Tag Archives: ‘cautionary

COVID-19 didn’t overwhelm Africa as some feared. But Uganda is a cautionary tale of rising risk

Henry Bugembe riding his bright red motorcycle became a familiar sight in the town of Nakawuka during Uganda’s lockdown last spring.

With public and private transportation banned at the time, and ambulances few and far between, it was one of the few vehicles on the road.

A volunteer health worker, Bugembe used a permission connected to his work with an NGO to get through the security checkpoints enforcing the lockdown in order to ferry people in need to hospital on the back of his bike.

He also delivered medicine, a vital service in a country where 1.4 million people are living with HIV and where malaria is the leading cause of death.

“The existence of COVID-19 didn’t stop people from suffering from other diseases. But it was very hard for someone to travel to the hospital,” he said.

When there was a very strict lockdown, people depended on Bugembe to deliver their medicine on his red motorcycle. (Lily Martin/CBC)

Bugembe’s empathy is not hard to locate. He lost his wife to a brain tumour just months before the pandemic, leaving him a single parent to their two children.

After the government imposed its lockdown on March 31, permissions were required from often absent or unavailable officials. In an emergency, said Bugembe, people sometimes had to simply try their luck and hope for a sympathetic soldier or police officer.

Critics have blamed the lockdown, the most intense version of which lasted several months, for unnecessary deaths in Uganda. Blood banks reported shortages, and at least seven women died in labour because they couldn’t reach medical help, according to the Women’s Probono Initiative, a non-profit legal aid organization based in Kampala.

But predictions that COVID-19 would completely overwhelm African nations with seriously fragile health-care systems have not, for the most part, been borne out. At least not yet.

“What is happening in Uganda and many African countries [is] the infection may be spreading, but most of these [cases] are asymptomatic or mild,” said Prof. Pontiano Kaleebu, executive director of the Uganda Virus Research Institute (UVRI) in Entebbe.

Infections in Africa account for 3.4 per cent of the 72 million COVID-19 infections recorded around the world, according to figures released Thursday by the Africa Centres for Disease Control and Prevention (Africa CDC).

And a World Health Organization study released in September found that 80 per cent of the cases in Africa have been asymptomatic.

The strictest lockdown measures are long over in Kampala, where the streets are once again crowded. (Lily Martin/CBC)

Kaleebu points to both the warmer climate and the high proportion of young people across the continent as contributing factors to limiting the pandemic’s deadly impact. Another theory, he said, is that Africans might have existing immune responses because of heavier exposure to some diseases, including other coronaviruses.

In Uganda, figures for Dec. 16 put the cumulative number of COVID-19 infections at 29,361, with 228 deaths.

“I believe there are more people infected,” said Kaleebu, “but they have not been tested.”

However, he doesn’t believe there is a corresponding unseen higher mortality rate, he said.

“We cannot be missing the very severe cases that need intensive care, oxygenation and ventilation. I don’t think we are missing them.”

Few ICU beds

That doesn’t mean Uganda couldn’t very easily find itself overwhelmed.

An assessment last February by Makerere University found that in a country of about 42 million people, there are only 55 functional ICU beds, most of which are in the capital, Kampala.

Africa CDC’s report this week pointed to Uganda as one of the five African countries reporting the highest number of new cases over the previous week, along with South Africa, Morocco, Tunisia and Libya.

The Uganda Virus Research Institute, founded in 1936, handles much of the country’s COVID-19 testing. The case numbers have spiked in the past month. (Lily Martin/CBC)

Uganda’s Health Ministry reported 16,563 infections between March and November, but there has been an increase of 12,798 cases in the past month alone.

“There’s been a lot of increased spread and it is getting out of hand,” said Dr Julius Lutwama, who heads the UVRI’s department of emerging infectious diseases.

“Now, given the political situation where there is campaigning going on and people [gathering] in big numbers, people are not putting on masks, people are not distancing, so the spread is becoming more and more.”

