WATERLOO — The pandemic “opened our eyes” to existing inequalities that create greater risk for certain communities, and a Waterloo health-systems researcher is hopeful those issues will begin to be addressed once COVID-19 subsides.
“Maybe the pandemic shouldn’t just pass by us once we get vaccinated and then we’re back to normal and things get back to normal and we forget about how this affected us differently,” said the University of Waterloo’s Moses Tetui.
https://www.therecord.com/news/waterloo-region/2021/06/28/covid-19-pandemic-exposed-long-standing-inequities.html
WATERLOO — The pandemic “opened our eyes” to existing inequalities that create greater risk for certain communities, and a Waterloo health-systems researcher is hopeful those issues will begin to be addressed once COVID-19 subsides.
“Maybe the pandemic shouldn’t just pass by us once we get vaccinated and then we’re back to normal and things get back to normal and we forget about how this affected us differently,” said the University of Waterloo’s Moses Tetui.
Despite groups designated as visible minorities being at an increased risk of infection and mortality from COVID-19, higher vaccine hesitancy persists among Black Canadians when compared to the general public. Some of the reasons put forward by members of the Black community as to why they’re hesitant to be vaccinated are lack of confidence in the safety of the vaccine and concerns about its risks and side effects. A team of researchers from the University of Waterloo including microbiology professor Trevor Charles, pharmacy professor Kelly Grindrod, and health-systems researcher Moses Tetui, seek to allay some of those fears. Are the COVID vaccine side effects the same for Black people compared to those who are not Black? Yes, there is no evidence that the side-effects from COVID-19 vaccines are different for any ethnic or racialized group. For all the vaccines approved in Canada, most people experience a sore arm for a few days after the vaccine. Around half of people experience tiredness and a headache, and less than half have body aches, chills or feel feverish. These are all normal and expected side effects and are common with many other vaccines as well. They are signs that the immune system is learning how to recognize COVID. For all these vaccines, these side effects will happen within a day or two of getting the vaccine and will disappear by the third or fourth day for most people. While there is a small chance that there will be a serious side effect, these are rare. Rare but serious side effects might be something like an allergic reaction. It’s always a great idea to speak with a health professional about any serious allergies or other health conditions or concerns you may have before you receive any vaccine. Are vaccines developed with considerations given to how they might affect Black people different from other races? Yes, around 10 per cent of the Pfizer and Moderna trial populations identified as Black. The studies demonstrated that there were no differences in efficacy or safety in any racialized or ethnic group. It is also important to note that there is no known evidence that would suggest that vaccines affect people differently based on racial differences. In the past, Black and Indigenous communities were used to test vaccines in what has widely been criticized and categorized as unethical today. The Moderna vaccine was co-developed by a Black immunologist named Dr. Kizzmekia Corbett. Is the wait-and-see approach adopted by some members of the Black community before receiving their first dose putting them at greater risk? Yes, vaccination is the best protection against severe disease arising from COVID-19 infection. Systemic racism means Black communities are more likely to live in crowded housing conditions or to work in higher-risk environments. When some members of the Black community decide “to wait and see” it can further increase the risk of COVID within the community. Often, people use a “wait and see” approach when they have certain questions or concerns about the vaccines. A better approach would be to discuss those concerns with a trusted health care provider or community leader. It’s important to note that the wait and see approach could have a similar risk for any racial or ethnic group depending on their risk of exposure.
https://uwaterloo.ca/news/media/q-and-experts-vaccine-hesitancy-among-black-communityUganda typically experiences recurring disease outbreaks throughout the year is in a state of continuous alerts (1). The country has invested in the Integrated Disease Surveillance and Response (IDSR) system which has helped to mitigate numerous outbreaks. Despite our fairly advanced surveillance system, the threat of an outbreak of the scale of COVID-19 poses a challenge. COVID-19 has a higher rate of spread when compared to previous outbreaks (2). The disease is difficult to identify as its symptoms are like many endemic diseases – common flu, malaria, and pneumonia being a few examples. Testing and treating the disease is expensive and are overwhelming even well-resourced health system.
Uganda’s response to COVID-19
In the face of COVID-19, Uganda took a precautionary approach. Control measures were instituted three weeks before the first case was diagnosed. In the last week of February, the Ministry of Health started screening travellers from affected countries at border points set-aside two hospitals to receive patients, intensified mass communication, and set-up an emergency helpline. A timeline of other measures to prevent its spread are :
- 7th March- all international conferences and mass gatherings were stopped, and travellers from affected countries were advised to suspend their travel.
- 18th March-all schools and institutions of higher learning were closed.
