Dear Countrymen and Women, Since my last two updates, the country has seen a more aggressive and sustained growth of the COVID-19 pandemic as opposed to the earlier months of April and May 2021. Over the past 3 weeks, the daily number of people testing positive for Corona has increased from less than 100 to now over 1,700. This represents a 17 fold increase in daily cases. As a result our epidemic curve is now on steep rise with increased reports of deaths nationwide.
This is the time it takes for the number of cases detected to double. The shorter this time is, the more intense the virus is spreading in the community. This time has dropped from 68 to 31 days in just one week. This means that if no major shift in the response is done, the pandemic intensity will double in one month; o We are experiencing very high hospitalization rates and deaths for COVID-19 patients among all age categories. o Cases have now expanded to cover most of the country.
When I addressed you three weeks ago, only 61 districts had significant spread of the virus, as of 16th June 108 districts as shown in this map below. 5 o Figure 2 Map showing distribution of Cases over the past 21 days 6 The top 20 districts are: Given the nature of this virus, the moment you detect one case, then it is a matter of time until the infections expand and the number increases. 7 We have noted a number of danger signals in the trend of the pandemic.
These help to alert us to how we are doing. Some of these include; Table Summary of Key indicators of Covid-19 in the country Danger Signal 22nd -28th May 2021 29th – 4 th June 2021 5 th -11th June 2021 Increasing number of daily COVID-19 cases (number per week) 2,887 6,308 9,042 Increasing positivity rate (in %) 10.1 16.1 17.2 Decreasing admission rate despite increasing numbers of cases (in %) 12 10 8 Increasing proportion of severe and critical cases on admission (in %) 49 47 57 Reducing doubling time, meaning the intensity of outbreak moving faster than before (in days) 68 36 32 8 The rapid surge in the intensity of the pandemic appears unprecedented, but still manageable using the similar measures we have used since last year at the beginning of the pandemic and in all our previous revolutionary endeavors in the past more than 50 years.
This situation was anticipated by Government, and hence manageable because we have the correct diagnosis, and the means to tackle it. To date, the country has registered a total of 68,778 COVID-19 cases; where 973 patients (Severe 894, Critical 79) currently on active admission at both private and public treatment facilities across the country, and 42 deaths reported today. This brings the reported total deaths to 542. These are reported and confirmed deaths by PCR testing, but there may be more deaths diagnosed by other means. However, we are cognizant that both the number of COVID19 cases and deaths may be higher than this, and the Minister of Health will accordingly explain and update the nation on this.
9 However, apart from individuals fall sick or die in the community or health facilities without being tested, scientists have also brought to my notice situations when Covid-19 patients may falsely test negative. For example, the individual may have taken the test and the virus is no longer in the nose or throat, but the virus is in other parts of the body or it has already started the “body panic crisis” which in some cases may lead to death.
Some of these deaths may not be immediately classified as Covid-19 until further investigation is done. In the longer run, most Covid-19 related illness and deaths will be well documented. But as noted above, despite the rapid escalation of the outbreak, the hospitalization rates have remained low, and dropping (from 12 to 8% over the past weeks as in the table above). This signals intense that the health system is beginning to get stained, we must do everything to protect the integrity of the health system. Since my address 3 weeks ago, the severely and critically ill COVID-19 patients have more than doubled straining the available oxygen supply.
An average non-COVID-19 10 critical patient consumes one-to-two oxygen cylinders per day, however, a severely ill COVID-19 needs four to six cylinders per day. The current national daily oxygen consumption stands at 3,000 cylinders per day, where each cylinder is 6,800 liters. With the estimated COVID19 patient increase in the coming weeks, the daily oxygen consumption will rise to 25,800 cylinders per day in one month, unless we change the course. This is nearly a 9 -fold increase in the overall national oxygen requirement.
The current overall national oxygen production (oxygen plants linked to our national and regional referral hospitals), including the private sector is 3,005 cylinders against daily consumption that stands at 3,000 cylinders. The current oxygen challenge we are facing is the availability of empty cylinders for distribution. Of course if cases keep expanding, it can also outstrip our production capacity. As I indicated in my last update, the current hospital beds to manage COVID-19 patients stand at 3,793 as summarized below.
11 Treatment Unit Standard Beds (n) High Dependence Unit (HDU) Beds (n) Intensive Care Unit (ICU) Beds (n) Mulago National Referral Hospital 600 300 27 Mulago Women’s Hospital – 60 – Regional Referral Hospitals 900 115 150 Namboole Treatment Unit 1,300 – – Bombo Military Hospital 120 – 10 The seven (7) Ministry of Health accredited Private facilities 180 – 31 Total 3,100 475 218 As noted above, unless we urgently intervene to reverse this, the estimates and observations by scientists show that the current number of people needing care will double in less than one month, outstripping our bed capacity.
