In light of President Yoweri Museveni's directive to lock down Ugandans at home for another 42-days. Daily Monitor's Nobert Atukunda sits down with Dr Monica Musenero, the senior presidential advisor on epidemics, to discuss a wide range of issues including the surge in Covid-19 cases and deaths, contact tracing and testing, government's hunt for more vaccines, and Uganda’s chances of producing a home-grown vaccine.
You got some money to procure vaccines, but the first batch was donation. Where did the rest of the money go?
I don’t deal with finances and logistics. But the money goes through the Ministry of Health.
Away from the money, do we have enough vaccines?
Not now, we don’t. But we’re trying to get more. We got the first vaccines through Covax. The World Health Organization and Unicef and some others who have been fighting to get some doses for us, came up with a distribution plan for countries which were not producing their own vaccines.
They distributed some and we got 964,000. Unfortunately, in Uganda just like in many other countries, people were misinformed by conspiracies. Even health workers here refused to take the jab, because it was to vaccinate health workers, teachers, security forces, the vulnerable, etc. Up to the beginning of May, we had low response yet the vaccines have an expiry date.
The Ministry of Health made a decision not to waste the vaccines by vaccinating other categories of people. But we didn’t have enough time left for expiry of the vaccines, so we gave everyone one shot although everyone needed two and sufficient time before the second one, ideally 12 weeks. The longer you take the better.
Government is trying hard to get more vaccines to have people protected. The second batch, which is expected later this month, if it has not already arrived, will be given to those people who have taken at least eight weeks since they got the first shot.
Government is looking to source vaccines aggressively because for us to manage Covid-19, we have to vaccinate more people. Initially, we had AstraZeneca but now there are other vaccines such as the Chinese vaccine; we have Moderna, there is Johnson and Johnson, there is Russian vaccines; so government is trying to procure multiple.
How far with our Ugandan made vaccine, what’s the progress?
We are working on our own vaccine, we have two vaccines that had made quite good progress. The third one is a little behind. We are still doing animal trials in one and we will be starting animal trials on the second one soon.
But getting the vaccine approved and all that takes time but you will be surprised that vaccine is still going to contribute to Covid-19 fight because the virus is not going to go away tomorrow. We are just fighting to reduce its threat and impact.
Is Uganda's Covid-19 epidemic getting out of hand?
There are definitely places where the rate of infection is so high that should you pick any five people, two or more of them would be positive. The rate of infection is very high because Covid-19 works by multiplying numbers; namely one person infects three and each of those three will infect three more.
Our reproductive number now is so high that one person is generating 10 to 15 new cases. That now means the cases are growing higher and we are reaching where Covid-19 does its biggest havoc.
The hospitals are close to full and in the majority, it’s very difficult for one to quickly get oxygen or the right intensity of oxygen.
Most of the private hospitals are full, Mulago opened their last floor and I am sure it’s almost full, Namboole is filling up fast and with few oxygen points there. Once you reach that level and you saturate it, then the other people cannot get onto oxygen early enough so they start deteriorating and dying because people who enter the hospital spend a minimum of 10 days.
Some of those who are really sick stay in the hospital for 15 to 30 days, so if every day you are admitting and they are not leaving and more are coming in everyday, then you reach full capacity, and your health workers get fatigued and emotionally drained. They lose concentration, and that’s when the dying begins and the deaths escalate so fast as we have seen in India.
What happened to the practice of contact tracing?
Contact tracing is a luxury that works in the early phases of the epidemic; call it four or five phases. Phase one is before you have the disease and want to detect any suspected case. Phase two is where most people are coming in from outside and you want to detect if they have had any contact you want to trace.
Phase three is community spread and we try to contain or reduce the spread, but phase four is where we have uncontrolled spread and we cannot do any more contact tracing because there are too many cases and our goal shifts to trying to save as many people as possible. Here, we try to apply population level interventions to stop the spread.
Those days if you were a contact, we would put you in quarantine because we didn’t want you to affect any other person, but now they are too many. There are people we know are positive but are at home and chances that they will infect their family members are high because the healthcare system no longer has capacity to handle that.
Shouldn’t we have free testing centres because of the spiralling cases?
That’s for the Ministry of Health to answer, but I know they have budget constraints.
Of course, they would love to have free testing all the time so that we can test as many people, but government is still providing free testing for people who have symptoms. I hope that message is clear because either some people still get charged or they don’t know.
We now have a lot of people testing because they have started feeling respiratory signs, which is a little late and that’s what causes people to die because some go to hospital when they’re already in need of oxygen and yet we have awaiting time of 24 hours for one to get an oxygen spot. So many may die because they get so damaged that by the time they are put on oxygen, it’s rather late.
What has forced the cases to soar all of a sudden from April?
There is something we call epidemic triad, which is a set of three factors that must interact for an epidemic to occur. One is agent or the virus. Since we had the last peak, the virus has been changing, with new variants coming in so now what we have is a mix of variants.
For example, previously the virus used to cause severe disease in the elderly, but now these ones cause severe disease in young people and our demographic profile has more young people than the elderly, so we are going to have more sick people because there’re so many hosts and those people need to hospitalised.