- 22nd March- the first case was confirmed with 33 more cases being confirmed within a week
- 30th March onwards- series of lockdowns and a night curfew were instituted permitting only essential workers to move.
- April 28th– a total of 79 cases had been reported with 0 deaths. The lockdown still endures till 3rd May 2020 if all remains as planned.
Our reflection is on three main aspects; first, how service delivery has been affected; second, missed opportunities due to a lack of robust information systems, and, third we review what we term as an “ill”-prepared ambulance system.
Health Service delivery
A resilient health system is one that continues to provide core services even amidst a crisis (3). Unfortunately, in the face of COVID-19, indications are that our system is not so resilient. Data from the two biggest maternity centres in East-central Uganda where we have field sites show a rise in maternal deaths, a rise in malaria deaths, and a drop in small and sick babies returning for review and immunization. In addition, the failure of health workers to get to work was widespread owing to a lack of transportation during the lockdown.
Although our focus is on the health system, it is imperative to recognize that this is only the smaller picture. The effects of these restrictions have had far-reaching effects on the rest of society. To mention just a few examples, the closure of businesses has affected employees who are now unable to earn an income, and the perils of street children with no homes during curfew hours are unknown. Our Police also reported a rise in domestic violence during this period (6).
Health information systems
The lack of a robust health information system has been an obstacle to a better response. Our health information systems still suffer from poor completeness and data quality issues (11). Robust information systems would have provided information for predicting consequences of control measures and thus informing mitigation. For instance, having integrated information on patients with chronic illnesses would have informed the strategies like how to deliver their medicines in the face of travel bans.
Ambulance system
The absence of an ambulance system was most felt following a ban on private and public transport. To mitigate, government vehicles at the district level were draftws as ambulance. However, there has been widespread frustration as the population is unable to access these vehicles. A local daily reported a nurse who pushed a patient in a wheelchair for over 2 km to get her to a referral center (7). There have been various incidences of laboring mothers who failed to get transport to hospitals and gave birth on the way (4,5). All these originate from the lack of know-how in handling an ambulance system and when combined with a crisis the negative consequences are inevitable.
Conclusion
Uganda had drawn on experiences from previous diseases outbreaks and responded well to COVID-19. However, the response has been at the cost of continuity of routine services. Better preparedness to ensure the resilience of our health system is a point of reflection . We need to take this into consideration and act as we move forward.
References
- Mbonye AK, Sekamatte M. Disease outbreaks and reporting in Uganda. Lancet [Internet]. 2018 Dec 1;392(10162):2347–8. Available from: https://doi.org/10.1016/S0140-6736(18)32414-0
- Zhao S, Lin Q, Ran J, Musa SS, Yang G, Wang W, et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. Int J Infect Dis [Internet]. 2020 Mar 1;92:214–7. Available from: https://doi.org/10.1016/j.ijid.2020.01.050
- Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet [Internet]. 2015 May 9;385(9980):1910–2. Available from: https://doi.org/10.1016/S0140-6736(15)60755-3
- The Independent. Woman gives birth to twins on roadside. 2020 Apr 1; Available from: https://www.independent.co.ug/woman-gives-birth-to-twins-on-roadside/
- Biryabarema E. In Uganda, mothers in labour die amidst coronavirus lockdown. 2020 Apr; Available from: https://www.reuters.com/article/us-health-coronavirus-uganda/in-uganda-mothers-in-labour-die-amidst-coronavirus-lockdown-idUSKCN21R2FA
- Matovu M. 328 cases of domestic violence reported during Covid-19 lockdown so far. Nile post [Internet]. 2020; Available from: https://nilepost.co.ug/2020/04/17/328-cases-of-domestic-violence-reported-during-covid-19-lockdown-so-far/
- URN. Nurse summoned for wheeling patient to hospital. 2020; Available from: https://observer.ug/news/headlines/64254-nurse-summoned-for-wheeling-patient-to-hospital
Authors:
Phillip Wanduru1*, Moses Tetui1,2, Peter Waiswa1,3
1Makerere University School of Public Health, Kampala, Uganda,
2Departement of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
3Department of Global Health Karolinska Institutet, Sweden,
Competing interests:
We have read and understood the BMJ Group policy on declaration of interests and I declare that there are no competing interests.
