Early cases of SARS-CoV-2 infection in Uganda: epidemiology and lessons learned from risk-based testing approaches – March-April 2020

Migisha, Richard; Kwesiga, Benon; Mirembe, Bernadette Basuta; Amanya, Geofrey; Kabwama, Steven Ndugwa; Kadobera, Daniel; Bulage, Lilian; Nsereko, Godfrey; Wadunde, Ignatius; Tindyebwa, Tonny; Lubwama, Bernard; Kagirita, Atek; Kayiwa, John; Lutwama, Julius J.; Boore, Amy L.; Harris, Julie; Bosa, Henry Kyobe; Ario, Alex Riolexus

doi:10.1186/s12992-020-00643-7

Cited by 32 publications

(33 citation statements)

References 28 publications

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“…Among the 40 cases, 14 did not have any symptoms (35%) while the remaining 25/40 (62.5%) had minor symptoms (13 with cough, 8 with fever, 4 with sore throat, 1 with shortness of breath) by the time of the laboratory confirmation. This is slightly similar to a study conducted among early cases in Uganda where 37% did not develop symptoms [ 8 ]. However, some studies in different countries indicated that early cases had a low proportion of asymptomatic cases [ 9 , 10 ].…”

Section: Discussionsupporting

confidence: 90%

Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020

Nsekuye

Rwagasore

Muhimpundu

et al. 2021

IJERPH

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We reported the findings of the first Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) four clusters identified in Rwanda. Case-investigations included contact elicitation, testing, and isolation/quarantine of confirmed cases. Socio-demographic and clinical data on cases and contacts were collected. A confirmed case was a person with laboratory confirmation of SARS-CoV-2 infection (PCR) while a contact was any person who had contact with a SARS-CoV-2 confirmed case within 72 h prior, to 14 days after symptom onset; or 14 days before collection of the laboratory-positive sample for asymptomatic cases. High risk contacts were those who had come into unprotected face-to-face contact or had been in a closed environment with a SARS-CoV-2 case for >15 min. Forty cases were reported from four clusters by 22 April 2020, accounting for 61% of locally transmitted cases within six weeks. Clusters A, B, C and D were associated with two nightclubs, one house party, and different families or households living in the same compound (multi-family dwelling). Thirty-six of the 1035 contacts tested were positive (secondary attack rate: 3.5%). Positivity rates were highest among the high-risk contacts compared to low-risk contacts (10% vs. 2.2%). Index cases in three of the clusters were imported through international travelling. Fifteen of the 40 cases (38%) were asymptomatic while 13/25 (52%) and 8/25 (32%) of symptomatic cases had a cough and fever respectively. Gatherings in closed spaces were the main early drivers of transmission. Systematic case-investigations contact tracing and testing likely contributed to the early containment of SARS-CoV-2 in Rwanda.

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Section: Discussionsupporting

confidence: 90%

Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020

Nsekuye

Rwagasore

Muhimpundu

et al. 2021

IJERPH

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“…These studies included a total of 104,058 laboratory-confirmed COVID-19 cases, of which 25,050 exhibited no symptoms at the time of testing and 7,220 remained asymptomatic. We identified 170 studies that reported asymptomatic infections ( 11 – 13 , 17 – 183 ), 332 studies that reported silent infections at the time of testing ( 10 – 12 , 14 , 17 – 20 , 23 – 27 , 31 , 32 , 35 – 40 , 42 – 44 , 46 , 47 , 49 , 50 , 52 , 53 , 56 – 58 , 60 – 66 , 68 , 69 , 73 – 75 , 77 – 79 , 81 , 84 , 87 , 90 – 94 , 97 , 99 , 101 , 103 , 104 , 106 , 111 , 113 – 116 , 118 , 119 , 121 – 123 , 125 , 127 , 128 , …”

