As the country prepares to end the additional 14-day lockdown, Ugandans ponder what measures will be taken by government to ensure that COVID-19 epidemic remains controlled. As at 13th May, 2020, 139 cases of COVID-19 have been registered, 40% of which have recovered and no deaths so far recorded. Uganda has been internationally applauded for leveraging her experience in management of several infectious disease epidemics such as Ebola Viral Disease, Yellow Fever, and Crimean Congo Hemorrhagic Fever to address the Ugandan COVID-19 epidemic.
In fact, to date, Uganda has the lowest number of COVID-19 cases in East Africa; majority of which are truck drivers from neighboring countries. Strict measures are currently being instituted by the Ministry of Health to ensure that truck drivers are tested for COVID-19 and results made available prior to entering the country. Such measures will go a long away in curbing potential transmission resulting from social mixing between exposed or infected truck drivers and locals; which could spark-off a widespread SARS-COV2 community transmission.
The COVID-19 epidemic in Uganda has been classified as “sporadic” by the World Health Organization; which means that there are few registered cases of COVID-19 mainly clustered, with no or little community transmission. In a bid to contain the epidemic and prevent “susceptible’ Ugandans from acquiring COVID-19, the President of Uganda has recommended wearing face masks as one of the pre-conditions for lifting the lockdown.
Face masks are non-pharmaceutical public health interventions with a potential to control COVID-19 spread. There are various kinds of masks available including surgical, N95 and cloth masks. It is possible that wearing a mask may protect an individual from contamination by virus containing droplets. However, research evidence so far shows that different types of face masks offer varying levels of protection. According to some sources, N95 masks are known to offer the highest level of protect with up to 95% protection, surgical masks 70-90%, while cloth masks offer 20-50% levels of protection against COVID-19 spread.
Even as the country prepares to lift the lockdown, it is important to understand whether wearing face masks and having other interventions that enforce social distancing will be sufficient to control the spread of COVID-19 to manageable cases if adhered to. In countries like Ghana, Austria, Morocco, Turkey and Germany, wearing masks in public has been made compulsory.
In Uganda, although the social mixing patterns are observed to be higher than most Western countries, effective social distancing and hand washing remain sub-optimal. Therefore, in fully lifting the lockdown, face masks could help to reduce COVID-19 transmission in the community particularly if used in public transport, crowded areas, schools and shopping centers. Thus, it is important to evaluate the effectiveness of wearing face masks in preventing COVID-19 in Uganda, when used alone, or in combination with social distancing measures.
We therefore modelled different scenarios of wearing face masks and social distancing either alone or in combination. Such modeling techniques are critical in planning and control of COVID-19 in Uganda. In our model, we varied different levels of i) effectiveness of identification, testing, isolation, quarantining and removing exposed or infected truck drivers and other locals at border points, ii) the proportion of the population effectively wearing face masks, and iii) proportion of population effectively social distancing. Using a determinist model, we then generated the estimated number of COVID-19 cases that the country could experience after the lockdown measures are lifted.
In Figure1, we observe the grave scenario of having no interventions after the lockdown. We compare this with scenarios of varying levels of wearing face masks, testing and screening truck drivers; and social distancing. At the100-day mark after lifting the lockdown, if no interventions were implemented, we would expect approximately 9,200 cases of COVID-19; 1,534 cases with wearing face masks only, 489 cases if social distancing was observed by 40% of the population, 225 if social distancing was observed by half of the Ugandans, 84 cases (few and manageable) would be registered if 50% of the population wore face masks while at the same time, 50% of the people observed social distancing. We believe that this realistic and achievable, since 100% adherence to either wearing of masks or social distancing cannot be expected.
Our results underscore the importance of adhering to several prevention strategies for preventing COVID-19 in Uganda. We note that using face masks alone would lead to a high number of COVID-19 cases that might not be effectively managed by the health care system in Uganda, given the limited hospital bed capacity and intensive care units (ICU) facilities. Not surprising, this in line with the World Health organization guidance that asserts that masks are effective only when used in combination with other measures including frequent hand-washing with alcohol-based hand-rub or soap and water. In the Ugandan settings where hand washing might not be consistently practiced, we demonstrate the effectiveness of combining face masks and other social distancing measures. The estimates from these combined strategies could lead to manageable COVID-19 cases. In addition, it is widely acknowledged that an intervention with a 30% impact is considered effective.
Our model provides empirical evidence showing that if 50% of the population in Uganda adhered to wearing face masks in combination with 50% adherence to social distance, there would be effective control of COVID-19 after lifting the lockdown. The public should therefore be cautioned against acquiring a false sense of protection when wearing masks; and should adhere to other interventions the Ministry of Health has recommended, such as staying home when sick, not touching the mouth, nose and eyes, as well as limiting unnecessary social mixing. All efforts must be made to educate the masses that although face masks are important in the prevention of the spread of COVID-19, they are not a fool-proof solution and that one needs to take extra precaution to ensure that they maintain a “social distance”.
In conclusion, it is our considered view that the lockdown measures can be relaxed further, as long as wearing of face masks is made mandatory and social distancing practices continue to be adhered to in crowded places such as markets, schools, churches, taxi parks, and shopping arcades. However, as shown in our modelling work, enforcing social distancing practices still remains the single most important fact in the prevention of the spread of COVID-19. Furthermore, as noted in our previous policy brief, Uganda is yet to experience a fully blown community COVID-19 epidemic. Therefore, testing should done at all boarder points effectively and no truck drivers or other individuals should be allowed to access the country before their COVID-19 status has been established. This will help prevent a community level COVID-19 epidemic within the Ugandan borders that would be difficult to manage.
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