely Operating Schools amidst COVID-19 CMY • Dr. Serukka David 16

K • Brenda Ayugi Ojara • Eric Mwima Uganda has potential to develop COVID-19 Vaccine • Dr. Jeremiah Twa-Twa. 19 • Dr. Maxwell Otim Onapa • Brenda Nakazibwe 22 Epi Tent -The Tent That Breathes • Abel Wilson Walekhwa • Mary Nantongo Lukenge 25 The Science of the Mask EDITOR: • Paul Watuwa Timbiti Does Uganda’s health system have the capacity to 28 treat COVID-19 Patients? CHIEF EDITOR: • Dr. Charles Wendo 30 A balanced diet means more life against COVID-19 COMPILED BY: Ministry of Science and Technology and PRESIDE partner • Cathy Muwumuza 23 to support COVID-19 Research and Innovation

CREATIVE DESIGNER: What do COVID-19 Statistics mean? • Gilgal Media Arts 35 PUBLISHED BY: 37 Ask Doctor PRESIDE! The Presidential Scientific Initiative on Epidemics Want to take a COVID-19 Test - Where do I go? (PRESIDE) 39 2 PRESIDE Magazine Volume 1, Nov. 2020 3 Dear Countrymen and women,

have the honour to welcome you to the first issue of this quarterly PRESIDE magazine. It is a publication whose pages we have pervaded with exciting views and other Ieducative materials on the theme that was appropriately chosen given the current pandemic of COVID-19, but also cognizant of the International Science Day approaching on 10th November 2020, that will also be celebrated here in Uganda and you cannot wait to learn more about it.

I know you are anxious to learn about the theme for this Editor in Chief issue; interestingly, it is COVID-19 in Uganda. Is science working? You should explore this in our exciting articles Dr. Charles Wendo well thought out by our own experts. [email protected] We bring you Dr. Monica Musenero Masanza, the senior presidential advisor on epidemics (SPADE), who answers some of your questions every Saturday in The Saturday CPHL Ad Vision. In this issue, however, you have the chance to learn more about her works, including her vision for science in Uganda.

The magazine has also been mellifluously packaged to bring you an extensive coverage of how Uganda successfully ran the COVID-19 race, subsequently getting recognized by Lancet among the best performing countries in the COVID-19 fight.

Lastly, body immunity being crucial in resisting COVID-19, we bring you exciting and exhaustive information on how to boost your immunity through nutrition, but also where to go in case you would like to do a COVID-19 test in Uganda. You can only miss this if you must.

Would you like to know more about PRESIDE? Read more and watch out for more releases moving forward.

I remain your editor in chief.

4 PRESIDE Magazine Volume 1, Nov. 2020 5 MESSAGE From H.E. Yoweri K. Museveni

We cannot Afford to Lag Behind in Science

and Technology Again and technology again. We must cure the original sin of backwardness which contributed to our being dominated by other superior races and ravaged by nature.

he major factor for the evolution of our With these unique capabilities, man was able to I am glad to note the great scientific awakening in Uganda in the various fields. This is a significant species, homo sapien, as the most dominant invent fire, agriculture, iron tools etc. Each of these achievement because we are beginning to see our scientists emerge with locally developed solutions to creatures on earth is that we developed the inventions significantly improved man’s quality of the challenges we face. Tcapacity to tame nature. This meant that finally, life and also enabled us to live longer. we were able to free ourselves from the oppression While other parts of the world continued to subdue This is the path that we must take and the NRM Government will continue to support our scientists of man by nature in the form of floods, drought, nature to serve their interests, the Africans remained to further research and product development. As the human race enters the 4th Industrial Revolution diseases, landslides, famine etc. Man’s uniqueness stagnant at the initial inventions of early man. We of Artificial revolution, let us not again make the terrible mistake of remaining mere spectators like lies in his ability to establish dominion over nature missed out on the first industrial revolution which our ancestors. through conscious actions. ushered the change from a reliance on muscle power to machine power. We were again spectators in the There are three special features which enabled us to second industrial revolution, which was the invention have meaningful impact on the environment. These of electricity. We also missed out on the third include: possession of a large brain, a hand that could industrial revolution which involved automation of hold and shape tools and bipedalism or walking on machines. Our failure to participate in these three Yoweri Kaguta Museveni two legs, which fact freed man’s head to think better industrial revolutions was a big disadvantage on our President of the Republic of Uganda and his eyes to see far. On account of these, man was part. It meant that we remained backward in terms of able to think of solutions to the problems he faced science and technology. and to make tools that could assist him to satisfy his needs. Therefore, we cannot afford to lag behind in science

6 PRESIDE Magazine Volume 1, Nov. 2020 7 will then attempt to show evidence of whether it is Strategic Level – Presidential, working or not. Prime Minister and Minister’s Over the past two decades Uganda has trained both Advisory Scientific Team locally and in foreign institutions and this has built The national response is coordinated by His a considerable human resource pool covering a wide Excellency, the President of Uganda, who chairs COVID-19: range of scientific expertise. Ugandan scientists have the National COVID-19 Task Force with overall participated in many research projects both here responsibility for the broad policy decision making. and internationally. Uganda is also well known for The agreed policies are presented to Cabinet for Is the Science her highly proficient epidemic response workforce debate and if passed, are adopted for implementation. which has prominently supported international The multi-sectoral operational coordination is done Working? epidemic response efforts whenever called upon. at Prime-ministers level. The president appointed a However, until this COVID-19 pandemic, many of Senior Presidential Advisor on Epidemics (SPADE) these experts, especially those embedded in academic who permanently works with him in collaboration institutions had not been called upon to actively with a team of experts to provide scientific advice Dr. Monica Musenero Masanza participate in the previous national epidemic control to that level of decision making. The SPADE also Senior Presidential Advisor Epidemics & Chair, efforts. supports Prime Ministerial level and other sectors in PRESIDE their decision making in the context of COVID -19.

Why Science and Scientists? At sector level, the Minister of Health appointed the ganda’s ongoing battle with COVID-19, knowledge in the form of testable explanations and As COVID-19 spread from China and threatened Scientific Advisory Committee, consisting of a team has put an unusual limelight on her hitherto predictions about physical life. Therefore a scientist to reach every country in the world, it became of experts drawn from various institutions, chaired hidden scientists. Science and scientists have is an individual well versed with at least one branch apparent that each country would have to strongly by Professor Misaki Wayengera, from Makerere Ubeen repeatedly referred to by His Excellency the of science. rely on her indigenous scientific human capital to University, to advise into the multiple aspects of President during his national addresses. The Minister control the disease. Unlike the other recent severe the technical response. They undertake extensive of Health has often appeared with scientists besides Uganda’s COVID-19 response has been anchored but geographically restricted epidemics such as the synthesis of all information emerging from ongoing her while updating the public about COVID-19. in Science where all key decisions have been made in West Africa and DRC, where international research globally and thus ensuring that each and Scientists themselves have been quoted or appeared through critical scientific analyses by experts in agencies such as the World Health Organization every intervention is backed by scientific credibility in various media guiding the public about various multiple areas. Various aspects of science have would globally source experts to support affected to the best of available knowledge. Responsibilities issues related to the pandemic. In addition, during been applied to the designing of field interventions countries, for COVID-19 each and every country have included, recommending diagnostic tests, this period, His Excellency has repeatedly appealed (), diagnosis (Laboratory science), would need their experts. strategies for field containment, treatment protocols, for improvement of emoluments to scientists at the case management (infection control and clinical as well as analyze potential impacts of specific various levels of service. management), testing new drugs (clinical trials), Secondly, being a new disease, there were no ready to actions on the disease trajectory in the country. The risk communication, and research to develop new use standard guidelines. Hence, the country needed team is also responsible for supporting the Ministry Scientists have been both praised and castigated by diagnostics, treatments, vaccines, and tools that local experts to read and interpret the large volume of Health in the generation of the wide array of the the public for what has been perceived to go well or reduce infection such as hand sanitizers and many of primary research publications coming out daily now famous Standard Operating Procedures (SOPS) not so well respectively. more. In my view, this is the first time there has been and translate into response actions in real time. to ensure the public is safe. such a direct engagement of a wide mix of national Moreover, it was imperative for each country to The fact is that the COVID-19 pandemic exposed to scientists in an ongoing public health emergency. contribute to the body of knowledge to support the the wider policy maker fraternity as well as the public, Whereas participation and advice have been global response. the secret behind Uganda’s successful track record received from international agencies, by and large against dangerous epidemics. While previously they the COVID-19 response has been led by Ugandan Lastly, given the wide scope of actions required to worked behind the scenes, the magnitude of the scientists. effectively respond to a pandemic of COVID-19 COVID-19 pandemic required the whole of society magnitude, it was prudent to recruit scientists to including deployment of the back-end workforce – Given that the country has been grappling with support the strategic and policy making levels, so the scientists. Actually there are many more scientists COVID-19 since March 2020, the question to ask the technical staff within the Ministry of Health working in the background in laboratories and the ourselves is – “Is the science working?” Or in other response can focus on technical and field execution. treatment centers than have been seen. words, “has the version of science implemented by The scientists were deployed at multiple levels of the Uganda been effective this far? How can we tell? response as described below: The word science (from the Latin word scientia) How are we adjusting as new scientific evidence literally means “knowledge” or to know. It is the emerges? In this article, I will try to explain what systematic enterprise that builds and organizes type of science has been applied, how and when. I

