Mathematical modeling of COVID-19 transmission dynamics in Uganda: Implications of complacency and early easing of lockdown

BACKGROUND: Uganda has a unique set up comprised of resource-constrained economy, social-economic challenges, politically diverse regional neighborhood and home to long-standing refuge crisis that comes from long and protracted conflicts of the great lakes. The devastation of the on-going global pandemic outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is likely to be escalated by these circumstances with expectations of the impact of the disease being severe. MATERIALS AND METHODS: In this study, we formulate a mathematical model that incorporates the currently known disease characteristics and tracks various intervention measures that the government of Uganda has implemented since the reporting of the first case in March 2020. We then evaluate these measures to understand levels of responsiveness and adherence to standard operating procedures and quantify their impact on the disease burden. Novel in this model was the unique aspect of modeling the trace-and-isolate protocol in which some of the latently infected individuals tested positive while in strict isolation centers thereby reducing their infectious period. RESULTS: The study findings show that even with elimination of all imported cases at any given time it would take up to nine months to rid Uganda of the disease. The findings also show that the optimal timing of easing of lockdowns while mitigating the possibility of re-emergence of a second epidemic wave requires avoiding the scenario of releasing too-many-too-soon. It is even more worrying that enhancing contact tracing would only affect the magnitude and timing of the second wave but cannot prevent it altogether. CONCLUSION: We conclude that, given the prevailing circumstances, a phased-out lifting of lockdown measures, minimization of COVID-19 transmissibility within hospital settings, elimination of recruitment of infected individuals as well as enhanced contact tracing would be key to preventing overwhelming of the healthcare system that would come with dire consequences.