12 As a result of all the above, my strategic interventions to maintain the fine balance of pandemic control will hinge on preventive health and urgent care for the severely ill. This will be tackled in two ways.
(a) Urgent interruption (or minimization) of community transmission to cushion the health system, sustain our people’s economic lives and save lives using previously used containment measures. Government will aim at reducing the speed and the intensity of transmission to within the next 42 days so that number of new cases is less than the available bed and oxygen capacity in the country.
(b) Ramping up oxygen supply to all COVID-19 treatment health facilities and optimize the available care capacity so that it can adequately handle current and new cases over the next 42 days. I must commend Ugandans; over the last 12 days many have heeded my directives and the Ministry of Health SOPs. My mobilisers in and around Kampala inform me they are staying in their houses more and 13 more.
They inform me they’re sanitizing more than before. I have also observed marked reduction in congestion around Kampala and more use of masks, meaning people are increasingly adhering to the SOPs. I thank you and commend you more for this patriotism. Despite this positive trend, we need to do more to preserve and protect our health system and hence our lives. To achieve the above two strategic objectives and augmenting my observations above, starting at 2200HRS today 18 th June 2021, I am revising and updating ALL the directives I issued on the 6th June 2021.
The revision is as follows: 1. Public and private transport: It has been observed that Taxis/ Boda-Bodas drop passengers at district boundaries (relay system) to be taken over by their colleagues waiting across the boundary districts which may result in further spread of the virus in communities. Additionally, it has also been observed that despite this directive, human beings walk 14 across district boundaries. This therefore has not achieved its intended purpose.
Furthermore, the movement of individuals fuels virus transmission, and without limiting the movement of persons which leads to mixing and re-remixing of individuals in the different categories of infected and non-infected. This needs to be stopped since and is the cornerstone of the current exponential transmission drive.
Directives: (a) Across the country, the Resident District Commissioners working with the Chief Administrative Officers and their District Health Officers are directed to make all the necessary arrangements to ensure all individuals that require medical care and medical evacuation in their respective districts, COVID-19 or otherwise are taken care of. (b) Only registered tourists’ vehicles will be allowed to move. These should move directly to their destinations and designated places.
15 (c) Emergency vehicles, police and army vehicles, and essential workers vehicles will be allowed to move. (d) I have defined the ESSENTIAL SECTORS and where there is need for additional clarity, The Rt Hon Prime Minister will study such and communicate accordingly. (e) Among the Essential Health workers include doctors, nurses, pharmacists, veterinary doctors, and other essential health staff. Details of other essential sectors will be worked out by the Rt. Honorable Prime Minister and her team.
The essential workers will be given specific identifications 2. Curfew: It is observed that some sections of the public are not adhering to the curfew hours (2100 Hrs to 0530 Hrs).
Directive: (a) As such, the curfew time throughout the country is pulled back to 1900Hrs to 0530 Hrs. All human beings except security and 16 those authorized to move should be their homes.
(b) Boda-Bodas will only be allowed to move only up to 1700Hrs. 3. Educational Institutions: Observation: Testimonies from credible sources indicate that schools had been deliberately silent about infections among students due to fear of closure.
Directives: (i) All schools and institutions of learning remain closed for 42 days
(ii) The Ministry of Health to reactivate Village Health Teams (VHTs) under the Community Engagement Strategy (CES) to strengthen sensitization of the communities.
(iii) The Ministry of Local Government is hereby directed to support the Regional Task Forces (RTFs) and District Task Forces 17 (DTFs) to be reactivated and supported to enforce compliance of all SOPs.
(iv) The Ministry of Finance and Economic Planning is directed to support the Regional Task Forces (RTFs) and District Task Forces (DTFs) should be reactivated and supported to enforce compliance of the existing SOPs.
4. International and Cross-Border Travels: Entebbe International Airport will remain open, but we shall ensure the no virus, or new variants enter Uganda. Uganda’s land locked country. All cargo movements, to and out of Uganda will be allowed without any disruption. Directives (a) Cargo truck drivers at land-border crossings will be tested allowed to move and be followed up at the designated Seclusion Areas and holding places for Cargo trucks.
18 (b) The Ministry of Works and Transport is hereby directed to reactivate the operations of Seclusion Areas for Cargo trucks.
(c) The Joint Intelligence Committee (JIC) to monitor compliance of particularly the private cars allowed to cross the borders to ensure total observance of the SoPs and guidelines.
(d) Non-cargo cross-border movement, except for licensed tourist vehicles is hereby suspended for the next 42 days.
5. Non-agricultural activities and markets: Efforts have been made to bring on board different actors including Kampala Capital City Authority (KCCA) and Ministry of Works and Transport (MoW&T) among others. However, the surge of crowds has not sufficiently subsided despite the effort to enforce social distancing and the use face masks. This might not take away the danger of spreading COVID-19 as envisaged.
19 Directives: (a) Food Market Venders should revert to the Presidential Directive of March 2020 to stay in their places of work.