8 PRESIDE Magazine Volume 1, Nov. 2020 9 Operational Level - The Incident in interpreting the results and outcomes in the field. Uganda’s approach delayed as well as slowed the tools have heavily weakened the envisioned impact The pillars include Surveillance, Laboratory, Case spread of the virus through to the population and in some cases resulted into opposite outcomes. Command System at Ministry of management, Infection Prevention and Control, especially at a time when the country had limited An example is the adoption of the face coverings Health Social Mobilization and Community Engagement, capacity to protect health care workers, diagnose and (masks) as a tool to control spread of the virus. Logistics, Security and Finance. treat it’s citizens. Whereas in principal the mask is a powerful public At operational level, the Incident Command System tool with potential to cut the rate of infection by up (a section set up in the Ministry of Health with It is worth noting that despite the considerable Probably one of the most significant outcomes of to 80%, the actual impact is quite low due to weak nationwide reach) has multiple pillars which deliver this approach, with significant long-term impact adoption. This gap can be partly blamed on the age- the service (See figure 1). Each of these pillars amount of time and effort required, this array of scientists is mostly composed of volunteers without has been the awakening of the scientific community old weakness of communication between scientists has a team of experts specializing in that field to which had largely laid dormant in academic and and society. To improve science for and with society, support in the design of the methods used as well demanding pay. They frequently hold meetings to streamline the response. research institutions to focus on solving national this gap must be bridged. problems. The other challenge results from the need to balance In March 2020 we woefully watched the virus the hierarchy of the population’s felt needs versus the approach amidst lack of basic tools to protect the benefits of science which may take time to become public and health care workers. visible. For example, while scientifically lockdowns work to interrupt COVID-19 transmission, the Diagnostic tools, personal protective equipment, crippling effect on people’s ability to make a living. sanitizers, medicines, and many more were in short This has rendered some of the scientifically sound supply globally and yet national capacity to produce Standard Operating Procedures (SOP’s) ineffective was almost at zero. With the engagement of some in actually slowing transmission. Similarly, the scientists, the country was able to quickly turn social, cultural and political drive in society must around some of these issues. With the urging of the be fully considered for the science to work. To be President and support from scientists, multiple local more effective, the science must expand to include manufacturers repurposed or set up new production experts in the social and political domains. A gap lines to produce essential pandemic response tools. in communication between scientists and sections Research laboratories started producing their own of policy makers, especially parliament and local sanitizers many of which have been commercialized governments has also been observed. Figure 1: Pandemic Incident Management System and for the first time the country has been able to export some of these products such as PPE and For the science to work there must be timeliness in What are the results now? sanitizers internationally. This is pro-activeness implementation of interventions. Frequently there Whereas it is too early to give a final verdict, current The Lancet COVID-19 Commission on the by scientists, even without external funding in have been significant time lags between the science evidence shows that Uganda’s approach to the occasion of the 75th session of the UN General unprecedented and if well nurtured is likely to turn recommendations and implementation resulting pandemic is yielding results. Apart from the evidence Assembly, ranked Uganda’s response among the top Uganda into a hub of locally produced scientific from tortious procedures in operationalization of from trends shown, there has been international 10 countries globally and the best in the African products. policies, procurement or funding. Such time lag recognition of Uganda’s efforts in response to region. This is an achievement despite the multiple nullifies the envisioned benefits. For example, the COVID-19 (See Figure 2). challenges the country has to overcome. Significantly, the launch of a Presidential Scientific delay in provision of face masks to the public greatly Initiative (PRESIDE) partnering with other reduced the impact of the tool in slowing disease stakeholders, provides a platform to fast-track spread especially in . mobilization of scientists to plunge into local research and development of epidemic response tools Conclusions and is poised to change the country from a consumer to a Recommendations contributor of solutions. From all evidence, it is quite obvious that Uganda’s What did not work so well/needs decision to adopt a scientific approach, coupled improvement with strong political support to the COVID-19 pandemic response has borne results. The spread of Figure 2: Uganda Ranked Among To present an all-glossy picture would be ingenious. the virus was not only slowed, giving time for the the Top 10 Countries Globally by Whereas scientifically guided recommendations have country to prepare. The engagement of scientists the Lancet Commission been continuously made, the actual adoption has has bolstered national confidence to not only fight greatly varied. Low levels of adoption of scientific this pandemic but potentially altered the positioning

10 PRESIDE Magazine Volume 1, Nov. 2020 11 of the country in the region as a hub for scientific scientific approach with strong political and financial expertise and products. We have also identified areas support, since COVID-19 is going to be a significant that require strengthening including communication consideration in all sector planning and operations and engagement with society throughout the in the country at least through the first half of 2021. scientific cycle so that both scientists and the public More emphasis should be put on engagement and can benefit more. communication between scientists and the rest of Images Forster/Getty Credit: Stu Photo society, making products of science more visible and As COVID-19 continues to affect global public incorporating more social, political and economic health and economies, it is only prudent that scientists to strengthen the linkage with society. Uganda moves to further consolidate her winning Combatting COVID-19: Uganda’s Race against the Clock

Vinand M Nantulya, MD, PhD, FRCPath Vice Chair-PRESIDE / Senior Presidential Advisor, Vaccines and Therapeutics

hen the COVID-19 outbreak began to emerge as a global crisis, countries around the world were forced to react and prepare for a potential outbreak within their borders. For many, closing their borders was an immediate solution, but for Uganda, it was a measure to buy time for a scientificallyW sound public health approach composed of multisector strategies.

Uganda has successfully employed Democratic Republic of Congo health outcomes needs to take various approaches to respond via the Mombasa Port in Kenya. into consideration the situation to epidemics time and again. Hence a useful discussion on in the neighboring countries. Uganda is a landlocked country that shares borders with Kenya to the East, South Sudan to the North, Democratic Republic of Congo to the West and Rwanda and Tanzania to the South. These colonial borders are extremely porous, with similar ethnic communities and families living on either side of the artificial border lines. Moreover, Uganda depends on long-distance cargo trucks to ferry, by road, imports and exports via the Mombasa Port in Kenya.

The country is also bound by international law to allow cargo trucks delivering imports into, and exports from, the countries further in the interior, especially South Sudan, Rwanda Figure 1: COVID-19 Timelines in Uganda (Adopted from Ministry of Health) and Eastern regions of the

