Reflecting on the First Two COVID-19 Deaths in Uganda: a Public Health Perspective
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Volume 12 • Number 2 • June 2021 • em00773 JOURNAL OF CLINICAL AND BRIEF REPORT EXPERIMENTAL INVESTIGATIONS Reflecting on the First Two COVID-19 Deaths in Uganda: A Public Health Perspective Joseph Kawuki 1,2*, Quraish Sserwanja 3, Nathan Obore 2, Zixin Wang 1, Joseph Tak Fai Lau 1 1 Centre for Health Behaviours ABSTRACT Research, Jockey Club School of Public Health and Primary Care, COVID-19 being a rapidly evolving pandemic, early lessons from the first deaths must be learnt Faculty of Medicine, The Chinese to help feed into the public health guidelines. This article, therefore, aims to present the first University of Hong Kong, Hong two deaths due to COVID-19 in Uganda and their public health relevance. This is a case study Kong - SAR, China of the first two COVID-19 deaths reported in Uganda, and the events were prospectively 2 Department of Global Health, documented. The first case was a 34-year-old female and support staff at a health center II. School of Public Health, Southeast She first presented with COVID-19 like symptoms before dying on 21st July 2020. The second University, Nanjing, 210009, Jiangsu case was an 80 years old female, who also presented with COVID-19 like symptoms before Province, China dying on 24th July 2020. The postmortem samples of both cases were confirmed positive for 3 Monitoring and Evaluation COVID-19. This study identifies a need for timely identification and testing of COVID-19 Department, Doctors with Africa, Juba, South Sudan suspects, strengthening of health center capacity, as well as more awareness for effective prevention and control of COVID-19. Keywords: COVID-19, first death, case study, Uganda, lessons learnt Correspondence: of schools and places of worship, suspending INTRODUCTION Joseph Kawuki mass gatherings and public and private Since its emergence in December 2019, Address: Centre for Health transportation, with a nationwide lockdown the novel Coronavirus disease 2019 Behaviours Research, Jockey Club that was declared on 24th March 2020 [5]. (COVID-19) quickly spread globally, School of Public Health and Primary Despite the above control measures in the Care, Faculty of Medicine, The creating a pandemic of global threat [1,2]. fight against COVID-19, Uganda reported Chinese University of Hong Kong, th On 11 March 2020, the World Health rd Hong Kong - SAR, China and its first death on 23 July 2020 [5]. Organization (WHO) declared COVID-19 a Department of Global Health, This pandemic has greatly strained the School of Public Health, Southeast pandemic having spread to over 110 University, Nanjing, 210009, Jiangsu countries and territories [1,3]. As per 18th healthcare systems in low, middle and high- Province, China March 2021, 121,858,289 cases and income countries [1]. Countries in the Sub- Email: [email protected] 2,693,445 deaths had been confirmed Saharan region which already face several globally, with 4,095,103 cases (3.4%) and health challenges such as the limited number 108,885 deaths (2.7%) reported in Africa [4]. of personal protective equipment, human African countries are generally showing resources and limited access to intensive much fewer cases compared to other care units, amongst others, need to continents; however, their inability to test strengthen their healthcare systems to fight many people may largely underestimate the COVID-19 pandemic [7]. Uganda is a incidence rates [3]. Uganda reported the first country with a population of over 40 million case of COVID-19 on 21st March 2020, and people and it currently has a nurse-to- as per 18th March 2021, 40,607 cases had patient ratio of 1:8, and at the start of the been reported with 15,099 recoveries and pandemic, it only had 55 intensive care unit 334 deaths with 907,398 tests done [4,5,6]. (ICU) beds, 80% of which are in the capital city [7]. Since March 2020, Uganda put in place different measures to contain the COVID-19 being a rapidly evolving transmission of COVID-19. These included: pandemic, it is crucial that early lessons from Received: 06.10.2020, closure of all international border points the first deaths are obtained to strengthen Accepted: 11.01.2021 including airports for passengers, the closing the current public health guidelines and https://doi.org/10.29333/jcei/10878 www.jceionline.org Copyright © 2021 by Authors. Licensee Modestum. OPEN ACCESS for all. | 1 / 4 First COVID-19 Death in Uganda hence contribute to the country’s efforts in containing the MoH-Uganda reported proceeding with vigorous and urgent pandemic. In this article, we therefore, present the first two identification of the source of infection, the possible deaths related to COVID-19 in Uganda and their public transmission lines, and the extent of community exposure health relevance. [8]. CASE PRESENTATION Case 2 Here we present the first two COVID-19 deaths in According to the MoH-Uganda, the second case was