(b) Kikuubo and other Business Centres should be closed, and the situation reverts to the Presidential Directive of March 2020. 6. Burials: Whereas the compliance on this has been low, the high-risk factor assessed is the pressure of people seeking permission to go and attend burials from place to place. This poses the highest danger of spreading the virus and breaches of the strategy. Directive:
(i) Burials to be restricted to the core family as applied in the military.
(ii) The Committee I put in place during my last address – led by Major General Rusoke and Dr. Musenero should ensure the institution of a well-coordinated mechanism which 20 enables a few family members to transport dead bodied for burial. RDC and DPC should ensure that all SOPs are observed and not more than 20 people attend burial. And avoid gatherings and visits to the deceased family after burials which will promote spread of the virus. 7. Bars, Discos, Sports Betting, and Cinema Halls: Despite the directive, the bar owners and clients have not fully adhered. Directive:
(a) KCCA, URA and Local Government authorities are directed to close and seal off all the bars. Police should accordingly arrest and charge with hefty fines imposed for reopening.
(b) It serves no purpose arresting the revelers while allowing the owners to reopen the following morning. 21 8. All other sectors which are not specifically mentioned should consider themselves closed for the next 42 days. 9. Institutions and Organizations: Although most offices have complied with the 30% physical presence at the workplace, the directive ought to be reviewed. Current information so far obtained indicates that despite this scale down, infection rates in this area are very high. I have thus revised this. Directive: (a) Further reduction to 10% in Non-core Ministries, Departments and Agencies (MDAs).
(b) The Rt Hon Prime Minister working with the Ministry of Public Service and the Ministry of Health will re-define the Non-Core MDA 10. Factories and construction sites: Whereas this directive is being adhered to, it remains tricky because in some areas, workers have to 22 cross different districts to reach their places of aboard. Therefore, a well-intended plan could yield less because of circumstances.
Directive: Where possible, the workers MUST be housed at places of work for the next 42 days. I encourage factory owners to work with the Ministry of Health to ensure only uninfected workers enter the camps. Where camping is not possible, the factory owners should work together with the Technical Committee to agree on a safe alternative to enable factory activities to continue safely during the lock down period.
11. Places of worship: The churches, mosques, and sports sessions are congregating settings and are a source that fuels rapid virus transmission. 23 Directive: All places of worship and sports events remain suspended for 42 days
12. The Monitoring of the compliance and adherence to these directives: The Joint Intelligence Committee (JIC), working together with the Technical Intersectoral Committee under Maj Gen Robert Rusoke are directed to closely monitor the compliance and enforcement of these directives. Except where specifically stated, all these measures take IMMEDIATE effect and will last 42 days when I will make subsequent revision.
For our lives to continue, the following sectors fully function: (a) agriculture, (b) industry, manufacturing and tourism, (c) health and medical services, (d) security (police and army), (e) utilities (water, electricity, mass media, telecoms, banking institutions, garbage/waste management, retail shops and markets), (f) cargo transport and goods distribution. I have thus categorized these sectors as essential sectors.
24 At this critical moment, I wish to call upon all the leadership structures throughout the country. Every village has community health workers known as Village health teams (VHTs) who are in touch with families and keep records on the health status of the villages. For example they know how many people are in the village, how many are pregnant, how many children etc.
These VHTs should now be leveraged to increase population awareness, support for SOPs and affected households. The district based governance structures are all in place with salaried staff and should take charge of the situation and support awareness creation and enforcement. The Ministry of Local Government has undertaken mobilization of these leaders and they are fully aware of their roles in the COVID-19 response. All district Covid -19 Task forces are hereby called upon to awaken the national wide response system up to the community level.
25 Update of vaccination: The above measures will give us a temporally relief, however, we know that the ultimate solution to this Covid-19 challenge is to get our people vaccinated. To date, we have vaccinated a total of 869, 915 people, which accounts for 90.2% of the 964,000 doses received. Of these 57,797 (6.6%) have received both 1st and second dose. Yesterday, 17th June 2021, we received another 175,200 doses and we are expecting additional 688,000 doses of AstraZeneca vaccine in early August.
I have directed that these doses be prioritized to give second dose to those who have got already got their first dose. Government is working with Chinese embassy to bring in 300,000 doses of vaccines (Sinovac) and discussing modalities of acquisition of more doses through direct purchase. We are also in discussions with African Union on terms of acquisition of the Johnson and Johnson vaccines. The government will continue to explore all ways of fast tracking the acquisition of enough vaccines to vaccinate a critical mass of our population to ensure the country returns to normal operations.
26 Conclusion Finally, to all of you Countrymen and Women, these are urgent and temporary, but extra-ordinary measures, which we as the Nation must jointly and fully embrace to protect and preserve our lives, our ways of life, the way we live, and our future. It is only through these measures that we shall in a long run protect our economy, preserve our democracy and sustain the NRM revolution. Thank you.