12 PRESIDE Magazine Volume 1, Nov. 2020 13 2.6 Comparative analysis of progression of COVID-19 pandemic in Eastern Africa Drawing on experience gained from combating progressed to phase 4 in some parts of the country. HIV/AIDS, Ebola, Marburg and many more However, with enhanced community education, epidemics, Uganda acted quickly in its battle use of masks, social distancing measures this helped against COVID-19. The response was guided by the country to cautiously begin to experiment into other steps including and this set in the response science and it was chronological and in phases for Figure 5: COVID-19 strategies from focus on prevention to mitigation example; pandemic analysis like no more quarantine, no mandatory isolation Phase 1: Before entry of the virus in leaving hospital beds for the critically ill cases acrossborder: East the country which helped the country to have low deaths and Africa Three days prior to the detection of the first case, manageable numbers, partial opening of schools, the country had to imposed a 21-day lockdown for churches, mosques in a bid to co-exist with the specific sectors. Public transport was suspended, virus to avoid catastrophic effects. schools and higher institutions of learning were (Adopted from Ministry In the context of general elections, through the of Health) closed, social and religious congregations were applied science there has been design of scientific suspended, non-food stores were closed, bars, elections, though there has been evidence of Lessons for other Low-Income For instance, 373 (48%) of the 774 positive cases nightclubs and restaurants also closed, and a curfew violations there is general cautiousness and imposed to ensure compliance to the prevention Countries diagnosed in the first 3 months of the response were awareness in the populations. truck drivers, mostly from neighboring countries. guidelines. The airport and border crossings were The Uganda experience offers important lessons Given the frequency of epidemic threats in the also closed. Individuals entering the country were The current control goal in the response is to for other low-income countries. The first lesson region, it’s urgent that a framework on Regional subjected to mandatory quarantine for 14 days and maintain the number of cases below the bed capacity is to focus on a public health approach to prevent cooperation dealing with cross-border transmission screened twice for COVID-19 and discharged only in each level of care (general, high dependance and transmission of the infection through early intensive care units) such that the system is not is institutionalized. on negative test results. Contacts of those found diagnosis, committed tracing of contacts of infected overwhelmed. To optimize the limited resources positive were followed up. cases, isolation of infected individuals, and early such as high dependence and intensive care beds The fourth is to beware of the negative influence of clinical management of those infected. Every effort In addition to this detailed response, regular press and diagnostic facilities the country set up an politics. Uganda’s general elections are scheduled for needs to be made to keep the number of cases low briefs that shared updates on the crisis as well as best exemplary referral system that extends services to January 2021. The experience from the campaigns to avoid the health system being overwhelmed by a practices were implemented. These information even those in remote settings. during the various party primaries with candidates sessions, led by the President, presented a unified huge number of cases. To prepare for the community mobilizing their supporters exposed the difficulty voice with guidelines given to the public on actions In addition, the second goal is early identification, phase of transmission, strategy and guidelines in enforcing standard operating procedures (SOPs) to be followed for self- protection. referral and treatment of those at and with risk of should be in place for self-isolation and care in their including social distancing, wearing of face severe disease. The country also gives free services to Phase 2: Imported cases and limited homes for patients who are asymptomatic or with masks, and washing of hands under political rally her population including diagnostic, referral, care minor symptoms, and to reserve for quarantine in conditions. At this stage, the country closing of borders with an and treatment. designated health facilities only the patients with aim of avoiding the importation, so those who were Phase 4: Uncontrolled transmission severe disease and those with co-morbidities. The effect of political activities shows on the out of the country were blocked, so few came back. Ugandan trend of cases starting September/October In land boarders like Malaba, Elegu and others were The country through the leadership of H.E the The second lesson concerns attention to the 2020 as it also exposes the higher risk group, also closed on the same fact. president of republic of Uganda has ensured that community factor. Effective communication and encourages mixing of people from different parts of the curve is flattened and the health system doesn’t Phase3 : Community transmission engagement of the community is crucial and it the country. This is undermining the gains made in get overwhelmed. Recently the country was ranked needs to be maintained through a community the early phase of the response. It is highly desirable, Along the battle of COVID-19, the country made as the best performing country in Africa and 10th engagement strategy. This is vital if the public therefore, that policy makers like ministers, MPs, tangible progress for five months with the curve worldwide in the fight against the pandemic. Great is to remain committed to observing the simple RDCs, LCV Chairmen and other Local Council flattened and preparations made like preparing applause to Ugandans who believed in the scientific prevention guidelines in the face of hard economic leaders observe and promote compliance with the treatment centre like Namboole, equipping regional response to COVID-19. circumstances brought about by the lockdown and COVID-19 guidelines and standard operating and national referral hospitals, risk communication attendant misconceptions that may arise about the procedures issued by the Ministry of Health, at all intensified, training of health workers, production Phase 5: Recovery pandemic. Here a clear voice of the country’s highest times as they go about their campaigns. of facemasks, production of sanitizers and other The country has made progress in this particular phase where by a total of 7,887 (62%) cases have authority is essential for engaging all stakeholders efforts, the country began to strategically open up The fifth lesson is there is need to customize recovered from the disease and efforts are still to reinforce the key messages. sectors to ensure continuity of business and services. various guidelines per groups/categories of people underway in this phase. All this is guided by science. As planned and after achieving the intended The third lesson is the need to pay attention to which could regulate cultural activities including preparations but also after prediction of the economic Health Outcomes cross-border transmission. The issue of cross-border circumcision, marriage functions. disruptions due to the lockdown measures, the The results of the first 5 months of implementation cargo truck drivers as a high-risk group drew the country towards the end of July 2020 started partial of the response are summarized in Figure 1. The country’s attention to the danger of cross-border Acknowledgement lifting of lockdown on public transport systems and figure shows that the curve for cumulative number transmission. As the screening of truck drivers The author acknowledges Prof. , other business activities as expected this ushered in of cases for Uganda had remained relatively flat and intensified, large numbers turned out to test positive Abel Wilson Walekhwa and Gloria Nantulya for the third phase (community transmission) which with low numbers compared to the neighboring and the numbers dramatically continued to rise. valuable comments on the manuscript. countries. 14 PRESIDE Magazine Volume 1, Nov. 2020 15 Safely Operating Schools amidst COVID-19 Photo by: Xinhua by: Photo Eric Mwima is a research associate and Management Specialist, Dr. Twa- Twa M. Jeremiah is a consultant and former member of parliament.

he eruption of corona need to ensure that the students’ diet is balanced, virus affected almost every Photo credit: UNICEF/UNI330896/ Frank Dejongh This is only possible if the stakeholders; the students, no outsiders mix with the students unless they are sector of society, including teachers, administrators, parents, government, local isolated for the mandatory number of days and Teducation institutions which were authorities, and communities play their roles well in school visits discouraged. The closure, although not a permanent decision, has greatly the control of the spread of the disease to and from closed and opened recently, but affected all stakeholders; the learners have lost time, school school. These are summarized in the what-to-do and In addition, schools should create electronic for only candidates and finalists. owners have lost income, teachers have lost income and what-not-to-do in schools. platforms for communication with the outside Running a school in these times is suppliers have lost business. certainly difficult and schools, writes environments, set up routine surveillance and The school administration needs to assess the level reporting mechanisms, place check points at Eric Mwima and Dr. Jeremiah Twa- This loss of income has certainly had a ripple effect on other of risk in their school environment by identifying the entry points, and have isolation facilities for Twa, must strictly follow established sectors of the economy, necessitating, that schools be opened the potential risk places, activities and vulnerable suspected cases. preventive procedures to keep the and run as safely as possible. learners safe. members. Having a well-equipped first aid facility, and However, the necessity to open schools has pushed people After identifying the risks, administrators should trained psycho-socio support people to respond to The corona virus forced most into asking whether it is a wise move to open up schools, and know what measures need to be put in place to psychological challenges that may erupt in the school countries in the world to close places whether it is safe for the children. of congestion and congregation, address the identified risks. Teachers need to support at any moment, are the other must-have measures. the administration in enforcing the standard In educational institutions, day schooling is a risky including schools. In Uganda, the These and many others are all critical questions worth answering. operating procedures (SOPs). factor; it promotes transmission of the virus among education sector is the biggest with Firstly, all epidemics end with time. The precaution is to ensure children from homes to school and vice versa; and over 15 million learners and the that we do not end with a very high cost in terms of life. Similarly, students need to ensure personal safety transmission on the way as they move from home biggest employer. That is why blocking entry, protecting the vulnerable and by properly and consistently using face masks, keep to school and vice versa in public transport systems. controlling the spread in the communities are critical. physical distances, and ensure personal hygiene by Crowding is another risk factor in big schools where The closure of schools did not Furthermore, we cannot close schools and the country forever, consistently washing hands using water and soap. social distancing, monitoring and enforcement of only limit overcrowding and other because epidemics have a cycle they follow. risky situations, but also enabled hand washing and respiratory hygiene are difficult. It is not wise for schools to allow students to use Performing medical procedures like tracheal the government to understand the The people and the economy need to survive and children need and keep alcohol-based sanitizers to avoid the risk of intubation during anesthesia and sputum induction, problem and develop appropriate to learn and progress. However, given the fact that schools misuse and abuse. The habit of exchanging personal increases chances of transmitting the virus by response strategies. in Uganda have large student populations and lack basic effects should be discouraged. inhalation to medical students. infrastructure, phased opening was the best way forward. This resulted in minimal spread of the All these are avoidable if the following what-to-do Therefore, parents should ensure that their children and what-to-avoid strategy is followed. virus among school going children How do we avoid the worst scenarios observed in other countries have enough personal safety requirements. Schools (6-17 years) and the youth (18-30 where schools have opened and closed because of increase in years). cases in schools? 16 PRESIDE Magazine Volume 1, Nov. 2020 17 Photo by: Xinhua by: Photo Uganda has potential to develop

