THE REPUBLIC OF UGANDA MINISTRY OF HEALTH PRESS STATEMENT Update on the COVID-19 response in Uganda Pea Dr Jane Ruth Aceng Minister of Health 18 April, 2020bes Update on the COVI 9 response in Uganda 18" April 2020- As you may all recall, Uganda registered her first case of COVID- 19 on Saturday 21 March, 2020. As of today, the country has a cumulative number of 55 confirmed cases of COVID-19. All the confirmed cases were admitted in Entebbe Grade B hospital, Mulago National Specialized Hospital, Adjumani and Hoima Hospitals. To-date, 20 patients have been discharged; Entebbe Grade B (7), Mulago National Specialised Hospital (11), Adjumani (1) and Hoima (1), leaving a total of 35 active cases. Uganda has NOT registered any COVID-19 related deaths. Allow me in a special way to appreciate H. E the President of the Republic of Uganda for the swift and decisive way in which he has commanded and guided the national task force for COVID 19 including issuing the 35 guidelines for prevention of infection to the general public to follow and adhere to. His Excellency has addressed the public several times and repeatedly emphasized on prevention and suppression of transmission. I would also like to appreciate the Health workers at the frontline in this battle. You are doing a good job in spite of the challenges and you are highly valued. I cannot forget to thank the communities, the entire population of Uganda for your resilience, support and cooperation. The direction in which this pandemic will move in our country will be determined by you, your behavior, support and cooperation. I have no doubt that you have been listening to the President, following his advise and oethe guidelines given to you by the Ministry of Health and also listening to what is happening throughout the world and are ready to ensure that COVIDI9 does not spread to manageable levels in Uganda. Following the declaration of the 14 days Lock down, the Ministry of Health developed a lock down strategic plan with 6 action points aimed at combing the country to ensure that all potential sources of infection are identified, tested and managed accordingly. ‘The Action plan included; itt VI. Following up of contacts and alerts and testing all. . Testing all those in quarantine and discharging those who test negative and have not had another contact Supporting decentralization of surveillance and management of patients to the regional and district levels. Enhancing risk communication to the regional levels, districts and the communities. . Screening and testing of all incoming cargo drivers from the East African community area Identifying, mapping and testing all returnees who came back between 7" and 22" March when the airport was closed. HseACHIEVEMENTS OF THE COVID-19 RESPONSE DURING THE 14-DAY LOCK DOWN PERIOD I. Management of confirmed cases As of today, Uganda has a cumulative number of 55 confirmed cases. Of these, 20 have recovered while 35 are active cases. Please note that this is a cumulative number comprising recoveries. Active cases are the cases that still have the virus and are undergoing treatment at the respective health facilities. From the onset of the Pandemic to date, a total of 9,975 persons have been done, of which 9,920 are negative and 55 were confirmed positive. An analysis of the confirmed cases reveals the following; History of travel — 46 persons broken down as follows . 30 from quarantine sites © 5 directly from the Airport 12 returned following the appeal to all those who returned from Dubai to come for testing © 1 truck driver from Malaba point of entry No History of travel — 7 persons, broken down as follows; © 7 contacts of returnees (1- Lwengo (UAE) 1-Kyengera/Nkonkonjeru (UAE), 1- Kyanja (UAE), I-Kayunga (Rwanda) and 1- Katabi (unknown bodaboda), 1 from Adjumani and 1 from Iganga. All staff in Entebbe hospital who have been taking care of the patients have been screened for COVID-19 and all tested NEGATIVE. This means they are appropriately following the Infection Control Procedures in the Isolationfacilities. A repeat test will be done after 2 weeks. aanPreparation of patients for discharge includes; counseling the community where the patient is going to avoid stigma and discrimination, psychosocial counseling to the discharged case, a 14-day follow up of the person to provide psycho social support and risk communication. The discharged patient with a discharge certificate, results slip of the last test and the SOPs of “DOs and DONTs”. II. Follow up of Contacts and Alerts A cumulative total of 1,396 contacts to the confirmed cases have been registered since the declaration of the first confirmed case, 1,078 have completed their 14 days of follow up, screening and or testing. 317 contacts are still under follow up. So far, 1,246 (89%) contacts have been tested after 10 days of daily follow up. All contacts to confirmed cases are followed up daily by our surveillance officers for 14 days. If they develop signs and symptoms of COVID-19, they are tested and if found positive, isolated for treatment. Institutional Quarantine Institutional Quarantine was an intervention that greatly limited the spread of infection to the communities. In spite of the challenges, 30 of the cumulative 55 confirmed cases were identified from Institutional quarantine. The cumulative number of persons quarantined to date is 2,661 country wide. Currently, a total of 437 people are still under institutional quarantine. (30 in Entebbe, 53 in Kampala, 354 in upcountry sites) aeIs A total of 18,860 high risk returnees between 7" - 22™ March were identified Ill. High risk returnees through the information obtained from the flight manifest. From the 6" March to 16" March, several people were put under self quarantine and successfully followed up. Those who came in from the 17" to 22"! March, from