Julius Lutwama, head of the Uganda Virus Research Institute’s department of emerging infectious diseases, says it’s difficult to get a clear picture of the pandemic in Uganda because there seem to be so many asymptomatic cases. (Lily Martin/CBC)

Ugandans will vote in presidential elections next month. Opposition parties have accused the government of using COVID-19 restrictions to shut down their campaign events and arrest their candidates while ignoring violations by President Yoweri Museveni’s National Resistance Movement.

Museveni, in power now for 34 years, is seeking a sixth term.

In addition to all the other work it does on virus sequencing, immunization and emerging infections, the UVRI in Entebbe has become Uganda’s main testing centre for COVID-19.

Lutwama says they are processing up to 1,500 tests a day. But with so much asymptomatic spread out in the community, it’s difficult to get a true picture of what’s happening.

“In these last three or four months, there has been an explosion. We don’t know how long this is going to be sustained or whether this is going to go down,” he said.

“The worry is with the health system. The health system is getting overwhelmed.”

WATCH | The National’s report on COVID-19 in Uganda: 

COVID-19 hasn’t had the devastating impact on Uganda that many expected, but doctors say it wouldn’t take much of a spike to overwhelm the country’s hospitals that have only 55 intensive care beds for 42 million people. 2:42

Shift in attitudes

There is also evidence of a shift in attitude toward the virus among the public, with seemingly fewer people willing to listen to public health advice and stay home.

In the town of Rubuguri in southwestern Uganda, the tourism industry that’s been built up around the mountain gorillas of the nearby national park has come to a complete halt, severely impacting people’s ability to support themselves and their families.

There are signs in town warning of the dangers of COVID-19, along with a number of rudimentary handwashing stations, but few people are wearing masks.

A warning sign stands at the side of a road in Rubuguri in southwestern Uganda. (Margaret Evans/CBC)

“At first, they would wash, put on mask, stay home, even would have soldiers telling people, ‘Go back home,'” said Carol Magoba, a young mother and unemployed social worker.

“But now, it has become like any other disease. People are like, ‘Uh, what should we do? Should we die of epidemic in the house?'”

In the town of Nakawuka, Henry Bugembe uses a loudspeaker along the town’s main shopping street to raise awareness about COVID-19.

In the past, his volunteer health team would go door to door to talk to people, but that’s not allowed given the nature of the pandemic.

They can try to keep track of people who might be sick by phone, but not everybody has a phone, or electricity to keep one charged.

Bugembe and his loudspeaker draw a crowd of kids, but few adults stop to listen.

“Most people here don’t have work to do, people are just starving, so they don’t have money to buy masks,” he told the CBC.

Poverty in Uganda creates added challenges when it comes to trying to control the pandemic. (Lily Martin/CBC)

Bugembe himself has few tools at his disposal. He and others who make up the village health teams aren’t paid salaries.

And both the loudspeaker and the red motorcycle came courtesy of a public health partnership between Makerere University in Kampala and the U.K.’s University of Nottingham Trent aimed in part at supporting Uganda’s community health-care workers.

Bugembe admits to being worried for Uganda.

“What if it turns the other way around, and we start [seeing] people being infected at a high rate and death? What can we do? Because it is a poor country.”

The worry has increased the focus on the role vaccines will play in Africa.

WATCH | How COVID-19 could also threaten Uganda’s mountain gorillas: 

There are concerns that COVID-19 could undermine 40 years of conservation efforts to protect Uganda’s mountain gorillas. The CBC’s Margaret Evans, Lily Martin and Jean-Francois Bisson went to the Bwindi Impenetrable National Park to see the challenges of balancing tourism and protecting the animals. 8:17

Concerns about arrival of vaccines

UVRI executive director Pontiano Kaleebu said he’s optimistic.

“I think there’s been international support now as we’re talking about vaccines. The discussions that are going on to ensure that low- and middle-income countries are not left behind.”

But that was before internal documents from Gavi, the global vaccine alliance that is partnered with the World Health Organization to ensure fair access to COVID-19 vaccines for poorer countries, were leaked to the Reuters news agency suggesting those efforts had a “high risk” of failure.