COVID-19 Vaccine Dr. Sheila N. Balinda

What To Do overcrowding. Put social distancing markings on Under Dr. Balinda’s Wings Uganda’s COVID-19 ray of hope Flashes the floor or walls of buildings to guide the social Wash your hands frequently with soap and clean distancing process. OVID-19 took the world, Uganda inclusive, by storm to proportions never experienced before, water or sanitizer. Clean and disinfect frequently touched surfaces leaving families, communities and global economies ripped apart, and the global health sector Hand hygiene is the most effective way of preventing and objects with soap and clean water; and/or apply deeply strained. Although its fury has calmed down, the ashes of its destruction are there for all and stopping the transmission of the Corona virus. recommended disinfectants and decontaminants Cto see, and the danger of another same storm or worse, loudly looms around until a vaccine is discovered. Observe respiratory and personal hygiene of floors, surfaces and objects that are frequently However, in an interview with Dr. Sheila Balinda, a PhD holder in molecular virology, focusing on the Cover your mouth and nose with a handkerchief touched. study of viruses, a glimmer of hope flashes through. when coughing and sneezing. All students, staff Stay home when not feeling well with flu-like symptoms. Seek medical care and do not self- and visitors should wear face masks when in the Who is Dr. Sheila Balinda? authoritatively say my research findings can be medicate. Eat well and exercise to boost your body school environment unless medically exempted. useful in future development of diagnostic tests. immunity. Masks are meant to protect other people. Wear a 1 I am a Ugandan “Woman in Science” with extensive clean cloth mask when in public and when sick experience in researching on the diversity of viruses and Apart from the FMD virus research, have with flu like symptoms like fever, cough, sneezing What to Avoid how this influences disease progression. This certainly you undertaken or done studies on other unless medically exempted. Avoid touching your eyes, nose and mouth with provides useful information in the development of 3 viruses? Wear a face mask when caring for a sick person with unclean hands. Avoid hand shaking and hugging. vaccines, drugs and diagnostic tests. flu-like signs and symptoms like fever, cough and Avoid close contact (less than 2 meters) with Studying the FMD virus was actually a gateway sneezing. Wash and iron your reusable masks or people who are visibly sick with flu-like signs and Several scientists have made research on viruses, to studying HIV-1 at the Joint Clinical Research handkerchiefs daily. In the school situation, masks symptoms like fever, cough, sneeze. what makes you unique about the same subject Centre (JCRC), where I was the project manager can be provided by parents or school management. Avoid spitting in public. It is in line with this 2 area? for two HIV-1 drug resistance studies involving Observe physical/social distancing in educational requirement that all stakeholders in the education adults and children. institutions while remaining socially engaged. sector, particularly school management, teachers My career has been unique. I have for over 10 years Social distancing means keeping a safe space between and learners, have to understand, interpret and studied both animal and human viruses, especially Later, I was involved in vaccine research at yourself and other people. The recommended space correctly apply SOPs. foot and mouth disease virus (FMDV), and the the Uganda Virus Research Institute (UVRI), is at least two (2) meters or two arm’s length away There is need for training of education stakeholders Human Immunodeficiency Virus (HIV-1). specifically, at the British Medical Research from other people outside home. Social distancing to build their capacity to understand, interpret and Council/London School of Hygiene & Tropical This has, subsequently, resulted in over 20 papers Medicine (The Unit). Our work at the Medical means no handshaking and no hugging. Instead, apply the measures appropriately. published in reputable scientific journals. In 2011, Resource Centre (MRC) identified new and encourage use of other forms of greeting like waving It is from this point that school managers and I graduated at with a PhD in cost-effective ways of testing the effectiveness of and verbal greetings. Limit visitors and activities teachers will play a pivotal role in understanding molecular virology, focusing on viruses . My work antiretroviral treatment and the development of involving external groups in schools to avoid and enforcing SOPs in all educational institutions. characterized the Foot and Mouth disease (FMD) HIV drug resistance in Africa. virus serotypes prevalent in East Africa. I can

18 PRESIDE Magazine Volume 1, Nov. 2020 19 What experience do you have in vaccine With all this virus research and vaccine research and development projects? development capacity cited, Uganda has 4 6 not developed any virus in the past, why? In 2015, I joined “The Unit” after a very competitive postdoctoral award by the Despite over 30 years of research, our International AIDS Vaccine Initiative (IAVI) understanding of, for example, how the HIV- in their Vaccine, Immunology, Science and 1 replicates, manipulates and survives the Technology for Africa (VISTA) programme. immune responses of the host is incomplete. This is a global challenge. It is not restricted to Working with colleagues and in collaboration Uganda alone. with scientists from Emory University, USA, and Imperial College London, we constituted Generally, funding has been the biggest a local team of molecular virologists to challenge in advancing science in Africa. identify and characterize HIV-1 transmitted Governments have relied on donor funding founder viruses in Uganda for future vaccine whose priorities may not necessarily be those of development. Africa or Uganda specifically. This has been the biggest setback for African scientists. In 2019, I was awarded a SANTHE (Sub- For purposes of saving costs, resources investment in the health Saharan African Network For TB/HIV That inadequate funding is the obstacle and urgent need to respond to a and ultimately wealth Research Excellence) path to independence to vaccine development in Africa, does 8 subsisting problem, most donor of its people. It is worth fellowship to further advance this HIV-1 7 that, therefore, mean no research and and government-funded appreciating because quite vaccine work. vaccine development is being undertaken projects have time lines, often, African scientists are faced with by Ugandan scientists in response to has this COVID-19 vaccine challenges of accessing a critical mass of In light of your impressively weighty COVID-19? research and development highly skilled teams and a critical density of experience in virus research, would you say project got a time line or it is an open equipment and funding, commonly funded 5 Uganda is capacitated enough to develop We have not sat back on our laurels; actually research adventure? by the development partners. Therefore, this a vaccine for COVID-19 and other such a lot is going on. I am leading the team that is funding commitment from our government diseases? working on the “novel adenovector COVID-19 Development of new medical technologies, for is a “God send” to the Ugandan scientific vaccine”. The intended vaccine will be example, drugs, devices or vaccines is justifiably a community. We have embraced it and are It is my affirmation that Uganda has the developed from our local adenoviruses (flu-like huge investment of time, effort and finances. In the striving to give the Ugandan taxpayers the potential to develop a COVID-19 vaccine. First viruses) that we shall obtain from Ugandan past, it took up to 20 years for some medicines to results they are anxiously waiting for. of all, there are limitless global opportunities chimpanzee droppings. reach the market. However, with new technology available to do it. Similarly, we have, as a and focused investment, this time has been How about to the women outside country, built our virus research and vaccine Into these adenoviruses, we shall insert the most abbreviated to few years. These are the fruits of the there who may want to be like you and development capacity for over 20 years now. immunogenic portion of the SARS-CoV-2, Coalition for Epidemic Preparedness Innovations 10 reach the highest rung in the sciences, For example in the late 1990s, Ugandan the virus that causes COVID-19. The goal (CEPI) that saw the Ebola vaccines rapidly especially in the medical field? scientists, led by the late Prof. Roy Mugerwa, is to develop a harmless ‘hybrid’ virus that is developed into the market within record time. pioneered the first HIV-1 vaccine trial in capable of causing immunity to COVID-19, It is my invitation to the women and the Africa codenamed “ALVAC”. when administered to a human being. In this specific quest for a Ugandan COVID-19 African girl child to have self-belief. With vaccine, we have planned for 18 months for the self-belief, it is possible for the African Prof. Pontiano Kaleebu, the current UVRI Our team is multidisciplinary and comprises first stage of developing the novel vector (backbone) woman to grow a flowery career in STEM director, and Prof. Peter Mugyenyi, the former senior and young African scientists, including and viral insert followed by trials in animals. (science, technology and mathematics) JCRC director, were part of this team. It is women, to provide for knowledge and skills Our team will then pass-on this technology to the and succeed highly as a woman in science. my argument that these two medical brains transfer through mentorship and capacity veterinarians at College of Veterinary Medicine, Although such possibilities manifest, have mentored and equipped young clinicians, building. Animal Resources and Bio-security (COVAB) to African women in this space are quite virologists and immunologists, to take on carry out further tests in animal models before few perhaps due to historical and social the task of vaccine development in Uganda. It is our hope that our integrated teams from approval for human use. injustices occasioned by patriarchy. It is, Additionally, Uganda, due to these efforts, is UVRI, Makerere University, Ministry of therefore, my appeal to the government to part of global scientific research collaboration Science, Technology and Innovation (MoSTI) Any last message to Ugandans about science continue investing in the Ugandan girl networks through which we have acquired and Uganda Wildlife Authority, will form a and products development? child and women in the area of STEM. equipment and training for personnel. robust foundation to combat future epidemics 9 or similar problems. As a molecular virologist based at the UVRI, I am excited that the government has prioritized this

20 PRESIDE Magazine Volume 1, Nov. 2020 21 The Problem construction of permanent hospitals (with the 6 requirements above) for response to this pandemic. COVID-19 which originated from Wuhan, China, has spread to more than 180 countries worldwide In addition, where the epidemic is widespread; with all the 54 countries in Africa for example, Italy, Spain, reporting cases (WHO USA and other European 2020, Africa CDC, countries, establishment of 2020). fully built isolation units (hospitals) in multiple To-date, the cumulative localities has not proved number of confirmed cases feasible due to severe are over 49,175, 499 with resource constraints and 1,241,912 reported deaths the urgent need to contain globally (JHU live updates, the wide spread of the November 6, 2020). disease.

