How the management of the COVID-19 outbreak as an emerging disease impacted the world

By Anslem Wandega

In December 2019, a cluster of unexplained pneumonia cases in Wuhan China, rapidly progressed into a large-scale outbreak, and a global pandemic by 11 March 2020, as declared by the World Health Organization (WHO, 2020). COVID-19 is caused by a single-stranded RNA coronavirus (SARS-CoV-2) similar to the pathogen responsible for severe acute respiratory syndrome and Middle East respiratory syndrome (Liu et al 2020). COVID-19 outbreak has greatly affected the world leading to high morbidity and mortality. As of 15th July, 2022, 565,628,788 confirmed cases and 6,382,671 deaths had been reported in nearly 200 countries and territories globally (WHO, 2022).

To contain the outbreak several measures such as curfews and lockdowns were applied across the globe with varying degrees of success.

As a distinct example of an emerging disease, some containment measures left behind significant public health, economic, social, and political consequences as shared below. In terms of its public health consequences, the COVID-19 outbreak put enormous pressure on the health system.

For instance, in Uganda, hospitals were overwhelmed with cases when the second wave of COVID-19 hit the country.

Many people turned to the costly private health facilities that took a substantial amount of their money. With many cases, fewer hospital beds and a constrained health workforce, the health system was greatly affected.

In certain contexts, governments shifted most public health resources to COVID-19 detection, control and prevention negatively impacting detection, control and prevention of other diseases control efforts.

The containment of the outbreak placed extraordinary pressure on the public health workforce. A survey of over 26,000 public health workers, conducted in 2021 in the US, reported that 90% of participants spent at least some time on the COVID-19 public health response, while slightly more than 50% spent more than half of their work time on COVID-19-related activities; 59% worked over 40 hours per week, and 12% worked more than 60 hours per week on COVID-19-related activities.

For those individuals who worked for more than 40 hours per week, 63% reported depression and anxiety while over 90% felt moral injury (American Society for Microbiology, 2022). The efforts to contain the COVID-19 outbreak limited households’ access to food.

Reduced access to food was expressed in terms of no money to buy the required food, increased food prices and limited availability of certain foods that form a balanced diet. Patients suffering from chronic illnesses were affected more because they had to take their medication on an empty stomach.

Most sections of the population also reduced their frequency of meals and portions (Nuwematsiko et al. 2022). There was also an increase in cases of drug and substance abuse during the lockdowns. Most people took to drinking excessive alcohol and while others smoked cannabis and marijuana, with some developing mental illnesses.

One of the studies done in Uganda attributes the increase in drug and substance abuse during lockdowns to increased stress in the population resulting from idleness, loss of jobs, incomes and businesses (Nuwematsiko et al. 2022).

There has been a reported upsurge in the cases of mental health illnesses as reported by Butabika National Referral Mental Hospital in Uganda. The COVID-19 outbreak with its containment measures widened inequities in access to health care services.

Due to limited movements during the lockdown, increased transport fares and no incomes, some sections of the population resorted to not seeking health care when sick. More so, most people were ignored and did not receive care when they visited the health centres as all attention was on COVID-19 patients.

In some parts of the world, those on chronic medication like people living with HIV, could not refill their medicines because of transport challenges (Nuwematsiko et al. 2022). This affected the health of the population. Economically, COVID-19 outbreak took a significant toll on the global economy due to severe control measures.

The outbreak disrupted international trade relationships, exacerbating tensions in the trade relationship between the United States and China (Open Access Government, 2020). Some regional markets experienced significant economic downturns as a result of the pandemic (UN, 2020). Moreover, financial markets became increasingly volatile (Allianz, 2020) and the global supply chains were heavily disrupted (Laborde et al, 2020).

The creative arts sector struggled to cope with and adapt to the outbreak (Stone 2020) as many music venues, theatres, and cinemas around the world were forced to keep their doors closed due to social distancing rules and to reduce risks associated with the spread of COVID-19 in indoor environments. The transportation sector was also affected as there was a record-breaking financial loss for the commercial aviation sector (Gradek 2020) while those offering transport services like Uber experienced a low demand for their services (Dubal et al 2020) due to the containment measures.

In East Africa, cross-border truck drivers were subjected to regular COVID-19 tests increasing the cost of doing business. The hospitality industry was affected by travel restrictions and lower levels of disposable income among consumers who were financially hit by the outbreak, resulting in hundreds of billions of United States Dollars in losses across the sector (UNWTO 2022).

The hotel industry suffered a sharp decline in hotel bookings (Gursoy et al 2020), the restaurant sector faced significant obstacles to profitability and many businesses were forced to shutter their doors (Dube et al 2020).

It became so difficult and costly to run a business. Football (soccer) leagues made the decision to simply suspend or cancel their seasons (Grossobel 2020) to comply with the government directives to contain the outbreak and when play resumed, it generally occurred behind closed doors, generating less returns for the investors. Some players lost jobs! The prices of agricultural goods fell significantly, particularly due to lower demand from hotels, restaurants (Bhosale 2020) and households.

