Outbreak of COVID-19 in Home-Based Care Settings October – November 2020, Uganda

After the first COVID-19 case was identified in Uganda on March 21, 2020, the outbreak grew relatively slowly, and institutional isolation of all cases was feasible. Starting in August 2020, cases began increasing rapidly, and as of late October 2020, approximately 12,500 cases had been confirmed. As cases increased, healthcare facilities became stressed, and many ran out of space. Some began charging exorbitant costs outside the reach of most patients for treatment. Patients expressed increasing reluctance to go to the healthcare facilities due to cost, lack of space, and other issues. As a result, towards the end of 2020, the practice for patients with COVID-19 in Uganda began shifting from hospital care to Home-Based Care (HBC), despite the challenges. In October 2020, there were no formalized HBC guidelines in Uganda, yet persons were beginning to be treated at home in large numbers. During November 2020, more than 750 cases had been reported in the districts of Kasese and Kabarole, many of whom were household members of case-patients in HBC. FETP fellow Geofrey Amanya (@jeffamanya) led the investigation into an outbreak of cases in home-based care, looking at household-specific factors and individual factors associated with COVID-19 infection among household members of COVID-19 case-patients in Kasese and Kabarole. The team found that having more than 1 person per household room and interaction with the index case increased risk, as did the presence of specific underlying conditions. Home-based care guidelines in Uganda were modified based on the findings from the study.