As of November, 4, 2020, In Uganda and other Uganda had cumulative African countries, it confirmed cases of 13,568 has been reported that EpiTent -The Tent That Breathes and 117 deaths as reported patients seeking care for by the Ministry of Health. other health conditions have abandoned existing The increasing number of health facilities for fear confirmed COVID-19 of being contracting the By Prof. William Bazeyo cases has posed a great COVID-19. RAN Chief of Party/Lab Director challenge to the health systems of all affected This has posed an immense Difficult human conditions throughout human history have necessarily driven innovation and research countries, including high risk to the health systems as a solution to the problems. Innovations such as the discovery or development of the bulb or a plane, income countries. across nations. Due to such would not have been possible if had it not been the urgent need for light or to travel longer distances. constraints and learning With the increasing cases from similar epidemics like in African countries, Ebola, most treatment and there is need to quickly isolation units depend on n the same sense, the global emergency brought Public Health, through the Resilient Africa Network up the health system in temporary structures that about by the Coronavirus (COVID-19) and (RAN), has developed the EpiTent – a re-imagined response to this pandemic, are rapidly deployable – stretched to the limit the response capacity of tent for emergency service delivery designed for hot especially increasing the the tent is the hall-mark of Ivarious countries, has brought about the EpiTent. humid climates. bed capacity. such structures. Globally and specifically in Africa, cases are rising It has two versions: 1) an ordinary version (known Because of the current The Proposed by the day and now, there is an inevitable need for a as the Low-End Version) that provides space requirements for infection large number of hospital beds to accommodate those for a typical hospital ward, and 2) an optimally prevention as outlined Solution who are severely ill. Yet, Africa suffers from immense accessorized version (known as the Portable Hospital by WHO, the standard unit for providing care to The EpiTent is a portable habitation solution for infrastructure gaps and is already overburdened with or the High-End Version). COVID-19 patients requires some essentials, such humanitarian emergencies. It is Humane Emergency many prevalent acute and chronic disease conditions as 1) an arrival/triage area; 2) an isolation ward for Use Canopies and Accessories. that need to be addressed – the current health systems These structures are made from cheap material that is confirmed cases; 3) a treatment ward for confirmed are at the limit. locally available and can be produced by both high- cases, including an intensive care unit for advanced The EpiTent is the result of a call for proposals to end manufacturers and low-end artisans. cases; 4) a PPE dressing area; 5) A PPE removal and improve the lives of caregivers during the West The sudden upsurge in cases justifies the need sanitization area; and 6) staff room/information African Ebola outbreak of 2014. One major setback for alternative means to cope with the need for management office. to current tents in use in Africa today is the heat. hospitalization. Makerere University School of However, majority of the countries affected by the Coronavirus pandemic have other major health EpiTent solves this problem by passively lowering system constraints and are unlikely to afford rapid 22 PRESIDE Magazine Volume 1, Nov. 2020 23 the temperature and use of electricity in by over ten degrees the tents. Celsius more than any other product The provisions include on the market distribution panel today. conduits and trunking The Science system, lighting Apart from cutting conduits and PVC down humidity wiring, a socket system, of the Face by over ninety-five bulb mountings and percent, greatly various other accessories contributing to support lighting. Mask to temperature reduction by over Also, the tent is Dr. Serukka David ninety-five percent, amenable for other uses the tent’s general within the hospital. It ike a blunt object swang or thrown in design allows can be an outpatient darkness, COVID-19 caught us unaware, people inside department, an office hitting us so hard. However, with the benefit greater interaction as well as use in logistics Lof science and expert advice, the face mask, writes carrying the virus and get infected. with the external management. Dr. Serukka David, a senior research associate with Therefore, the main objective of wearing a mask is to environment, the Presidential Scientific Initiative on Epidermics cover your nose and mouth to prevent droplets from while keeping out Although the Epi-Tent (PRESIDE), is one such reliable tool against the spreading from us to other people and vice versa. negative aspects is a temporary structure, virus if properly and consistently worn. like bad weather it can be durable if How do masks help stop the spread of the and airborne pests such as mosquitoes. properly maintained. For example, similar tents were How does COVID-19 spread? virus? deployed in Adjumani in 2017, one of the hottest When an infected person breathes, talks, The main objective of wearing a mask is to prevent The design was tested and was found to protect the environments in Uganda, and they are still intact coughs, or sings, they generate large wet droplets the spread of the virus. If you have infected yourself healthcare workers and patients from contamination and being used to provide care. Even those deployed containing the virus that causes COVID-19. and wear a mask, the mask largely blocks those and transmission of diseases while in admission. It is in are still intact as well. If you are within 6 feet (2 meters) of someone droplets from coming in contact with other people accessorized to allow for hospital use; thus, no need infected, the droplets can land on your eyes, nose when you breathe, talk, or cough. Not wearing a to procure accessories like drip stands and work- The materials used on the tent can last up to 10 or mouth, and infect you, too. mask increases the chances of spreading the virus to tops. For easy rapid deployment and set up, the years. Steel is resilient and tarpaulin requires regular And, if you are physically closer to someone others. tent measures 6X12 meters and we are looking at cleaning with soap and water.. infected, you can breathe in some of the droplets enlarging the design to accommodate more patients. Our tents, which are currently in use in more than Epi-Tent accessories like hooks, bed side tables, 5 regional hospitals in Uganda, including Adjumani, provisions for drip stands and curtain railings Mbarara, Masaka, Gulu, Bombo Military hospitals, substantially reduce the need to put other fixtures among others, can be disassembled, packed and needed for a hospital ward, reducing cost of set up. transported to other places. The tent has two square plates welded onto the RAN, working in partnership with Luwero Industries tent frame system on either end to which speakers, Limited, a company under Uganda People’s Defence and security cameras can be affixed for monitoring Forces National Enterprise Corporation (NEC), purposes. embarked on massive production of these next- generation tents, to respond to this pandemic. The tent also has a disinfector mounting point used Wearing a mask properly also protects you, because it prevents COVID-19 virus-carrying droplets from for placement of the hand-disinfection bottles. reaching your nose and mouth. It also prevents you from frequently touching your nose and mouth. This Many of the places targeted for use of these tents do greatly reduces the virus that can enter your body to cause disease. not have electricity. Wearing a mask limits the transmission of droplets containing virus particles. It also reduces the number However, in the event that electricity is available, of droplets passing through the mask of someone nearby. provisions have been made for entry, distribution

24 PRESIDE Magazine Volume 1, Nov. 2020 25 What is the proper use of a face mask? Are there any types of masks I should avoid? Hold your mask up to the light: If it appears to be a in construction work, are not a good option either. see-through, do not use it. Such masks are probably This includes N95 respirators with exhalation valves. not going to block as many particles as more opaque They completely defeat the purpose of a mask. They Avoid frequently masks or those with more layers. allow breath and infected droplets to be exhaled removing or Masks with an exhalation valve, similar to those used without any filtration. adjusting your mask below the What can we do to maximize the effectiveness of masks? nose or mouth as you talk. The Always clean your hands, either with soap and water If you are using disposable surgical earloop masks, more you use the or an alcohol-based sanitizer, before touching your throw them away at the end of the day or if they mask, the more mask, and try not to touch the outer part of it. become wet. Cloth masks should be washed accustomed you Remove it with clean hands by the earloop so that frequently, and always use fresh clean masks become. you are not touching the outside, which could be whenever possible. contaminated.

