COVID-19: Why Uganda Needs to Rethink Social Distancing Guidelines

Uganda which some public health experts heralded as shining examples for its handling of coronavirus has had a "dramatic" increase in deaths and cases.  What some have described as “rapid increase” in Covid-19 infection rates has prompted appeals to people to adhere to public health guidelines.

There is concern about the effectiveness of the Infection Prevention Control (IPC) as well as Public health and social measures (PHSMs) introduced in mid-March 2020 to curb the virus. Uganda had by the time of filing this report registered 317 deaths due to COVID-19.

There were 38,534 confirmed cases, while over 13,400 persons had recovered.

According to the January 20th epidemiology statistics from Africa Centre for Disease Control (CDC), Uganda is among the 38 countries in Africa reporting 40 Covid-19 cases per one million populations per day.

Uganda’s case fatality ratio is currently estimates at 2%. The increase in cases and deaths continue to occur despite studies indicating that most Ugandans are aware, knowledgeable and understand how the virus is transmitted and spread.

A study on citizens’ knowledge, attitudes and practices related to Covid-19 found that 8 out of ten Ugandan’s or 80% know how the virus can be transmitted.

It found that the awareness was high across most of Uganda though little lower in rural areas. Twaweza Sauti Za Wanainchi survey findings were not different from the one conducted by Uganda Bureau of Statistics (UBOS) between July and August 2020.  

Apart from awareness about the COVID-19 awareness levels, the UBOS Uganda High-Frequency Phone Survey on COVID-19 (UHFPS) found that a big share of respondents thought that existing lockdowns measures were effective in curbing the spread of COVID-19.

The increase in cases and deaths amidst high knowledge about infection transmission and prevention measures is puzzling health ministry officials and scientists.

Some experts suggest that the pandemic fatigue’ is setting in among some Ugandans tired of social distancing and wearing masks.

The Presidential Advisor on Epidemics, Dr. Monica Musenero said in an interview that complacency is one of the biggest concerns hampering the COVID-19control of transmission efforts.

“In fact for some people it is becoming normal for one to die of COVID-19. They attend burials without observing social distancing, they don’t put on masks and so the risk transmission is high” said Musenero 

Wilson Winstons Muhwezi, an Associate Professor of Behavioural Sciences at, Makerere University’s College of Health Sciences said it is important that message against complacency continues to be spread.

“I recall reading recently in a newspaper that was tracing how HIV and how one of the most prominent Ugandans Philly Bogoley Lutaya announced that he had HIV people had doubts. They thought he was acting out; he had been given money. So it’s very important fellow Ugandans that we take our own safety very seriously and adhere to the guidelines” he said

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Prof. Mukwanason A. Hyuha, an economist with  Centre for Critical Thinking and Alternative Analysis in December wrote a paper warning about the fact that many Ugandans were not wearing masks and adhering to the public health and social measures (PHSMs) for slowing transmission of COVID-19.

“I often attend funeral, wedding, du’a and other ceremonies while wearing my mask, observing social distancing, avoiding shaking hands and touching my mouth, eyes and nose), and so on. However, I have always observed that only a small minority of the attendants of such events do observe the SOPs—a percentage in the region of 5-10% or less” wrote Hyuha

According to Hyuha, to many of his village mates back in Butaleja the fear about dying of COVID-19 is not very scary as it were at the time COVID-19 was declared a global pandemic.

“In fact, a few people even have had the guts to tell me to my face that “If you do not die of COVID-19, you will still eventually die of old age or something else—So, why so strict with SOPs?” he said

For Hyuha and behavioral expert, Wilson Winstons Muhwezi, there shouldn’t be room for complacency about COVID-19 prevention measures. “It will take extreme behavior change by accepting the inconveniences that prevention guidelines throw on us to be able to survive this challenge” advised Professor Muhwezi

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In April last year, scientists from several universities in Uganda including Makerere University published an article in the Frontiers in Public Health Journal warning about the misconceptions on COVID-19 risk among Ugandan men. The study found that men in Uganda perceived themselves to be at greater risk than women they also associated COVID-19 with “the white” race.

Professor Hyuha said most of those misconceptions still persist especially in rural areas and therefore need to be demystified through communication messages.

Biological Science Versus Social Science Debate In COVID-19 Response

Almost a year since the Health Ministry and the National COVID-19 task force instituted the the prevention guidelines providing for social distancing, wearing face masks and generally limiting public gatherings, social scientists say those have not helped to stem the infections.

They say the government seemed to have underestimated the role of social  scientists in responding to the COVID-19 pandemic.

Professor Hyuha says  social scientists would play to sensitize and persuade communities to strictly observe the SOPs and related issues. 

“Most likely, it was assumed (wrongly in my opinion) that the scientists would do everything necessary, including working on sensitisation and society’s mindset change” said Hyuha 

This week, the College of Humanities and Social Sciences at Makerere released a study about Strengthening Public Health Responses to COVID-19. Among the findings was the fact that the procedures adopted to prevent COVID-19 infections were more based on biological sciences but largely lacked aspects of social sciences.

Professor Kikooma Julius, Deputy Dean at College of Humanities and Social Sciences, Makerere University said the challenge with response to the pandemic has been coming from the way human beings conduct themselves. He says aspects like individuals’ social issues, their politics and others were not thought about when COVID19 regulations were designed.

“This pandemic is not just a snapshot in our lives. What we are learning is that we are in this thing for quite a while. And if we are in this thing for a quite a while, we cannot rely on measures that were thought   in a snapshot way. That is why you see that that even when they came up with lock down measures, they were thinking in terms of three weeks, and then they kept on increasing and that is a challenge” said Kikooma    

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What Options  as cases surge?  

Some experts interviewed for this story say there may be need for stricter measures to enforce the COVID-19 measure while others say that people are simply tired of the masks and social distancing measures.

Prof. Dennis Byarugaba, who heads the National Flu Surveillance Group recently told journalists in Kampala said that enforcement of COVID-19 prevention measures could be an option since many people are not abiding.

“We are a little bit used to being pushed to do things we are supposed to do. We probably might move into the next stage where probably the government should come up and ensure that the enforcement of government comes in very strongly to ensure that our public is safe.” Suggested Professor Byarugaba

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Dr. Monica Musenero, a field epidemiologist with experience in combating virus like Marburg and Ebola in Uganda and West Africa said now that Ugandans are not adhering, the only hope is that Uganda gets hold of vaccines against the virus.

She explained that unlike Ebola which does not spread when a person is seriously sick, the control COVID-19 becomes complicated because those infected with coronavirus spread it even when they have not shown any signs and symptoms.