The second one is the environment. For instance, in March we had a dry season, the temperature was hot and most Ugandans go out, so we are not close together. In the villages too, people get out of their homes and come back to sleep, but when it rains, they have to sit inside. While in towns everyone runs to the neighbouring shop and stays there, or gather at petrol stations. So the weather also helps in distribution of the germ when it’s cool and moist, then the virus survives better and it can be transmitted more efficiently so it will affect more people.
The third factor is the host behaviour, or the human being. In this case, when the cases went down, we had a very intensive campaign in December though people were having campaigns, we had to insist on warning people on what was happening and people feared and wore masks and observed social distancing.
When the cases went down, people relaxed. Taxis were carrying more passengers than allowed, travellers stopped wearing masks and sanitising and abandoned SOPs because they believed Covid-19 was over.
Those three factors interacted, plus the crowding of children in schools by having more than one class at the time, universities were supposed to have one class a at time but as things went down, they sneaked in more and many schools were having all classes .
That did not only reduce the space but also increased the people in that space who can get sick. This particular spike has been driven by a number of cases in schools and institutions of learning.
We’re carrying out a detailed investigation next week (this week) but there is something which is happening in the corporate class, namely people who work in offices; very many are infected. Those dying are the corporates of 25 to 45 years because of their social activities. From there they brought it home, so we see a lot of children, we see children in schools, university lecturers, young children who have been infected by parents who go out to socialise.
Why did it take you long to highlight schools and corporate class as hotspots?
The schools did not want to be known and hid the cases, and those singled out were discovered accidentally. My own niece was at school of midwifery and she almost died. I sent there the brother to check, the administration refused to talk to me they didn’t want to test. There were so many sick children in the schools, we discovered so many. In fact, we have been shocked by level of infection in the schools.
There have been stories of parents finding their children on oxygen but the schools did not report. When they closed, parents found their children hooked onto small cylinders of oxygen.
People are having all sorts of herbs, using leaves and flowers. What is your message to them?
My message is if something has not been officially announced that this works, it works like this, then how does somebody just sell or pick leaves and boil and yet they don’t know how much and how long to boil or how much to take those concoction? For us, we really have no evidence that they work.
May be they work but we don’t have evidence and we cannot tell Ugandans to start using something that we don’t know whether it works or not. We know that many people do steaming.
You can do some steaming if you have some respiratory issue to help open the system. But many people are damaging their respiratory systems, they are exposing themselves to a lot heat and it’s damaging their mucus membranes because that steam doesn’t reach where the virus is.
The body has a system which does not allow hot things beyond a certain temperature to go. For this virus, if you have ever taken a test, the medics don’t just pick [samples] from here outside the nose or outside the mouth. They try to poke down there; that’s where the virus is, and may be by the time you fall sick, it might have already gone inside the body.
So the assumption that people have that if they steam they will kill the virus is wrong. What steaming does is that sometimes there are some things which will help to open the respiratory system if the temperature raises a bit.
That’s why they use steaming when you have flu, but it’s not going to be a remedy to killing the virus. It will be useful at certain stage when you are coughing…but later it becomes harmful because it will cause things to go inside the chest and worsen the situation.
But in terms of food, things like ginger, garlic and fruits; take them at food rate. This whole business where one is advised to mix pepper, lemon, mix this and boil that is caustic. You are going to harm your gut if ginger is too strong for you to eat. If lemon is too strong than what you would tolerate, you are going to hurt yourself because the virus is not here for you to kill with this strong concoction.
This assumption that the virus is somewhere where this ginger is going to touch and kill; that’s the imagination. But you can take it in ordinary amounts.
People who take that concoction and feel it’s going to work, should take it as a balanced diet, which are going to help you strengthen your immune system. Don’t wait until you are sick; take some greens, even raw ones, which are not cooked but it works if this has been a routine.
Finally, don’t entertain visitors, especially in the next three to four weeks, it’s very dangerous.
Report by Nobert Atukunda
Vaccine vetting process
1. Drug/vaccine discovery takes place in a laboratory by trying out molecules with theoretical effect on a disease or virus lifecycle.
2. Selected molecules are taken through other chemical tests to see if they have a chance to make it to the next levels.
3. Tests are conducted in lab animals - mice, guinea pigs, dogs and sometimes monkeys to assess safety.
4. Phase I studies – first in human studies – are conducted in humans after rigorous regulatory approval to test the safety profiles of the drug candidate. Most drug candidates fail at this stage.
5. Phase II studies are conducted in humans to assess whether the candidate vaccine actually treats the intended disease.
This comes after rigorous regulatory assessments and approval for phase I.
6. Phase III studies are conducted on thousands to hundreds of thousands of patients/humans to assess the true or near true picture of the drug candidate in real life.
7. After successful completion of phase III and thorough regulatory scrutiny and approval, the drug can then be allowed for use on the market, with requirements for pharmacovigilance, or Phase IV.
The entire process on average takes about 10 years and cost in the range of hundreds of million dollars
*Source: National Drug Authority (NDA)