In East Africa, this was also due to restricted movements of people and vehicles. The East African countries are now struggling with general increase in commodity prices as economies opened up. In addition to its extensive economic consequences, COVID-19 outbreak with the containment measures had social consequences. Government measures related to COVID control eroded community relationships by drastically reducing opportunities for physical face-to-face interactions.

These measures significantly affected family life, both by increasing proximity among those forced to shared confined spaces during lockdowns (Fitzgerald 2020) and sometimes by keeping families apart to prevent risk of infection.The outbreak rendered relationships among families and friends more difficult for many (Ellison 2020).

However, it also brought some people closer together thanks to greater flexibility in time schedules, alternative working arrangements, and reduced opportunities for other social activities (Selinger-Morris 2020). Big social events like weddings had to be postponed in some places during the lockdown (Murray-Atfield et al. 2020).

In Uganda, burials were restricted to those approved by the government to burry. The outbreak also resulted into a housing crisis, as many people in urban areas could not afford their rent, risking eviction (Mason 2020).

In East Africa, some people were forced to return to the villages in order to escape the high cost of living in urban areas. Schools and Universities were forced to adjust courses and curricula for online delivery. While this was practically feasible, students had fewer opportunities to participate in the off-line social networking that is crucial for career development (Wharton University of Pennsylvania 2020). Households saw spikes in domestic and family violence during COVID-19 onset (Bradbury-Jones 2020) because most couples were not used to staying in a confined setting for long together.

The Uganda Child Helpline reported that the helpdesk received an average of 100 calls per day, reporting violent behaviour against children (UNICEF 2021) during the first lockdown of 2020. The global pandemic also generated a range of international and domestic political consequences. The health crisis constituted an exogenous shock to the broader international system, disrupting international politics and creating new tensions between adversaries and allies alike. It left profound implications for and lasting effects on geopolitics for years to come (Heisbourg 2020).

In many contexts, governments were left scrambling to secure sufficient supplies and resources to effectively contend with the virus, prioritizing national interest and the well-being of their own citizens. A form of ‘vaccine nationalism’ took hold in a race to develop a vaccine for the virus that created barriers to cooperation and prioritized domestic delivery when mass production got underway (Bollyky 2020). President Museveni of Uganda in his statements came out to speak against vaccine nationalism especially when India hoarded its vaccines due to increased cases of COVID-19 in the country.

The outbreak also compounded pre-existing international problems related to the movement of people across borders. Asylum seekers and refugees were particularly affected, (Europeansting 2020). The outbreak impacted on temporary economic migrants, particularly as a result of the economic downturn that forced many companies to lay off employees (Staynor 2020). Even when certain governments began bailing out their citizens with restarter economic packages, refuges and asylum seekers were left out.

The outbreak with its control measures also posed unique challenges to state stability and compounded risks of political violence, internal armed conflict, and incidents of state failure. For instance, rebel groups and other militant actors in Ethiopia seized the opportunity of the outbreak to expand control, advance political objectives, and demonstrate a capacity to govern and enforce rules in the Tigray National Regional State.

They later advanced towards the capital Addis Ababa, but were later repulsed by the Ethiopian army. COVID-19 induced consequences have led to several resignations of various political leaders in several countries while others lost elections. Political participation was affected by COVID-19 outbreak. Protest politics, for example became the epicentre of all public debates. On the one hand, citizens in some countries took to the streets to protest against government restrictions to contain COVID-19, such as lockdown and stay-at-home orders (Connolly 2020). On the other hand, protests such as those organized by Black Lives Matter activists around the world became a topic of contention as citizens and political leaders disagreed as to whether those gatherings may have contributed to new COVID-19 outbreaks (McCutcheon 2020).

In some countries local and national political authorities decided to postpone elections (Barron 2020) such as in Ethiopia while others instituted COVID-19 control/containment measures during elections, such as in Uganda.

Lastly, it is known that trust is an important aspect of political life as it relates to politicians, law enforcement, and the media, among others. High-profile incidents of politicians who ignored their own stay-at-home orders (Fancourt 2020), those involved in stealing COVID-19 funds or who publicly contradicted or undermined health experts (Olorunnipa 2020) led to general confusion and the erosion of trust in public officials.

The politicization of issues like longer curfews illustrated how a lack of consensus and divergent policies can frustrate public health measures and lead to greater distrust not only towards politicians but also towards law enforcement officials tasked with ensuring compliance.

In extreme cases, law violators were lashed out in violence against police officers enforcing new laws (Koob 2020).In future, countries world over should build resilient systems to manage emerging pandemics of this scale should they occur.

More importantly, countries may want to rethink some of the measures used to contain the outbreak such as curfews and total lockdowns.

Otherwise, the COVID-19 outbreak with its containment measures left the world far different from what was desired in a very short time.