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Institutional Quarantine: A Weapon for Combating COVID-19 Transmission as Ugandans Return from Abroad

By Emmanuel Ainebyoona

We thank the almighty God for bringing back home our country men and women safely following many months of lockdown abroad.

Indeed, it’s a great sight of relief to many, including myself given the number of heartfelt pleas from Ugandans who were greatly afflicted by the Covid-19 preventive measures.

One of the measures was the closure of Entebbe International Airport, a major entry point for most Ugandans abroad and all other border points on 21st March,2020 following a set of Presidential directives, that left many Ugandans and residents of Uganda closed out of the Pearl of Africa, a place that is home to so many.

But most importantly, Ugandans who are returning home are finding us more ready and prepared to receive them unlike the case of those who arrived mid- March when mandatory institutional quarantine was instilled as the country was still undertaking responsive measures to keep the virus outside its borders.

This measure came as a surprise and discomfort to the over 1,500 returnees but it greatly saved Uganda from increased Covid-19 cases.

The news of the outbreak of Covid-19 in China which had spread to over 50 countries in different continents, Africa, notwithstanding, now led to a targeted preparedness process which saw surveillance teams focus on travelers coming into the country.

In Africa, Egypt became the first African country to register a Covid-19 Case on 14 February, 2020 of an Egyptian national, who had returned from Serbia via France. It was later followed by Algeria, and Nigeria respectively.

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As our preparedness activities intensified, highly suspected travelers with flu-like symptoms were isolated at Entebbe Grade B Hospital and tested for Covid-19 at the Uganda Virus Research Institute (UVRI) while those without symptoms were required to undergo 14 days of self-quarantine at their homes and our surveillance officers would follow them up on a daily basis.

As the situation evolved, the Ministry of Health tightened its measures and introduced mandatory institutional quarantine for all returning travelers. This was after returnees violated and abused the option of self-quarantine.

Similarly, Uganda had already issued a travel advisory classifying countries based on the Covid-19 risk profile.  For example, travellers from countries classified in category one were advised to delay or defer their travel for all their non-essential trips into Uganda. Those whose travel couldn’t wait were subjected to institutional quarantine at Government accredited facilities.

The category one countries included: Italy, USA, UK, Netherlands, Sweden, Norway, San Marino, Iran, South Korea, France, China, Germany, Spain, Belgium, Austria, Malaysia, Turkey among others. Ugandans in the above affected countries were not exempted.

As you may recall, Uganda became the fourth East African country after Kenya, Rwanda and Tanzania to register her first COVID-19 case, a 36 year old male on March 21. All first cases detected in East Africa were imported from Asia, Europe and North America. The confirmed case was returning from United Arab Emirates but was detected by our team of health workers deployed by the Ministry of Health who endeavored to screen each and every passenger that entered the country.

Indeed, among other preventive measures like hand hygiene, physical distancing and proper mask use, mandatory institutional quarantine has become instrumental in curbing the spread of the infection in Uganda. The mandatory institutional quarantine has enabled our systems detect over 40 COVID-19 cases.

Quarantine as a strategy, according to World Health Organization, disrupts COVID-19 transmission of the virus through separation of healthy persons who might have been exposed to the virus from the rest of the population, with the objective of monitoring their symptoms and ensuring early detection of cases.

At the same time, the Ministry of Health has developed a document dubbed: “National Guidelines for quarantine in the context of COVID-19” that is aimed at offering guidance to all ministries, departments and agencies on implementing home, institutional and geographical quarantine measures for high-risk individuals.

According to the domesticated guidelines, quarantine is a transparent home or institutional restriction of exposed persons activities when they are ill or do not have symptoms of COVID-19 for the purpose of protecting unexposed members of the communities from contracting the disease should any at risk person become sick.

In its nature, quarantine involves the restriction of movement, or separation from the rest of the population, of healthy persons who might have been exposed to the virus.

As a result, all the 2400 returnees who were recently cleared by Cabinet will be subjected to mandatory institutional quarantine as a precautionary measure to protect the over 40 million Ugandans that have sacrificed their livelihoods and social life for about 6 weeks of total lock down and now slightly over 2 weeks of partial lockdown.

On a good note, the first cohort of 41 returnees from Khartoum, Sudan and Netherlands have already complied with the 14 days of institutional quarantine at accredited public and private quarantine centers.

The Ministry of Health, working with Foreign Affairs, have made available the list of private hotels and public institutional quarantine centres where any returnee is at liberty to make an informed choice.

A fortnight of separation from friends, relatives and loved ones is not a pleasant thing but we should remember that the minute enemy at hand, COVID-19, is not yet defeated.  Now that we are closer to a grand re-union to our families, let’s religiously observe the standard operating procedures of quarantine until when we obtain our negative test result and a completion of quarantine certificate.

Remember, a sample will be obtained on the 14th day of quarantine and results will be returned after 48 hours of the testing process.

Remember, what started as a pneumonia-like disease in the China’s City of Wuhan, Hubei Province on 30th December, 2019 later became a global pandemic as declared by World Health Organization having spread to all continents. To-date, over 450,000 lives have been lost to COVID-19, globally while in Africa, over 9,000 lives have been lost.

Uganda, however, has not registered any COVID related death and this is attributed to the leadership of the country, efforts of the health workers, strong public health systems and the sacrifices endured by the Ugandan population.

A comparative analysis of progression of COVID-19 pandemic in East Africa indicates that Uganda has kept a lower curve compared to its neighbors. With strong Presidential directives and appropriate guidelines in place, Uganda will remain the benchmark for handling public health emergencies just like we have been during the Ebola and Marburg outbreaks.

With over 170,000 samples tested, and around 800 confirmed cases to-date, Uganda’s case-load curve has remained stable for the past three weeks and largely flat. This is good news, despite the three localized transmission hotspots (Buikwe, Kyotera and Amuru), transmission appears to have been interrupted in many parts of the country.

The author is the Senior Public Relations officer at the Ministry of Health (Uganda) emmanuel.ainebyoona@health.go.ug

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