Is there any scientific proof that masks prevent COVID-19 infection? Yes, according to one of the studies by the World properly, we can stop many virus transmission Health Organization, face masks reduced the chances chains. It is also reported that if proper mask-wearing of infection by more than 80 percent. reaches 80% in the community, COVID-19 would be greatly reduced and eventually die out. Another study showed that even a crude cloth covering that is less than 100 percent protective It is also reported that individuals who consistently against the virus could significantly reduce the wear their mask reduce their chance of getting the number of infections, and ultimately, the number of severe disease (variolation effect – resulting in passive deaths. immunity)

If everyone wears their face mask consistently and

What are the best types of masks for my family? The most effective tested mask documented is the virus to escape. unvented N95 respirator used by many frontline health workers who work in highly contaminated Masks with a moldable piece across the nose bridge areas. But you do not need to wear the N95 to get will help shape the mask to the face for a closer fit; protection. they may also help keep your glasses from fogging up. There should be adequate opening for the nose If you and your family wear cloth masks, choose and mouth to allow for breathing and talking. varieties with several fabric layers. Masks should properly fit to the face (cover the nose, mouth, and The bottom line is that any mask that covers the nose wrap around the chin), so as no gap is left for the and mouth properly will be of benefit.

It is not just having a mask that matters, but properly and consistent use of it is what protects you.

26 PRESIDE Magazine Volume 1, Nov. 2020 27 Category of COVID-19 disease severity and where it is handled

A. Asymptomatic and Mild Cases C. Severe Cases Does Uganda’s health system Non-Traditional Isolation Facilities i. Mulago National Referral i. Achwa Power Hydro Dam in Pader District ii. Naguru General Hospital have the capacity to treat ii. Namboole National Stadium iii. Entebbe Grade B Hospital

COVID-19 Patients? B. Moderate and Severe Cases D. Private Hospitals i) All Regional Referral Hospitals; a. Victoria Medical Hospital (UMC) By Brenda Nakazibwe a. Arua b. Medipal International Hospital b. Fortportal When at its commencement the COVID-19 caused seek medical care. c. Gulu Note: Accreditation for these two hospitals is many deaths the world over, a rather opaque state d. Mbarara still underway. of gloom and uncertainty engulfed the entire world. Advisedly, people with pre-existing conditions such e. Masaka as diabetes and heart disease should urgently test to As the number of coronavirus patients in the f. Mbale Pessimists were even quick to alarmingly argue that know their status upon noticing COVID-19 signs country surges, the Ministry of Health is assessing g. Kabale considering the cumulative mass deaths in countries and symptoms, because they are also at a high risk the capacity of private hospitals to admit and treat h. Jinja such as the USA with robust health systems, medical of progressing faster to severe disease. infected persons in order to relieve public hospitals. i. Hoima expertise and high income levels, low-income j. Currently, most private health facilities mainly countries such as Uganda would not have the In the face of the pandemic, the Ministry of Health, k. Moroto focus on case identification and referral of cases to capacity to handle cases. together with support from her partners, has not l. Mubende the designated public hospitals. relented, but put up a spirited fight in the response. m. Lira As fate would have it, the numbers of the novel It is due to this response that the country has coronavirus disease cases have continued to slowly registered a significant number of recoveries from ii) Prison - Hospitals E. Asymptomatic Cases increased since Uganda confirmed her first case on the pandemic. a. Masaka According to the Ministry of Health guidelines, March 21,2020. b. Jinja individuals who test positive for COVID, but are Of the 13,351 total confirmed cases as at 3/11/2020, c. Fortportal not experiencing any symptoms or only mildly sick, In the case of Uganda, which is not unique for most Uganda has registered only 117 confirmed deaths d. Gulu should be managed at home. For more information African countries, different people have presented and 7,981 recoveries. Most of these cases have e. Moroto on home- based care, follow this link; differently with the disease. been managed at public facilities and a few private iii) Other Hospitals https://kso.page.link/wps hospitals that were given the mandate to offer a. Adjumani General Hospital Some remain asymptomatic (no symptoms), others COVID-19 treatment to the different categories of get mild and moderate disease, while some people patients presenting with the disease. progress to severe disease. Most of those who end in the last stage of disease die if not managed fast and What must an ideal COVID-19 Treatment Centre For General Information Contact: properly. have? • It must provide isolation services and bed Health Promotion Advisor Public Information Officer Please contact the The general public should take it as a matter of capacity which is away from the regular patients. Tel.: +256 414 335505 Tel.: +256 414 335569 Ministry of Health importance to ensure that anyone with COVID-19 • It must have oxygen capacity. Cell: +256 772 507906 Cell: +256 786 497073 on a toll-free number: signs and symptoms is tested to ascertain his/her • A high dependency unit (HDU) with patient Email: [email protected] Email: [email protected] 0800100066 or 0800203033 status. monitors. Mwebembezi Edmond • Intensive care facility. Where one is found negative, the person should • The facility should have laboratory testing continue observing standard operating procedures services. (SOPs) such as properly wearing the mask by • X-ray to test the patients and monitor organ Please note that you are not charged any money covering the nose and the mouth, handwashing with functioning and blood. when calling a toll-free number. soap and clean water and physical distancing. And, if So, contact the Ministry of Health any time one is found positive, the person should immediately you need the services.

28 PRESIDE Magazine Volume 1, Nov. 2020 29 A balanced diet means more life against COVID-19

Fighting COVID-19 is as simple as eating and behaving simply Fighting COVID-19 is about dieting and behaving simply Eat a balanced diet and behave simply to fight COVID-19 The body also needs vitamins for protection against • When eating meat, it is better to eat white meat; infections, and minerals to strengthen the bones and fish, chicken, rabbit. By Brenda Ayugi Ojara muscles. • Reduce the amount of salt you consume. The author is a Public Health Specialist with a background of Nutrition • Reduce amount of alcohol taken. and Dietetics. She is a member of the Nutrition Society of Uganda. It has been found that people with a weak immunity • Reduce consumption of deep fried foods; chips, are most at risk and get serious illnesses when infected crisps, samosas, cassava chips. with the corona virus. This, therefore, cements • Reduce intake of foods made of overly refined ating a balanced diet although widely This, therefore, means that the amounts of every the emphasis on balanced dieting, in addition to carbohydtrates; cakes, biscuits, pies, chapatis, and medically recommended, and is such nutrient in our bodies keep increasing or decreasing, consistent wearing of masks and avoidance of big mandazis. a simple task considering that it mainly E depending on the kind of work one does, food eaten, groups, as an immediate and cheaper way of building • Avoid carbonated and sweetened drinks; sodas, involves eating simple and affordable foods, most body’s health condition, age and sex. a strong immunity. sweetened juices. people have not taken this recommendation • Avoid processed meats; bacon, sausages, ham serious. However, the onset of COVID-19 frankfurters. Dieting, therefore, is not just a matter of eating, It is affordable because unlike other countries, has inevitably brought a new wave of dieting • Avoid tobacco in all its forms; cigarettes, shisha, but what and how much one eats matters most, Uganda has all the foods we need to attain a balanced consciousness and subsequently demand, chewed tobacco. especially in terms of quality and quantity, if one diet, irrespective of where one lives. In some parts of especially among people with chronic conditions, is to be healthy and ably fight diseases in the body. the country, some foods attract no cost. which if strictly followed, writes Brenda Ayugi Additionally, one should; Ojara, buttresses one’s immunity against the virus. As a rule, we must first provide energy, which is the • Sit under the sun in the morning and evening to Considering that people with chronic diseases and get Vitamin D. first need of the body; second, we must provide the conditions are more vulnerable to COVID-19, the It has been said that we are what we eat every day. body building and repair foods; and third, we must • Carry out physical activity; any form of exercise, following diet guarantees a strong immunity against house chores, fast walking, jogging, at least 30 This is true and important when it comes to our provide the body protecting foods, which help the the virus: minutes daily. health and the way our bodies fight diseases. body to fight infections, in their right amounts and • Avoid situations that stress you such as thinking time. • Daily consumption of various types of coloured about problems of life, instead have hope and Whereas most people eat food at regular intervals, vegetables; buga, nakati, gobe, spinach, dodo, enjoy every day as it comes. they seldom pay attention to the basic concept of a To be healthy, one’s diet should be 60% avocado. • Remember to follow all the health care advice balanced diet taught to us in primary schools. carbohydrates, for immediate energy; 25% fats, • Eat various fruits especially those high in vitamin given to you and take medication in time. for stored emergency energy; and 15% proteins, C; guavas, oranges, lemon, pawpaw, • Do not miss your appointment with the health Eating a balanced diet should not be as hard as for body building and repair. We need water all • Drink at least two litres of water daily. Put water care worker. writing on flowing water; it is as simple as eating the the time, as much as one can drink. Sipping small in a bottle and sip throughout the day. • Trust God for your health and well-being. right amount of the right type of food as required by amounts at a time is very beneficial. • Ensure food eaten is mainly from plants: whole the body at a particular time. grains; beans, peas, millet, sorghum.

