Are we Prepared for the Novel CORONA Virus diseases

On 31st December 2019, the Chinese government informed WHO of an epidemic of a new Corona virus from Wuhan, in China.

Corona viruses are a large family of viruses such as the one that causes common cold. The novel virus, 2019-nCoV, is a new strain that has never been seen in human beings before.

As of 8th February 2020, there were more than 35,000 confirmed cases and 723 deaths including the young doctor, Dr Li Wenliang, who was the whistle blower.

What are the symptoms of this disease?

As with other viruses that affect our breathing system, the 2019-nCoV can cause mild symptoms including running nose, sore throat and fever or can even be more severe in some people leading to pneumonia, severe acute respiratory syndrome, renal failure and death sometimes.

Persons exposed to the virus are first well for a few days, before developing symptoms and in most cases, 1-12 days after exposure. However, the exact incubation period is still not known thus affecting the establishment of appropriate prevention methods.

Two to three people out of every 100 with symptoms die. Most deaths are of older people and those with additional medical conditions such as diabetes and heart disease. It however is still early days and we are yet to learn more about the disease.

How is this virus spread?

Transmission is mostly via droplets. When an infected person coughs or sneezes, the virus is carried along in the droplets from the mouth or nose. If you are nearby, you can be infected if these droplets come directly into contact with your eyes, nose or mouth or indirectly when you touch them with your hands and then touch your face.

The virus can also spread through surface contact by touching. When the infected person sneezes or coughs, the droplets may fall onto rails, tables or chairs where the viruses may remain alive for a few days. When someone touches the surfaces, the virus can be transferred to their hands and if they rub their eyes, nose or mouth without washing hands, they may become infected. That is why handwashing is an important prevention strategy.

As with most coronaviruses, infected people are most infectious when they have symptoms. This is likely the case for the novel coronavirus. There has however been some cases of spread from persons without symptoms. This is uncommon, and has so far involved a few cases only.

Treatment

There is currently no medicine to cure this disease. For infected persons, what is done is to provide supportive care to reduce the complications and to allow time for the patient to recover. There is no vaccine currently. Currently appropriate drugs and vaccines are still under development.

Response of the Ministry of Health, Uganda

Among other actions, the Ministry of Health activated its Public Health Emergency and Epidemic Control system and has engaged several activities to prevent the disease from entering Uganda. The focus is on the entry points in to Uganda and especially Entebbe Airport where a trained team from Entebbe hospital is working in shifts to screen people entering the country.

Everyone coming through Entebbe is screened. Those especially from China and without symptoms are asked to go home and remain in their homes for up to 14 days and checked daily to see if they will develop symptoms before being allowed into public. An Isolation unit that can accommodate up to 30 people has been created in Entebbe hospital for people found to be symptomatic. A similar unit has also been created in Naguru Hospital. To date, no affected person has been identified.  The Uganda Virus Institute will be testing for samples as and when it is required.

Uganda Medical Association would like to commend the Ministry of Health for these and other actions to contain the epidemic. However, more is needed, some of the steps taken are inadequate and we are indeed concerned particularly about the risks to our health workers and families in case one is infected and has not expressed the symptoms and happens to be infectious.

1. Mental health care services for the health workers screening at entry points

This is a potentially fatal disease. The health workers involved in the screening exercise are doing so under extreme stress, fear, worry and concern for both themselves and their immediate families. You are not sure whether you may not end up contracting the disease and die.

1. We quickly need to train and deploy more health workers at the screening points and give longer periods of rest in between deployments. The current team is grossly inadequate and over-stretched.
2. Secondly, we need to create a system to provide Mental Health Support for the health workers conducting the screening. A team of psychiatrists and clinical psychologists should be put in place to provide this help. Our colleagues in Psychiatry and Clinical Psychology and Counselling will be happy to support such an initiative.
3. Personal protection equipment and supplies

It is a matter of urgency that personal protection equipment and supplies – such as gloves – be supplied to ALL health units in the country. There has been a lot of outcry from health units in different parts of the country about the lack of or inadequacy of these supplies since late last year. With the advent of this epidemic, the lack of protective equipment is creating a lot of anxiety among health workers.

• Involvement of private health units and hospitals in the preparations

People who may develop symptoms and present with this disease after coming to Uganda are more likely to present to private rather than public hospitals. We urge the Ministry of Health to urgently engage the administration of private hospitals especially around Kampala and our border entry points to prepare them for this.

• Quickly develop management guidelines and train health workers on disease management pathways.

There is a need to quickly develop disease treatment/management guidelines and train health workers on this. Uganda Medical Association will be happy to work with the Ministry of Health to develop or adapt the guidelines. In addition, there is also a need to create, train and deploy emergency groups and a system to transfer patients from private hospitals where they may present to the isolation units.

• Lastly, we need an increased engagement of the public with health messaging.

To the Public, what can you do? How can you protect yourself?

The most effective way to protect ourselves is to practice good personal hygiene.

1. Let us regularly wash our hands with soap and water.
   1. Avoid touching your face, eyes, nose and mouth with your hands.
   2. Maintain a social distance of at least 1 metre from especially people with a cold or cough who have fever.
   3. If you have fever, cough and difficulty in breathing, seek medical care early. Remember, the same symptoms may be due to other severe infections.
   4. But if you have similar but mild symptoms with a runny nose and have not travelled recently, use the basic hygiene principles and stay home until you are better if possible.

These measures sound so simple but are effective in preventing many kinds of infection.

Let’s start these measures now and not wait for the disease to reach Uganda.

We all need to protect ourselves and others – our loved ones, friends, and colleagues we come into contact with.

Dr Richard Idro                                                  

President, Uganda Medical Association

Service with Honour