The rise in community transmission of Covid-19 can be attributed to many factors, ranging from election campaigns, holiday festivities, and prevention fatigue among other causes.
Cumulatively, 39,579 cases have been confirmed and 324 deaths reported as per Ministry of Health reports on January 30, 2021.
As a clinician, the rapid spread and lack of a definitive cure is what makes Covid-19 a real threat although the numbers per se are comparable to other common illnesses. In the absence of a cure, I commiserate with the dilemma of fellow clinicians faced with the desperate cries for help from families hoping for some magical solution. It’s heartbreaking!
I recall the early days of the HIV/Aids scourge when clinicians looked on helplessly as ill patients deteriorated and perished with little or no treatment to reverse the trend.
It took decades for anti-retroviral therapy to become available in Uganda, years after a discovery in the Western world. A similar lag is anticipated before the Covid vaccine becomes available and accessible in Uganda. The rise in Covid cases and deaths has seen Ugandans resort to a multitude of remedies for the prevention and treatment of Covid-19.
Some home-made herbal options like ginger and garlic are proven to contain immune boosters and are safe to use if guided by a care provider to avoid side effects like worsening of intestinal ulcer disease if taken on an empty stomach.
However, the use of some prescription drugs like antibiotics which have been making rounds on social media as a ‘Covid kit’, poses a huge risk of immediate bodily harm and even more disastrous long-term risk of running out of treatment options for common illnesses. The result would be exactly what has made Covid a real threat - a rapid spread of hitherto curable diseases, albeit without a cure.
This is what is referred to as drug resistance when germs causing common illnesses like diarrhea and respiratory tract infections develop mechanisms of persisting despite treatment as a result of irrational or excessive use of antibiotics.
At the current scale of the epidemic, the use of the “case definition” is not as specific in identifying Covid-19 cases as it was earlier in the epidemic when travel history for instance was very important.
Symptoms like fever, dry cough, sneezing and difficulty in breathing can also be due to other illnesses such as infections, allergies and other lung-related diseases, which remain the leading cause of outpatient attendance in Uganda before and during the Covid-19 pandemic.
Irrational use of antibiotics not only exposes users to potentially life-threatening side effects like drug reactions and kidney damage but also promotes drug resistance to common disease-causing bacteria. This has happened for diseases like malaria and gonorrhea whose drugs were extensively used in Uganda and overtime there was widespread resistance.
Unfortunately, there has been almost no discovery of new antibiotics for decades and developing resistance to existing ones is cause for alarm. Fortunately, many of the diseases that present with the same symptoms as Covid-19 do not require antibiotics at all.
Rather, they require boosting the immunity through rest, ample intake of non-alcoholic drinks, a balanced diet, and heal without antibiotics. If antibiotics must be used, the benefits need to be weighed carefully against potential risk and should be in appropriate dosing frequency, amount, and timing.
Covid-19 will pass but we will need these lifesaving medicines much longer; so, the onus is on us to protect them and not live like this is the end of time. It has also been reported that the fear to contract Covid-19 is the reason some individuals would prefer to self-medicate instead of seeking medical advice.
To counter this, it is important to decongest hospitals and clinics, especially outpatient units by using open, outdoor spaces and supervised home-based care for potential Covid-19 patients. This will reduce transmission risk and promote health-seeking during the pandemic.
Furthermore, health practitioners require basic diagnostic tests to exclude or confirm diseases with similar presentation as Covid-19 to decide whether or not to prescribe antibiotics. In the absence of the test kits, generic prescriptions covering a wide range of common diseases are inevitable. It has become very common to leave the hospital with a diagnosis of “infection” with no specific mention of what infection that may be and this is a pointer to limited diagnostic ability.
Maintaining sufficient stocks of supplies needed to test for common illnesses and having sufficient well-trained health workers is key to promote rational drug use. Regulators, owners, and operators of pharmacies have a key role to play in saving these precious medicines by ensuring that individuals access them only when they need them.
Additionally, expanded and subsidized access to testing and rapid scale-up of the Covid-19 vaccine could help reduce the irrational use of antibiotics. The recent approval of vaccines manufactured by Pfizer and AstraZeneca for use against Covid-19 globally and news of planned procurement by the government of Uganda have provided a new lease of hope for mitigation of the impact of the disease.
Lastly, we all should know that not all cough and flu is Covid-19, and medicines, if misused, can kill just like Covid-19. Therefore, endeavor to confirm Covid-19 diagnosis before initiating treatment.
The author is the country director, Seed Global Health.