The definitive metric of a pandemic is the number of infections and bodies it leaves behind. But with only two fatalities, about 1,115 infections as of July 26, and a whopping 975 recoveries since the first Covid-19 case was confirmed in the country in March 2020, Uganda’s handling of the pandemic, which has killed thousands elsewhere, has received good marks inside and outside the country.
Interviewed by Audrey Brown on BBC Focus on Africa radio on July 24, Dr Fred Nakwagala, the head of Covid-19 case management at Mulago hospital, shed some light on the country’s high recovery rate.
Without diminishing the severity of the disease, Dr Nakwagala put the glowing performance down to two things: A mild strain of the illness and peoples’ immunity bolstered by their exposure to malaria and other tropical parasites. Below are excerpts of the interview.
Uganda is one of the few countries in the world with an incredibly low death rate, how have you managed to achieve that?
There have been quite a lot of discussion around this, but first of all for the majority of the cases we have had in Uganda, we have had mild illness, about 40% of the patients have been completely asymptomatic, that means they had no symptoms at all.
They just happened to have a positive test. Then among those that had symptoms, the majority, possibly like 97% of them, there were mild symptoms, the kind of flu-like illness that everyone else has been experiencing before.
So tell me, what is it about the patients then, that meant that they were asymptotic mostly or experienced very mild symptoms because as I understand it, asymptotic patients can still spread the disease as well. But what was it in the nature of this group of people that meant they were not as infectious or effective at spreading the disease or actually getting seriously ill with it?
A lot of discussion has taken interest in this, about why we had a muffled clinical presentation. Some of the points have rotated around the fact we could have had a mild strain of the illness circulating in the country different from the strains elsewhere. Some other reasons have been about the hosts themselves.
Could it be possible that prior infestation with malaria and other tropical parasites could have impacted on the immunological strength of these persons to the point that the way they cross react with the coronavirus could lead to be muffled? For me, my personal theory is that of the strain.
The strain that has been circulating. Because in Uganda we were able to lock down the country both locally and internationally in March when the illness first occurred. We locked the airport, we locked all the borders and so we think that the first immediate success was the ability to control incoming infections. We of course had a lot of prior experience in controlling epidemics of this nature, particularly Ebola, that our responses tend to be quick and our lockdowns tend to be effective.
This is not the first this theory has been discussed publicly. Dr Baterana Byarugaba, the Mulago hospital executive director, while addressing members of the Rotary Club of Kololo on July 16, said Ugandans should stop fearing coronavirus because the strain in the country is a mild form of flu, which does not require hospital admission since it can be treated at home. But days later, the executive director was forced to walk back his assertion after he was verbally attacked by the head of the government Covid-19 taskforce.
So far, two fatalities have been reported; a 34-year-old Ugandan female from Namisindwa district in eastern Uganda, who died on July 21 at a clinic in Mbale district and an 80-year-old female who had been admitted to Mengo hospital in Kampala.
She was a resident of Mengo, Kisenyi III in Kampala.