the high risk countries ‘were put under institutional quarantine. A good number came back following the call from the Ministry of Health to those who returned from Dubai. Of the 9,975 tests done to date, 2,878 are from the border points of entry, 700 are contacts and 6,397 are part of the high risk travelers. In total, over 8,000 people have already been identified and cleared. Others have been reached during follow up and contract tracing. The process of reaching out to the returnees is still ongoing with support from the Telecom companies. A Nose and throat swab and blood samples may be removed from the persons once reached depending on the assessment by the surveillance officers to rule out the possibility of asymptomatic infections. I request those not yet reached to be patient and cooperate for the exercise to be completed this coming week. Support to Districts and Regional Referral Hospitals to enhance their capacity to respond to the pandemic and offer basic medical services e Each district has been provided with funds to facilitate the various functions of surveillance, contact tracing, sample removal and testing, quarantine, risk communication and case management. © Training of district and regional referral hospitals teams on COVID 19 preparedness and response is being rapidly undertaken. The exercise includes training of case management teams and setting up isolation facilities. ede |© Ministry of Health has deployed a team of four specialists per region comprising of a senior clinician, a senior Ministry of Health officer and two epidemiologists. These teams will carry out the following tasks o Train the regional and district health teams to build their capacity for handling COVID19 cases. © Support coordination of information and prompt reporting to the incident command center. Support the districts to carry out surveillance and contact tracing within ° the communities. © Support risk communication activities throughout the parishes and villages by ensuring that the district leadership engages the village health teams ° Support the districts to ensure smooth continuity of the other basic health services for all ailments © All districts and Regional Referral Hospitals have received protective wear, sample removal kits and other supplies to enable them safely remove samples and send for testing V. Risk communication ‘The district leadership is being supported to disseminate preventive messages and other Key messages related to Standard operating procedures for many areas as prepared by the health promotion and communication teams of the ministry of health and partners. These messages have been translated into 7 different languages. The districts are encouraged to use all channels of communication including the Village health teams to disseminate preventive messages information.VI. Screening and Testing of Cargo transporters The Ministry of Health began screening and testing truck drivers across the 53 Points of Entry. To-date, a total of 2,878 samples from truck drivers have been screened and tested, of these 1 Ugandan truck driver tested positive, while the other two were from Kenya and Tanzania respectively. On average, 2,500 trucks cross the border points daily. In light of the high numbers at the Points of Entry, the Ministry of Health working with the districts is training more health workers and will increase the number of health workers manning these points. The high numbers of truck drivers crossing into the country will require a substantial amount of test kits. Further discussions will be held with the East African community member countries on how to handle this area. I am aware that many of you have been questioning why we do not hold the truck drivers until their test results are returned. This is because; 1. They are transporting critical supplies that could save many lives during this lockdown both locally and regionally 2 If we hold them at the borders for a long time, crowding occurs. Crowding is a risk factor for transmission of COVID-19. Standard Operating procedures have been developed to allow for easy tracking of the truck drivers. They are also given the Do’s and Don’ts guidelines to follow and strictly advised not to interact with any of the communities along the way to their destination. Implementation of the above six strategies is still ongoing. Subsequently, on 14 April, following the end of the 14 days lock down period, H.E the President of Uganda declared an extension of the lockdown for an additional 21 days (14" April to 5"" May). por wses REMINDER OF WHY GOVERNME) THE LOCK DOWN UNDERTOOK AN EXTENSION OF The purpose of a lockdown or extreme social distancing is to suppress transmission by reducing the number of people any undetected yet positive case in the community can infect. The goal is to ensure that each confirmed case infects less than one person, on average. Justification for the 21 day lockdown a) Evidence available from the response to the COVID-19 pandemic in countries where Lock down was delayed or shortened (USA, Italy, Spain and other countries in Europe) compared to others (South Korea, Singapore, Hongkong, Japan and China) where Lockdowns were implemented early in the pandemic and prolonged for over 2 to 3 months shows a better outcome in countries where time was taken to fully implement activities which were identified to reduce suppression of the virus. b) The experience from the Asian countries that have flattened the curves or kept their infection rates very low shows that very strict tracking, testing and quarantining of exposed individuals and their contacts has a big impact on the spread of the disease at community level. c) The 14 days Lockdown strategy had only been partially implemented. d) Extreme social distancing measures for the un-infected people reduces the mixing with infected