30 PRESIDE Magazine Volume 1, Nov. 2020 31 Technology ministry and PRESIDE partner to support COVID-19 David O. O. Obong (left), Research and Innovation Dr. Maxwell Otim Onapa (middle) the MoSTI director science, research and innovation and Dr. through its Directorate of Science, Research and Monica Musenero (right) By Dr. Maxwell Otim Onapa Innovation (DSRI), among others, coordinates the at the signing of the MoU. and Ms. Diana Katiti implementation of all research, development and innovation, and provides leadership in developing and implementing guidelines for the management combination of science, technology and of research and innovation funds, policies, plans and innovation being the power that propels programs for research promotion and development. Following this partnership, MoSTI and PRESIDE fact that the procurement funds were released two world economies and developments today, have made tremendous strides in facilitating weeks to the close of the financial year. The first UgandaA has in the same breath embraced science, For example, upon the onset of the COVID-19 scientists’ efforts towards coming up with solutions batch of procurement equipment was sourced both technology and innovation (STI) as the cornerstone Pandemic, DSRI explored how research and to the coivd-19 pandemic. locally and internationally. for its economic growth and development. innovation could contribute to addressing the Pandemic. Accordingly, the directorate in April Among other things, MoSTI is facilitating the We are happy to report that the locally procured Over the years, His Excellency Yoweri Kaguta 2020 convened a virtual meeting of national experts procurement of the research and innovation equipment that commissioned by technology Museveni, the President of Uganda, has supported from various institutions, agencies and universities, equipment. In this regard, MoSTI in the financial minister Dr. Elioda Tumwesigye and Dr. Monica scientists and innovators through different initiatives, to define the role of science, research and innovation year 2019/2020 finalized in record time procurement Musenero Masanza, is now ready for use. including giving direct support to individual in addressing COVID-19. of the first batch of equipment notwithstanding the scientists and institutions, underscoring the fact that the science, technology and innovation ecosystem in It was a fruitful meeting considering the several Uganda enjoys support at the highest level. thematic research and innovation areas the experts identified. Basing on the identified areas, the ministry This support notwithstanding, various STI initiatives and the Presidential Scientific Initiative on Epidemics remained for many years scattered in different (PRESIDE), a think tank created by the President institutions. This, therefore, necessitated improving and chaired by Dr. Monica Musenero, the senior and streamline the coordination of all these scattered presidential advisor on epidemics, have remarkably initiatives and government funding. synergized by working together to support research and innovations aimed at COVID-19 therapeutics, Equally, considering the need to explicitly prioritize vaccines and diagnostics thematic area. issues relating to STI as key drivers of economic development, the President in June 2016 directed It is hoped and intended that this synergy creates the creation of the Ministry of Science, Technology a platform to be used to unlock the potential of & Innovation (MoSTI). Uganda’s research and innovation fraternity to contribute, not only to the development of STI, but also to the transformation of the country as whole. The ministry’s mandate is to provide overall policy Dr. Elioda Tumwesigye guidance and coordination for scientific research, (left) commissioning To facilitate this partnership, MoSTI, represented development and the whole national innovation equipment at the National system in Uganda. by permanent secretary David O. O. Obong, and PRESIDE, represented by Dr Musenero, recently Chemotherapeutic Research signed a memorandum of understanding. Institute on 6th October In pursuance of the above mandate, the ministry 2020.

32 PRESIDE Magazine Volume 1, Nov. 2020 33 Under international procurement, the ministry has procured a DNA synthesizer expected to be delivered in November. A DNA synthesizer is a versatile platform that can synthesize DNA oligonucleotides (primers). This will improve our diagnostic capabilities in the country and results turnaround time.

The DNA Oligonucleotide What do COVID-19 Synthesizera Statistics mean? By Abel Wilson Walekhwa Research Associate - PRESIDE a) Current number of Cases and WHO earlier predictions. MoSTI and PRESIDE have now embarked contribution of Uganda’s research fraternity to the procurement of the second batch of equipment. We COVID-19 fight, but also contributing to the body Cases refers to the people who have been tested culminated into unrestricted travel, congestions, are happy that the process is nearing conclusion and of knowledge in the biomedical field. and confirmed to be having Corona virus disease engagement into cultural and political activities the equipment will be ordered soon. (COVID-19). The testing is done from accredited leaving many people exposed hence increasing the This platform will also be leveraged to respond to any laboratories in the country. Cumulative cases refer to number of cases in the country. Besides providing research and innovation equipment, future infectious disease epidemic or public health the total number of sick people since the disease was MoSTI and PRESIDE are also supporting scientists challenge, and will certainly enhance Uganda’s self- detected in Uganda in March 2020. As of October There is an observed decreasing trend in the number with the requisite funds for operations; for example, sufficiency in the area of diagnostics. 31st 2020, Uganda had a total number of 12,743 of reported cases for the month of October 2020. a total of 23 projects are set to receive the operations cases and of these 7,887 have recovered from the However, the public should not think that the funds. Additionally, it is our belief that this combined effort disease and been discharged to their communities. disease is under control but this could be due to the shall deliver a transformative approach to mobilizing changes in policy where by few categories of people Also, the ministry in collaboration with PRESIDE the research and innovation fraternity and resources According to the prediction after modelling by (frontline health workers, contacts of the cases, alerts, has so far scrutinized and approved 14 projects that in Uganda. World Health Organization (WHO) in March 2020, surveillance samples) are able to access free testing have already received operations funds for research Uganda was supposed to have 18,878 confirmed services leaving the majority of the population activities. Lastly, this platform, it can be argued, will form a cases by April 25th 2020 if no interventions were having to access the tests at a minimum cost of UGX nucleus around which other future similar efforts made. However, six months later we have not reached 185,000/=. that level, credit goes to the Ugandans who took The MoSTI and PRESIDE synergy not only aims at shall coalesce for the benefit of the nation. This makes us detect fewer cases than the situation providing world class biomedical research equipment the presidential directives and Ministry of Health guidelines seriously. than the reality on the ground because fewer people and an excellent platform that will enhance the are being tested and this calls for encouraging the The months of August through September 2020 saw general public to do the tests even when they do not an increase in the number of cases. This partly could see signs and symptoms of COVID-19. Remember be attributed to the fact that there was relaxation of about 83% of the corona virus patients in Africa are the lock down measures across the country which asymptomatic (do not show signs and symptoms).

34 PRESIDE Magazine Volume 1, Nov. 2020 35 Ask Doctor PRESIDE!

Basic information for COVID-19 patients undergoing home- based isolation and care

b) Corona virus disease deaths, recoveries and cases. Question: What is Home Based Isolation? Question: Who is eligible for Home-Based The graph above illustrates Answer: This is when a patient confirmed to have Care? that Uganda has continued COVID-19 is mandated to restrict activities and Answer: This will be determined by a designated to maintain a flat curve with movements outside their home unless when seeking Health Care Worker (HCW) or a Health Assistant few cases as compared to other medical care and should not also use public transport after the assessment but two categories are eligible; African countries but notably like taxis, buses and boda-boda (motorcycle) rides. I. Newly confirmed or Suspect COVID-19 shows that due to free and case with mild or no symptoms. timely health care services in Question: What is Home Based Care? II. Any patient discharged from treatment the country like ambulance, Answer: This is when a COVID-19 patient is center for home care. treatment. Majority of the people have recovered provided the required care directly in the home by a and therefore this calls for care giver (family member or friend or community Question: What are the necessary continued efforts in observing member) while cooperating with the advice and adjustments to make the home suitable for the Standard Operating support from the trained health workers and strictly home-based isolation and care? Procedures (SOPs). following the home based isolation standards and Answer: These include; other COVID-19 prevention & control measures. i. Preparing a separate room for isolation with c) Local transmission across the country adequate ventilation. 2.5 Map showing districts with local transmission (n=11,355) Question: Why Home Based Isolation and ii. Availability of source of clean water for hand Care? washing. Answer: The Ministry of Health has advised that iii. Availability of soap or other hand-hygiene some categories of COVID-19 patients for example, products. asymptomatic patients, those with mild disease or iv. Availability of a designated adult caregiver who could be attributed to cultural activities those who are not at risk of developing severe disease can regularly monitor the patient. (circumcision) that are currently can undergo home-based isolation and care so as not v. If possible, presence of a separate toilet/pit ongoing. to overwhelm the health . latrine. Lastly, the Karamoja region is also vi. If possible, presence of immediate access to a highly hit and this could be attributed Question: What is the importance of functioning telephone for communication. to the prison break out incidence that home-based isolation and care standards/ vii. A guaranteed source of food. happened in Moroto which made many guidance? viii. The patient should be readily accepted at home inmates mix with community members Answer: To prevent the spread of the virus to others by the family. who could transmit the infection. (family members, friends, and the wider community) ix. A health facility within reach of the home. Therefore, all districts should be alert including the vulnerable individuals who might be in x. Availability of community resource persons and ensure active surveillance through the home. The vulnerable include the elderly (above (VHT) linked to the home of the patient. The map above shows that Kampala has the highest number of their local council leaders, village health 60 years) or people with impaired immunity due xi. Reliable transport to rush to Health Facility. cases partly because of the populations and congested streets but teams and health assistants who are to other illnesses like diabetes, HIV/AIDS, cancer, also people have relaxed in observing the SOPs. Also Elgon region based in the communities to report all and other chronic illnesses (like high blood pressure, with districts like Mbale, Sironko, Bulambuli, Bududa, Manafwa the suspected person(s) to the district or chronic kidney disease, and chronic lung diseases). and neighbouring districts show a hike in the numbers and this National taskforce.

