Uganda: Govt On the Spot Over Covid Deaths

By Elizabeth Kamurungi

The government yesterday moved to alley public fears that it is under-declaring deaths from the second wave of the Covid-19 pandemic now ravaging the country.

Whereas on some days government has reported no deaths, a number of people claim on the same days they have had relatives die of Covid-19.

Sunday Monitor understands that many people who die with Covid-19 symptoms at home and in lower health centres across the country are not being tested due to the high costs involved.

A Covid-19 test costs between Shs80,000 and Shs300,000 per person.

Experts in the health sector say the few tests carried out have also contributed to underreporting in the general statistics recorded.

Contacts and alerts, however, are tested at no charge in public facilities.

The inconsistency in death tallies is magnified in the country's epicentre, Kampala City, where officials have admitted that they do not have adequate testing capacity to include large numbers of people dying in their homes.

The problem is equally worse in other parts of the country.

In the last 14 days alone, between May 27 and June 9, the country has registered a total of 47 deaths.

As of June 9, the cumulative deaths stood at 408.

In the same period, out of the 82,714 samples tested, 13,282 turned out positive. As of June 9, a total of 47,760 people had recovered from Covid-19.

However, some people Sunday Monitor talked to described the official count as a "misrepresentation" of the current Covid-19 curve in the country.

Hospital deaths

Dr Moses Muwanga, the director of Entebbe Regional Referral Hospital, told Sunday Monitor yesterday that in the past one week, five deaths had been recorded.

Dr Nathan Onyachi, the director of Masaka Regional Referral Hospital, said from June 6 until yesterday [Saturday], five deaths had been recorded at the facility.

Dr Rosemary Byanyima, the deputy executive director of Mulago National Referral Hospital told Sunday Monitor she did not have the number of deaths off head but confirmed that the deaths have doubled in the previous week.

"In a day, we are registering double digit deaths. It is no longer 1 up to 9," Dr Byanyima said.

Dr Byanyima' s revelation on "double-digit" numbers for Mulago National Referral Hospital alone, however, appear to contradict the latest count from the Ministry of Health, which indicated that on June 9, the country lost only six people.

On June 8, the ministry reported zero death from 14 a day earlier.

Prof Francis Omaswa, the head of the Covid-19 Community Engagement Strategy sub-committee, admitted that some Covid-19-related deaths that occur in communities may go unreported and that the ministry figures are not conclusive.

"What is for sure is that the [death] reports are not actual. There are many illnesses, many deaths that are not reported because there are many people who do not report to health facilities at all," Prof Omaswa said.

He, however, says this is not unique to Uganda.

But Dr Henry Kyobe, the Covid-19 incident commander, yesterday clarified that collecting information on Covid-19-related deaths takes time but also requires verification to ascertain the actual cause of death.

"We appreciate it has caused some confusion in the population; with some saying we are concealing deaths, but we are not. It is just due diligence that we do so that we report accurately. We shall come up with a press statement to explain the issues surrounding the reporting of deaths," he reassured.

"We have a process of verifying deaths so when you see zero [deaths], it is not [that] there are no deaths... we have not reported. It might not be a zero.

Collecting information on deaths is not as easy and we need to go back and verify it. Some deaths might not be Covid-19-related, some might not have a positive test," Dr Kyobe said.

Dr Diana Atwine, the Ministry of Health Permanent Secretary, told Sunday Monitor that only those who die in both private and public hospitals, with positive results, are reported as Covid deaths.

"You see as if we have a number of unreported deaths but it is because when you look in their chart, there is no result to show PCR positive yet they are in intensive care unit. The question is, are you going to declare everyone who comes with difficulty in breathing and dies? We are not yet reporting those whose results are not yet confirmed," Dr Atwine explained.

She added "According to WHO, you can only declare someone who has died of Covid when they test positive for Covid yet we have known that there are a number of people who arrive with PCR negative but on X-ray, it is clear it is Covid. Or they arrive and die, especially in private clinics before they are tested but they tell you the person presented like Covid."

Dr Atwine says some considerable numbers admitted to or dying in ICUs are battling the aftershocks of the virus, and yet at this stage, the results will most likely be negative.

According to Ministry of Health, after 10- 14 days the body eliminates the virus but may leave severe damage that is actually claiming many more lives.

"You start getting complications of the cytokine storm. This means that as a result of reaction to Covid, you get exaggerated inflammation, your lungs are all inflamed, you get micro clots or the air way is blocked. What is happening is some people came in that stage, when the virus is gone, you test and the PCR is negative and then they die. They are clinically Covid but the test has not confirmed. So should I go ahead and declare that this is Covid death?" Dr Atwine added.

Currently, the Health ministry is working out a plan to introduce death categories that may include confirmed or probable Covid deaths in both private and public hospitals to give a clear picture to the public.

"We have another list of deaths that are not yet captured in our system because we had not yet agreed. The deaths we have declared are those whose positives are available. Some people died of Covid-related complications, although on the chart, they may have negative results," Dr Atwine added.

Dr Atwine explained that results are collected from all over the country daily and their team takes time to process the data.

Tests carried out from private or from public health facilities, are uploaded into one central system controlled by Central Public Health Laboratory (CPHL).

According to the Ministry of Health, all laboratories accredited for testing upload to this system and when a death occurs, it is submitted to the Incident Management Team in the situation room that works 24 hours. The death must be confirmed that there was a positive PCR result in their chart.

"If it is not there, even if they presented Covid symptoms, it is not reported as a Covid death," Dr Atwine said.

Dr Atwine, however, said this data is reliable and shows the situation the country is going through.

"The official data comes in from the district and should be coming in on a daily basis. If there is an incident in the community, it is reported from the district surveillance office, on to the Ministry of Health. Even the health facilities report through the district," Prof Omaswa said.

Dr Kyobe said the number of those admitted in hospitals is data from both public and accredited private health facilities that are treating Covid.

According to Uganda National Association of Private Hospitals (UNAPH), a number of cases on admission are not captured in the Ministry of Health data as a number of unaccredited private health facilities are treating and testing Covid.

"We have a challenge, there are centres which have not been accredited yet they are testing and treating Covid cases. Even the Health ministry got in touch with us, we sat and have reached out to our members," Dr Denis Kimanyo, the UNAPH chairperson, said yesterday.

A big proportion of Covid-19 cases remains in the communities, which has continued to fuel transmission. Government has urged the public to observe standard operating procedures.

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