The documents, prepared for Gavi’s board of directors, cited lack of funds and supply risks as potential problems, Reuters reported.

Africa CDC’s goal is to vaccinate 60 per cent of Africans — more than 813 million people — a huge logistical challenge given the varied nature and circumstances of the continent’s 54 countries.

“The continent has never ever vaccinated more than 100 million people in [any] one year and we have to do more in 2021 to have a fighting chance against this pandemic,” Africa CDC director Dr. John Nkengasong said in a video news conference on Thursday.

“We are working hard, as much as possible, to ensure that the continent is not left behind,” he said, while admitting he didn’t know when they’ll be “putting vaccines in the arms of Africans.”

In the meantime, the fight against COVID-19 may well depend on people like Henry Bugembe.

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A stem cell ‘cautionary tale’ as Health Canada cracks down on private clinics

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here

For the medical team at the Health Sciences Centre in St. John’s, N.L., it was a shocking discovery — a patient had cells from his nose growing in his spine. It was the result of a stem cell treatment gone terribly wrong. 

“It was really surprising,” said Dr. Nanette Hache, a radiologist and assistant professor at Memorial University. “We offered him radiation in the hopes that it would slow down growth.”

The 38-year-old patient sought medical treatment because he was losing function in his arms. 

The doctors assumed he was experiencing complications from a spinal cord injury almost two decades earlier that resulted in partial paralysis.

This should be a cautionary tale for the manipulation of stem cells– Dr. Nanette Hache, Memorial University 

Instead, they discovered a spinal tumour. A biopsy revealed that nasal cells had somehow ended up in his spinal column and they were growing.

That’s when the doctors learned their patient had travelled to Portugal 11 years ago and paid $ 50,000 for an experimental stem cell treatment. 

“He was desperate. He would have done anything basically to walk again,” said Hache. “These guys were providing him with hope and obviously he was willing to spend the money if there was any chance at all he could walk.”

The Portuguese doctors were doing the controversial procedure based on a theory that glial cells harvested from a patient’s nose could be transplanted into the spinal cord where they might help regenerate neurons and promote healing in spinal injuries. 

When Hache and her colleagues searched the medical literature, they discovered reports of several other patients who also developed spinal cord tumours after receiving the same treatment.

“This should be a cautionary tale for manipulation of stem cells in the body because realistically we don’t know what the long-term adverse effects are,” said Hache. “If you transplant stem cells from one organ type into another these type of risks would be a reasonable thing to expect.”

This magnetic resonance image shows a spinal tumour caused by olfactory mucosal cells transplanted from the patient’s nasal cavity in a controversial stem cell procedure performed in Portugal more than a decade ago. (CMAJ)

Hache did not reveal her patient’s name, but said he agreed to have his story published to warn others about the risks of stem cell therapies.

“He’s doing okay. He’s obviously very disappointed with the outcome and everything that occurred,” said Hache. “He wanted people to be aware of this complication because he really didn’t want this to happen to anyone else

Although the Portuguese researchers patented their procedure and published their early results, there has been no long term follow-up for the estimated 140 people around the world who received the treatment, Hache said. Through her research she learned that Portugal group is no longer doing the operations. The lead researcher died in 2012.

‘Not enough evidence’ for effectiveness: Health Canada

The “cautionary tale” was published this week in the midst of a mounting stem cell controversy in Canada now that Health Canada has started cracking down on private clinics offering so-called “stem cell” therapies. 

The agency has sent letters to 36 clinics across the country requesting them to stop doing the procedures until they have received regulatory approval.

None of the Canadian clinics are known to be harvesting nasal cells and performing the type of surgical implants that the Newfoundland patient received in Portugal. Most use cellular fluid extracted from a patient’s bone marrow or fat tissue. That fluid is put into a centrifuge and then some of it is either injected back into the patient’s body, infused intravenously or inhaled through a respirator. 

The clinics do not examine the fluid to determine what kinds of cells it contains, but they assume that there are at least some mesenchymal stromal cells (MSC) sometimes called “adult stem cells” although some experts dispute the validity of that term. 

