When it became inevitable that COVID-19 was changing from simply being an epidemic into a fully-fledged pandemic, Africa waited with bated breath as daily news reports from countries with unlimited resources and the best medical services in the world were brought to their knees by this new yet to be understood disease.
Daily reports of thousands confirmed and numbers of about 1000 dying overnight. Hospitals over flooded, people dying in the streets and excavators digging thousands upon thousands of graves. The news forecasts for Africa were bleak. Melinda Gates, one of history’s greatest health benefactor predicted bodies lining the sidewalks of Africa, prominent research institutions predicted millions of cases and deaths in Africa come July 2020. As cases started springing up across Africa, Africa’s health workers were certain that Armageddon was upon the “dark” continent. In March 2020, all of Africa was locked down and we waited …
Three months later, things were not looking bad, so we cautiously started unlocking up. Today, almost a year since the first COVID case was reported in Wuhan China, Africa is yet to reach epidemic levels even close to the wealthier continents. Uganda for instance has had 10,000 cases confirmed as of mid-October 2020 and under 100 deaths. The health system has been affected more by the stringent preventative measures than it has been with cases of COVID-19. Now, the debate that started when the storm seemed to have bypassed Africa still continues.
Is it because chronic flues and other illnesses had rendered the African population immune, maybe it was the fact that almost all Africans had for more than four decades been subjected to mandatory infant BCG vaccination, maybe it was simply the fact that the African population was predominantly young, rendering it immune to the fatal effects of COVID-19. Whatever the explanation, Africa has thus far not experienced the devastations of COVID-19 predicted over it.
However, the health of Africa has been indirectly massively hit by COVID-19. It may never be known the number of mothers and babies who died from complications of pregnancy, labour and delivery. During the lockdown in Uganda, no one was permitted to use any mode of transportation without prior written permission of the Resident District Chairperson or with the official sticker for emergency workers. A nurse was even nearly prosecuted using a wheelchair to wheel a patient several miles into the health facility. Deaths from malaria, the major killer of children under 5 during that period will never be enumerated.
I loathe to imagine the missed vaccinations and therefore the possibility of killer diseases like measles and hepatitis, which will at a more distant date wield its power. Mental health from isolation, domestic abuse, extreme stress from loss of livelihoods, and fear has also not been estimated.
The one area where there is some data given that it is the one area in health care that is extremely organized is HIV care.
The way of HIV infection is that, no matter how long one has been on treatment, it requires that the person with the infection religiously takes their medication daily if the virus is to be kept in the sleeping state. Unfortunately for many, the lockdown was sudden and to an extent, not anticipated by anyone. This meant that patients who did not have enough medications to run the entire duration of the lockdown had to either find a health facility providing HIV medications that they could walk to.
Those that could not find such a facility had to go without treatment. Also, there were interruptions in delivery of HIV medications to some facilities as well as an interruption in services, since not all health workers had access to transport and therefore could not go to work. Also, owing to fear of the COVID-19 virus, a number of patients preferred not to risk their lives going to health facilities. What this means therefore is that patients who were virally suppressed (had their virus properly controlled) experienced an increase in the virus.
This means a number of things. That for a so far unknown number of patients, the virus may not respond to the same medication as before, meaning that they have to start a new set of drugs with more side effects, more pills to swallow daily, and costlier to whoever is buying them. Increased virus levels in blood also means that the person is more likely to infect another person; their infant or sexual partner.
Because of the COVID-19 restrictions, there has been a significant reduction in the availability of HIV testing services and community outreach services for home-based testing have been paused.
Resultantly, the newly infected as well as others who were previously infected do not have easy access to testing. The longer one spends with HIV, not on treatment, the more likely that they may transmit it to others and also the more likely that their immune system will be destroyed exposing them to potentially fatal illness. These scenarios are not limited to Uganda; they are being replayed all over Africa.
By Dr. Miriam O. Laker-Oketta
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