an Uganda. The data and information were mainly obtained 80-year-old female, a resident of Mengo, Kisenyi III in from the Ministry of Health-Uganda website [8], which gives Kampala. She was admitted to the Platinum hospital on routine updates on COVID-19 in the country. In addition, Friday 24th July 2020 at 5:00 pm after she presented with extra information was sourced from the major national news COVID-19 symptoms of cough, fever, chest pain and websites, as they communicate daily nationwide events difficulty in breathing [9]. She was later referred to Mengo [9,10]. hospital (a tertiary care hospital) for further treatment but unfortunately died at 6:30 pm on the same day. During the Case 1 admission process at Mengo hospital, the medical team According to the Ministry of Health (MoH), Uganda suspected her due to presentation of COVID-19 like registered its first COVID-19 death on 23rd July 2020. This symptoms and effectively took the standard operating was a 34-year-old female Ugandan and a support staff of procedures of handling COVID-19 suspected patients, Wasungui Health Center II in Namavia sub-county in including isolating her in an Intensive Care Unit. The Mengo Namisindwa District. Two weeks before admission, she hospital team immediately notified the MoH-Uganda and travelled to a border town (Malaba in Tororo district) for a Kampala City Council Authority (KCCA) through the visit. She was reported to have participated in the community normal channel [9,10]. distribution of mosquito nets three days before her admission [6]. Namisindwa district is bordered by Kenya in Following her death, postmortem samples analysed at the the east and south, with a lot of illegal border crossings Uganda Virus Research Institute, and Makerere University between Uganda and Kenya. The deceased first presented Hospital confirmed positive for SARS-COV-2. The MoH signs and symptoms similar to those of COVID-19, which also reported having initiated contact tracing of all the people included; fever, dry cough, headache, and difficulty in who might have come into contact with the deceased. As of th breathing [8]. 30 July 2020, 75 contacts had been listed, of which 27 were health workers [6,10]. She was initially admitted to the Wasungui Health Center II on Wednesday, 15th July 2020, and was treated for severe LESSONS LEARNT AND RECOMMENDATIONS th pneumonia. However, on Monday 20 July 2020, she was Timely Screening, Testing, and Diagnosis transferred to Joy Hospice health facility, in Mbale District, There is a need to ensure that all health workers have the where she was isolated in the female ward. While in isolation, ability to identify COVID-19 suspects, as per the MoH the patient’s condition deteriorated, presenting with guidelines. The first case was first admitted at a health facility difficulty in breathing, chills, cough, and headache. th on 15 July 2020 before she was referred to another health st Unfortunately, she passed away on Tuesday 21 July 2020 at facility on 20th July 2020, without being identified as a 2:00 am, samples were taken off for further investigation, and COVID-19 suspect. Given the symptoms she presented with, rd she was buried on 23 July 2020 as per safe, dignified burial the district response team should have been notified on the procedures [11]. The postmortem samples from the deceased first day of admission and relevant precautions like isolation, were confirmed positive for SARS-COV-2 by four referral and COVID-19 tests done according to the MoH laboratories; Uganda Virus Research Institute (UVRI), COVID-19 guidelines [12]. This would help in early Makerere University laboratory, Tororo laboratory and diagnosis, limit the number of case contacts and also enable Central Public Health Laboratories (CPHL). Furthermore, early initiation of treatment. The second case was initially gross anatomy findings at postmortem exhibited features of admitted into a well-equipped and stuffed private hospital acute pneumonia, which is consistent with COVID-19 located within the capital city and less than 2 kilometres from infection [8]. Mulago National Referral Hospital. However, this patient As part of the response, the MoH-Uganda reported that was still not suspected to have been a potential COVID-19 108 contacts to the deceased had been so far listed and placed case despite the typical symptoms and age risk. This could under quarantine by the health authorities as of 30th July partly be due to inadequate awareness or a low index of 2020; in Namisindwa district (76 contacts), Manafwa (11 suspicion among healthcare providers. contacts) and Mbale district (21 contacts). The listed Strengthening the testing services by ensuring increased contacts included family members and healthcare workers. laboratory coverage is required. At the time of the first two Of the samples collected from these contacts, 3 were positive deaths, the country had only 6 accredited COVID-19 testing and were all health workers who cared for the deceased while laboratories.