In May, Health Canada announced that it considers the cell therapies to be a form of drug treatment, which means they must undergo a rigorous review and be formally approved before they can be legally offered to the public.

It’s Health Canada’s first action aimed at reigning in Canada’s thriving cell therapy industry, which has flourished for several years despite warnings from researchers that the safety and effectiveness of the treatments has not been proven. 

My position is I’m a surgeon and I’m doing surgery.– Dr. Scott Barr, Ontario Stem Cell Treatment Centre

Legitimate clinical trials are underway testing the use of cells extracted from adipose or bone marrow tissue for a variety of conditions. But those studies are tightly controlled and patients volunteer to be tested free of charge. Clinics selling direct-to-consumer cell therapies are operating outside of the clinical trial system and Health Canada has ruled that neither the safety nor the efficacy of the procedures has been proven. 

“Generally, products using stem cells to cure or treat disease remain at the investigational stage of development. This means that Health Canada has not yet seen enough evidence that they are safe and effective,” a Health Canada spokesperson told CBC News in an email.

Sudbury clinic continues to do cell procedures

Dr. Scott Barr, a plastic surgeon at the Ontario Stem Cell Treatment Centre in Sudbury received what he described as Health Canada’s “cease and desist” letter on May 23. But he said he is not stopping the treatments. 

“My position is that I’m a surgeon and I’m doing surgery,” said Barr. “They’re saying we’re manufacturing a drug and we’re not. We’re basically allowing patients to use their own cells.”

“I sent a note to Health Canada inviting them to my office to review what we’re doing.”

In fact, Barr said he performed one of the cell procedures on Thursday, treating a patient with Parkinson’s disease by extracting material from the patient’s fat tissue and infusing it intravenously into the patient’s blood. 

Barr said he also administers the tissue extract using respirators and direct injections to treat a range of conditions.

“We do all sorts of stem cell procedures. We do joint injections —hip joints, knee joints, shoulder joints — for arthritic changes. We do other patients with neurologic conditions some people with respiratory conditions so there’s lots of conditions that we’re doing.”

The patients pay thousands of dollars for the treatments.

“It could be anywhere from $ 6,500 and sometimes a little bit more,” said Barr. 

Dr. Scott Barr, a plastic surgeon at the Ontario Stem Cell Treatment Centre, said he will continue to do the cellular treatments despite Health Canada’s order. (Marcus Schwabe/CBC)

A Health Canada spokesperson told CBC News in an email that it intends to verify that the clinics have complied with federal requirements, adding that Health Canada “will take action to address any non-compliance and engage the appropriate provincial or territorial regulatory body as needed, including Professional Colleges within Canada.”

The College of Physicians and Surgeons of Ontario (CPSO) has the power to take disciplinary action against doctors who do not follow Health Canada directives, although a spokesperson said the CPSO could not comment on a specific case.

At the Toronto PRP and Stem Cell Clinic, Dr. Adrian Le is complying with Health Canada’s request to stop the treatments. 

“We sent an email back confirming we would comply with the order,” said Le who has been performing the cell procedures using fat tissue to treat osteoarthritis in the knee and hip. Le estimates he has done almost 100 treatments charging around $ 4,000 for the full therapy. 

He said he has mixed feelings about Health Canada’s actions. 

“On the one hand I understood where they were coming from,” said Le. “There were some clinics both in the United States and in Canada that were doing things outside the bounds of what the research or evidence would suggest stem cells are appropriate for. And I think regulation was needed.”

This an excerpt from one of the letters Health Canada sent to 36 private clinics across the country ordering them to stop advertising and selling cellular therapies. (CBC News)

Back in St. John’s, Dr. Nanette Hache said she has reservations about the safety of the cellular procedures, based on her patient’s experience.

“People are desperate and they will try anything and they will spend any amount of money if they think it can make them better,” said Hache. “With regards to these clinics we don’t know what the long term outcome will be for these patients either.”

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