people and protects them as the surveillance system operates to track and quarantine all exposed individuals. More emphasis needs to be put on this. getdes e) The lock-down reduced the pressure on the surveillance system and the health system by keeping the numbers low. The country must maintain the low numbers and low rates of infection —when the numbers of exposed and infected individuals grows so fast, the stress on the system is huge and the system cannot cope as we have seen in several countries in Europe and USA where the response was initially slow. With the potential sources of infection still not fully identified and with the numbers of confirmed cases in the neighboring countries rising, it would be too soon to lift the Lockdown. What is Government doing in the 21 days of lockdown? Ministry of Health will ensure that all the six action points are implemented. Focus will be put on the following areas: © Screening and testing all the Cargo transporters. Working with URA and Ministry of Transport, our surveillance officers have been oriented on how to track the cargo transporters. Standard operating procedures, Joint border clearance forms (JBCF) with details of the truck driver indicating his origin and destination have been developed for them to fill, truck routes have been mapped for the cargo transporters to follow without deviation and a tracking mechanism is in place for the surveillance officers to quickly track them and return them to the country of origin or quarantine them accordingly. Two (2) mobile PCR laboratories have been procured and will be received in the country tomorrow, Sunday 19" April 2020 and officially commissioned by the Rt. Hon. Prime Minister of Uganda. They will be deployed at the congested border points to quicken testing and return of results. I appeal to all bea 10of you who live along the roads followed by the truck drivers including the women who interact with them for different purposes to stay away from these truck drivers. During this period of Lock down, please do not accept visitors into your homes, not even neighbors, ensure adequate physical distancing with people who do not live with you every day. Stay at home, avoid trading centers and other business places because you do not know where your friend has been or whether he/she is safe. Those who defiantly use these trucks as a means of transport during this lockdown period are warned to stop these unlawful activities. Routinely test all health workers who are carrying out surveillance and managing COVID 19 positive patients in isolation. An inventory of health workers responding to this pandemic has been generated and testing has started and will be carried out every 7-14 days. Test all other incoming people like the UN staff who come to give support, identify illegal entrants into the country through the porous borders with support from the communities and test them Enhance risk communication to ensure everybody is aware about the potential danger of COVID 19. The Ministry of Health would like to hear from you on a weekly basis. The Ministry website and the twitter handle will publish an online survey to obtain feedback from you about our response. To ensure that the country is cleared of all pockets of transmission, the Ministry will carry out a rapid assessment survey focusing on previously known foci of transmission and points of congregation of trucks.Essential Medical Services I appeal to all health workers, and all health facilities to continue offering essential health services. Systems to facilitate patients to access services have been clearly communicated by H.E the President. KCCA should ensure that they publish all their routes and necessary phone numbers for the population in Kampala to access transport to health facilities. All the District Health Officers are again reminded to ensure that transport is available for the sick and vulnerable women and children to access health facilities. Ministry of Health is in the process of deploying the vehicles donated to the districts that are largely lacking transport facilities to support this process. Let us work together to provide the much needed services to our people and reduce the non-COVID related mortalities to avoid reversing the gains that we had made. Welfare of Health Workers and Frontline Workers The Ministry of Health regrets the delay in the payment of allowances to health workers and frontline workers in the COVID-19 response. We are in the process of ensuring that these allowances are swiftly paid after receiving bank account details of the health workers in this response from their respective supervisors. The Ministry will also ensure that health workers and frontline workers benefit from the donations to the COVID-19 response. This process has already started. Update on Research Scientists supporting Government in this response have prepared over 30 protocols for research to answer the some of the questions that we continue to ask as this is a new virus BegLastly, I would like to, in a special way and with deep appreciation recognize the tireless efforts of the health workers, public, private not for profit and private service providers. ‘The Ministry continues to appeal to the general public to remain calm and practice the preventive measures. Wash your hands with soap and water or use an alcohol based hand rub at least three times a day, maintain a social distance of at least 4 meters and if you have flu like symptoms, cover your nose and mouth with a mask. To report any suspected cases of COVID-19, call the Ministry of Health toll free lines on 0800-100-066, 0800-203-033 or 0800-303-033. You can call the shorter toll free code on 919. Residents of Kampala are advised to call 0800-990-000 or 0204- 660-816. Af Thank you. Dr. Jane Ruth Aceng MINISTER FOR HEALTH 18" April, 2020