https://blogs.bmj.com/bmjgh/2020/05/02/covid-19-response-in-uganda-notes-and-reflections/
How deep does COVID-19 cut? The novel coronavirus disease has divided the world mostly along hard borders—and to a certain extent along the lines of race or tribe. That much is known. What is completely uncertain at the moment is how far these divisions will go in rolling back the gains made in regional integration and globalization in places like East Africa. Here, as in the rest of the world, responses have been almost completely uncoordinated, with every nation largely fending for its own survival. The United Nations Security Council has toyed with the idea of declaring this a global threat to peace and security. This is COVID-19 unlike health emergencies in the past, including the Ebola outbreak in West Africa in 2014, when then U.S. President Barack Obama rallied the security council to collectively help contain the epidemic, has largely polarized global actors. For the coronavirus, many countries took time to take a cue from China to restrict movement as a measure of slowing transmission, while others like the United Kingdom considered but later dropped the idea of developing herd immunity. The result has been the unforgiving spread of the virus, with global cases topping 3,087,102 and resulting in more than 212,691 deaths as of April 28. U.S. cases and deaths have spiked, a situation that could have be avoided had lessons from China and history been heeded. The pandemic has also given rise to expressions of xenophobia. U.S. President Donald J. Trump called it a Chinese virus, evoking anti-China sentiments. In the East African region, false allegations were spread on social media of Rwanda sending a sick person in the throes of COVID-19 to enter Uganda and spread the disease. The lockdowns are effective measures, but they go against the vision of regional blocs of cooperating states—including the East African Community—free movement of everything from people to goods and resources. Instead, borders have been unilaterally closed, and the rapid retreat from regional cooperation has been the first refuge of the pandemic. While the health emergency indeed calls for lockdowns, border closures should have been part of regionally agreed strategies. But member states across the blocks called for cancelation of regional meetings and closure of boarders almost without any regional-level consultations. Indeed, most recently, Uganda has returned confirmed cases of truck drivers from Kenya and Tanzania to their countries after initially not including them in the national count of positive cases. Wouldn’t finding treatment where one tests positive signal greater regional integration? If there is one lesson from the COVID-19 pandemic for Africa, it's the need to develop modern health care systems for all within national boundaries The virus has also spurred politicians and government strategists to start thinking about more self-sufficiency, albeit in almost everything, from medical care to capacity to manufacture masks, hand sanitizers. When the storm passes, that thinking could extend to other fields, going against the economic sense of countries concentrating on comparative advantages while leveraging regional cooperation and supply chains for other needs. Indeed, if there is one lesson from the COVID-19 pandemic for Africa, it's the need to develop modern health care systems for all within national boundaries. The pace of transmission and the death toll of the virus has chilled the world and led to reckonings across Africa, as border closures and flight suspensions have meant that powerful and wealthy citizens have suddenly not been able to fly out for medical procedures at high-end hospitals outside their country. The only thing that has preserved a certain level of regional importance are the multilateral financial institutions such as the World Bank, the International Monetary Fund, and the European Central Bank. These have largely stepped up to assist their members. It is an infrastructure that the East African Community as well as the other African regional blocs should not lose vision for because of failures at regional response to the COVID-19 health emergency. Additionally, the coronavirus pandemic has been a rude awakening of the region’s and indeed world’s social inequalities. The disease is infecting everyone from mighty politicians to Hollywood celebrities and from the jet-setting rich to ordinary people from the poorest countries. Whether an eight-month old baby in Uganda or a senior royal in-line for the British throne, anyone can be infected. The indiscriminate infections should be a reassuring reminder that all humans are equal on some level, but instead they often only reveal the cruel, glaring social inequality that looms in the world. There is little faith in how effective social distancing measures will be in slowing transmission for African cities from Lagos, Nigeria to Kampala, Uganda to Soweto Township in Johannesburg, South Africa—all of which have crowded informal settlements. The lockdowns are challenging given that a big part of the population in sub-Saharan Africa has no savings and lives hand-to-mouth daily. Indiscriminate infections should be a reminder that all humans are equal, but they often only reveal the cruel, glaring social inequality in the world The UN has called for emergency help for poor countries, and while that’s desired, it still carries a north-to-south dependency tone and could add to disentanglement sentiments in the COVID-19 pandemic's aftermath. That notwithstanding, African countries have taken the social distancing message to heart, they can’t afford to gamble with experiments like the U.K.’s herd immunity. Uganda, for example, shut down schools and places of worship even before confirming a single COVID-19 case. Is it time for us to reflect on what matters for humanity—perhaps taking lessons from princess Sofia who has temporarily set aside her tiara to work as a medical assistant in support of the fight against COVID-19 in Sweden? How should we use available resources to bridge the inequality gap? These are the questions we should be asking. Yes, COVID-19 has divided us and it will challenge unions, but the baby shouldn’t be thrown out with the bath water.
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