Section: Resultsmentioning

confidence: 99%

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Sah

Fitzpatrick

Zimmer

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

381

351

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Quantification of asymptomatic infections is fundamental for effective public health responses to the COVID-19 pandemic. Discrepancies regarding the extent of asymptomaticity have arisen from inconsistent terminology as well as conflation of index and secondary cases which biases toward lower asymptomaticity. We searched PubMed, Embase, Web of Science, and World Health Organization Global Research Database on COVID-19 between January 1, 2020 and April 2, 2021 to identify studies that reported silent infections at the time of testing, whether presymptomatic or asymptomatic. Index cases were removed to minimize representational bias that would result in overestimation of symptomaticity. By analyzing over 350 studies, we estimate that the percentage of infections that never developed clinical symptoms, and thus were truly asymptomatic, was 35.1% (95% CI: 30.7 to 39.9%). At the time of testing, 42.8% (95% prediction interval: 5.2 to 91.1%) of cases exhibited no symptoms, a group comprising both asymptomatic and presymptomatic infections. Asymptomaticity was significantly lower among the elderly, at 19.7% (95% CI: 12.7 to 29.4%) compared with children at 46.7% (95% CI: 32.0 to 62.0%). We also found that cases with comorbidities had significantly lower asymptomaticity compared to cases with no underlying medical conditions. Without proactive policies to detect asymptomatic infections, such as rapid contact tracing, prolonged efforts for pandemic control may be needed even in the presence of vaccination.

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“…It is important to note that this study was conducted during the early phase of the pandemic, in which many businesses were still under lockdown. Therefore, supermarket managers may have abode due to fear of locking down their businesses to curb the spread of COVID-19 [ 28 , 29 ], and thus losing a source of livelihood or profit.…”

Section: Discussionmentioning

confidence: 99%

Extent of compliance with COVID-19 prevention and control guidelines among supermarkets in Kampala Capital City and Mukono Municipality, Uganda

et al. 2021

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Background Despite the development and enforcement of preventive guidelines by governments, COVID-19 continues to spread across nations, causing unprecedented economic losses and mortality. Public places remain hotspots for COVID-19 transmission due to large numbers of people present; however preventive measures are poorly enforced. Supermarkets are among the high-risk establishments due to the high interactions involved, which makes compliance with the COVID-19 preventive guidelines of paramount importance. However, until now, there has been limited evidence on compliance with the set COVID-19 prevention guidelines. Therefore, this study aimed to measure compliance with the COVID-19 prevention guidelines among supermarkets in Kampala Capital City and Mukono Municipality Uganda. Methods A cross-sectional study was conducted among selected supermarkets in Kampala Capital City and Mukono Municipality in September 2020. A total of 229 supermarkets (195 in Kampala City and 34 in Mukono Municipality) were randomly selected for the study. Data were collected through structured observations on the status of compliance with COVID-19 prevention guidelines, and entered using the KoboCollect software, which was preinstalled on mobile devices (smart phones and tablets). Descriptive statistics were generated to measure compliance to the set COVID-19 Ministry of Health prevention guidelines using Stata 14 software. Results Only 16.6% (38/229) of the supermarkets complied with the COVID-19 prevention and control guidelines. In line with the specific measures, almost all supermarkets 95.2% (218/229) had hand washing facilities placed at strategic points such as the entrance, and 59.8% (137/229) of the supermarkets surveyed regularly disinfected commonly touched surfaces. Only 40.6% and 30.6% of the supermarkets enforced mandatory hand washing and use of face masks respectively for all customers accessing the premises. Slightly more than half, 52.4% (120/229) of the supermarkets had someone or a team in charge of enforcing compliance to COVID-19 measures and more than half, 55.5% (127/229) of the supermarkets had not provided their staff with job-specific training/mentorship on infection prevention and control for COVID-19. Less than a third, 26.2% (60/229) of the supermarkets had an infrared temperature gun for screening every customer, and only 5.7% (13/229) of the supermarkets captured details of clients accessing the supermarket as a measure to ease follow-up. Conclusion This study revealed low compliance with COVID-19 guidelines, which required mandatory preventive measures such as face masking, regular disinfection, social distancing, and hand hygiene. This study suggests the need for health authorities to strengthen enforcement of these guidelines, and to sensitise the supermarket managers on COVID-19 in order to increase the uptake of the different measures.

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Early cases of SARS-CoV-2 infection in Uganda: epidemiology and lessons learned from risk-based testing approaches – March-April 2020

Cited by 32 publications

References 28 publications

Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020

Investigation of Four Clusters of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Rwanda, 2020

Asymptomatic SARS-CoV-2 infection: A systematic review and meta-analysis

Extent of compliance with COVID-19 prevention and control guidelines among supermarkets in Kampala Capital City and Mukono Municipality, Uganda

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