36 PRESIDE Magazine Volume 1, Nov. 2020 37 Question: What are the responsibilities of v. Keep regular sleep routines, eat healthy food a patient under Home Based Isolation and and keep well hydrated. Care? vi. Keep things in perspective. It may not be Want to take a Answer: A patient must; possible to be provided with everything one i. Stay in a separate room and limit movements wants. COVID-19 Test - in the shared areas like bathrooms, toilet, kitchen etc. Question: What are the responsibilities of ii. Always practice infection prevention and the caregiver? Where do I go? control while at home. Answer: The caregiver should be only one person iii. Accept to be monitored by the health care (if possible) who is in good health. He/She should Compiled by Mary Nantongo Lukenge workers for at least 14 consecutive days from take good care of themselves and ensure that they Research Officer, PRESIDE Secretariat the date test was done while in isolation. are always protected. The caregiver should monitor iv. Agree to admission in case of symptoms the patient’s wellbeing and monitor development worsening that warrants hospital admission. of new or worsening symptoms like fever, cough, Here are some of the COVID-19 sample collection and testing centers you could reach out v. Stay confined at home until fit for discharge or runny nose or flue like illness, sore throat, shortness to or simply call and get your sample collected from wherever you may be!! de-isolation according to the guidelines of breath, headache and general weakness. vi. Only be visited by the care giver until is Contacts SN Sample Collection (only) discharged or de-isolated. The caregiver should also look out for and report key centers Well, it is important for you and your loved ones vii. Always wear the recommended mask while in danger signs like: Rapid and Difficulty in breathing 1 Makerere University Hosp 041542922 to know your “COVID-19 STATUS” if you have the shared places in the home. with or without abnormal chest movements, symptoms such as fever, cough, shortness of breath 2 0312531400 Difficulty swallowing, Fatigue, Abnormal behavior, or difficulty breathing, chills, muscle pain, headache, 3 Entebbe Hospital 0417712260 Question: What about isolation Follow-up? Seizures or convulsions and Inability to drink or eat. new loss of taste or smell, congestion or runny nose, 4 Case Hospital 0312250700 Answer: During the time you are undergoing sore throat, nausea or vomiting & Diarrhea. home isolation, you will be provided with a daily If a caregiver, observes that symptoms are worsening 5 Platinum Hospital 0392176915 – they should immediately contact the health care 6 Masaka Hospital 0481 420018 monitoring tool where you or your care giver will www.nfid.org/coronaviruses write down any symptom that you may develop. You worker or Village Health Team (VHT) or Ministry 7 Mengo Hospital 0414-270223 will also be expected to choose a convenient time of Health on a toll-free number: 0800100066 or 8 Mbarara Hospital 0485420394 0800203033. during the day when you will be contacted by our 9 Mbale Hospital 0454433193 system and respond to an automated call prompting SN Sample Collection & Testing centers Contacts 10 Gulu Hospital 0783727041 you about any symptoms. This system will also Question: When is a patient discharged or be available for you to activate in case of a new or de-isolated? 1 Lancet Laboratories 0414341621 11 Tororo Hospital +2564544515 worsening symptom. Answer: You will be discharged from home-based 2 MBN Laboratory 0700533954 12 Lira Hospital 0473 420139 If the call system is not activated for you, then you isolation in accordance with a criterion determined 3 Medipal Hospital-Kololo 0417799900 13 Mulago Hospital 0417712260 will have to use the USSD platform by dialing *260# by a healthcare worker. For more information follow 4 Naguru Referral Hospital 0414 289740 14 Nsambya Hospital 0414267012 daily at a selected convenient time during the day to www.health.go.ug. the link: 5 MicroHeam Lab Test & Fly 0200902074 15 Kibuli Hospital 0414 236476 report on your condition. 6 Mutukula Point of Entry Laboratory 16 Rubaga Hospital 0414270204 Question: How can a patient prevent or 17 Ruby Medical Centre 0800 388111 cope up with the psycho-social challenges SN Testing (only) centers Contacts 18 International Hospital (IHK) 0312200400 during home isolation? Uganda Virus Research Institute 19 Kampala Hospital 031 2563400 1 0414320385 Answer: A patients should; (UVRI) 20 City Medical Centre 0200906345 i. Stay connected with family and friends and 2 Joint Clinical Research Centre (JCRC) 0417723000 21 Frontline Medicare 0393242247 maintain their social networks via e-mail, social 3 Central Public Health Lab (CPHL) 0800221100 22 Kiswa Health Centre IV 04143448585 media, video conference, telephone, etc. 4 Makerere University CHS Lab 0755891834 ii. During times of stress, pay attention to own 23 Kisenyi Health Centre IV 0786224319 needs and feelings. 5 MildMay Uganda 0758947645 24 Kawaala Health Centre IV iii. Engage in healthy activities that the patient 6 Infectious Diseases Institute (IDI) 031-2211422 25 Kasangati Health Centre IV enjoys and finds relaxing. 7 Uganda Cancer Institute 0414549410 26 Kira Health Centre IV 0414696923 iv. Exercise regularly in ways that suit age and 8 Adjuman Mobile laboratory 27 Kitebi Health Centre IV 041 4581294 situation. 9 Tororo Mobile Laboratory 28 All hubs in various districts

38 PRESIDE Magazine Volume 1, Nov. 2020 39 Please do not go to the testing (only) centers for your sample to be collected but rather go to any of the above sample collection sites.

Your sample will be collected, packaged and safely transported to any of the COVID-19 testing centers/laboratories for analysis.

The testing cost ranges from UGX 185,000-450,000/= depending on your choice of center. Some categories of people can access free testing services

You will get your results from your sample collection 3. People who have no symptoms (are center within 24-48hrs. Always remember to ask for asymptomatic) but have tested positive for certified test results. infection with the virus

Who will pay for the COVID-19 testing Steps to take: services? 1. Stay at home for at least 10-14 days except to 1. Individuals seeking to know their COVID-19 get medical care status voluntarily 2. Monitor your symptoms. If you have an 2. People seeking COVID-19 certificates for emergency warning sign (including trouble international travel breathing), seek medical care immediately 3. Organizations (both Government and Private) 3. Stay in a separate room from other household that wish to test their staff for purpose of members, if possible prevention 4. Use a separate bathroom, if possible 4. Truck drivers at the different points of entry 5. Avoid contact with other members of the 5. Ugandans and visitors from abroad without household and pets negative COVID-19 certificates 6. Don’t share personal household items, like cups, towels, and utensils Who will get free (Government paid) 7. Wear a mask when around other people. COVID-19 testing services? 8. Eat a nutritious/healthy diet including fruits 1. Patients who report for treatment at a public and vegetables health facility with COVID-19 symptoms 2. Contacts of people who have tested positive For now, remember to properly wear your mask 3. Community surveys to establish the extent of covering nose and mouth when in public, maintain spread of the virus physical distance and regularly wash your hands with 4. Surveillance samples soap and clean water or sanitize with an alcohol- 5. Frontline Health workers based hand sanitizer. Stay Safe!!!

In-case you have symptoms or your results turn out Together, let’s kick the deadly ‘MONSTER’ out of positive, seek medical advice on home isolation and Uganda!! call Ministry of Health helpline on 0800-100-066 or 0800-990-000. “FOR GOD AND MY COUNTRY”

Home isolation guidelines include; Who needs to isolate? 1. People who have COVID-19 2. People who have mild symptoms of COVID-19.

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