Dear kinsmen and kinswomen,
Praise be to God Almighty who has kept us alive amidst this raging covid-19 pandemic.
On a sad note, I commiserate with those who’ve lost their loved ones or friends to this invisible enemy. Its tough.
In addition, I pray for quick recovery for the sick and patience for those taking care of their loved ones.
Covid-19 has brought to surface the long standing challenge of high cost of healthcare in Uganda.
For the last 20 years, since abolition of user fees in public hospitals, discusssions have been ongoing on how to bring down the cost of health care. One of the proposals was implementation of the National Health Insurance Scheme, which majority of stakeholders rejected.
Individuals who have interfaced with private sector will attest to high bills even before covid pandemic.
Inevitably, when covid came, covid care which is labour and resource intensive would escalate the costs.
There’s a covid survivor in the US who got a bill of USD 1.1million (3.9 billion UGX)!
Let me attempt to share with you some details of covid care.
First, coronavirus disease is on a spectrum. You can compare this to people in different classes (S.1 to S.6).
Not everyone with covid ends up with severe or critical disease.
The covid spectrum is as follows;
Category 1: some contract covid and do not develop any symptom. This is the majority (80%). And most do not even test for covid so they’re at large.
Category 2: Some contract covid and develop mild symptoms- cough, body pains and fever etc.
Category 3: some contract covid and develop moderate symptoms – breathlessness, fatigue, etc
Category 4: some contract covid and develop severe symptoms such as severe breathlessness, respiratory failure.
Category 5: some develop covid and get critical symptoms such as multiple organ failure, very severe respiratory failure.
95% of covid patients don’t need hospitalisation.
5% of covid patients need hospitalisation and eventually may need ICU care. These are the ones who end up with high medical bills in the private sector.
Second, Standard care for a severe/critical covid patient involves a multidisciplinary team with different skillsets such as an intensivist, pulmonologist, internal medicine physician, nutritionist, critical care nurses, IPC nurses, chest physiotherapist, janitors etc.
Third, the care for a severe covid patient varies from individual to individual;
Some of the treatment includes;
1) High flow oxygen (1 litre to 20 litres/minute, may go up to 70 litres/min)
2) Methylprednisolone
3) Ulinastatin
4) Anticoagulation.
5) Strong antibiotics for secondary bacterial infections.
6) Antivirals (for some patients)
The daily cost of these drugs may range between 1-3M.
Fourth, the other treatment depends on the complications arising from the disease.
Covid is a multi-system disease. It affects organs differently. One may get
1) covid heart – requiring heart medications.
2) covid kidney – requiring kidney support including dialysis.
3) covid brain – prevention of stroke and other care for neurologic deficits such as delirium.
Depending on organ involvement, additional treatment is instituted which varies from person to person.
And the patient must be monitored regularly to assess for worsening or improvement of the different organs.
Fifth, most patients have underlying conditions before covid such as diabetes, high blood pressure, heart disease which are usually worsened by covid, and treatment therefore must be administered accordingly.
Good enough, the second wave seems to be coming down (positivity rate has reduced from 18% to 12%, target is below 5%). But we must prepare for the third wave, if it ever comes.
So, how can one reduce covid care costs for a patient with covid.
- Know your individual risk. Much as anyone can develop severe covid, certain categories are at an increased risk such as -OBESITY (BMI>30) , DIABETES, HIGH BLOOD PRESSURE, HIGH EXPOSURE TO VIRUS -HEALTH WORKERS etc.
- Remember, 95% of people who test positive for covid do not need hospitalisation.
- If one contracts covid, don’t panic. Monitor closely for signs of early worsening and intervene early.
- Before admission to a hospital, inquire about bill projections and assess if you can afford.
Hospitals like Mengo, Rubaga, Nsambya, Kibuli, Kampala hospital, Lifeline, Najjera etc are relatively cheaper than other high end hospitals. - If you realise you may not afford, come to the public sector -Naguru, Kiruddu, Namboole and Mulago for Kampala region.
Infact the public sector, is taking care of many more patients than all private hospitals combined. And sometimes when patient worsens in the private sector, they refer to Mulago. - Finally, prevent, prevent, prevent!
The best way to avoid covid care costs is to stay away from the virus, if you can.
Follow SOPs. And for those who believe in vaccination and can access it, go for it.
I believe everyone is doing their best to fight this pandemic. Stress, anxiety and depression are on an all time high! Its not easy to stay calm in the storm but its possible.
Let’s pray for one another to ride through this storm.
StaySafe.
