Kampala, 14 September 2020: - Amuru Prison is just like any other prisons facility in Uganda with prisoners going about their daily chores and routines under the watchful eyes of wardens. The situation has been like this for years, and it continues to be. 

However, on 22 August 2020, the routine changed when 153 prisoners and one wader tested positive for COVID-19 at the facility. The confirmation changed Uganda’s COVID-19 narrative as this was the first and biggest cluster of COVID-19 infection to be detected in the country, significantly increasing the cumulative national tally. 

The detection of the 154 cases at the prison facility followed risk-based testing conducted following confirmation of three COVID-19 cases at Pece Prisons in Gulu who had transited through Amuru from Elegu on the border with South Sudan.  Therefore, with so many cases confirmed at one prisons facility, urgent action was needed at personal, district and national levels. 

“When they told us that we all have Corona, I knew that was the end of me. I had not even written a will… I thought I was finished!” narrates Solomon an inmate of Amuru Prison. That summarises the prevalent mood, anxiety and fear by the time the Uganda Prions Service (UPS), Ministry of Health and WHO made urgent tactical interventions at the facility.  

Several activities were immediately initiated to address the crisis yet being careful enough not to cause fear and panic, especially in the local community. For starters, all the 153 inmates were evacuated to the treatment facility at the Gulu Main Prison that had earlier been prepared as a treatment center for the non-severe asymptomatic COVID-19 patients. The only positive prison wader was taken to Gulu Regional Referral Hospital. 

The rapid medical team implemented an already developed algorithm to assess and classify patients for admission into the Gulu Main Prisons facility located about 1 Km away from Gulu Regional Referral Hospital. Luckily, there were no severe cases among the prisoners requiring advanced care and they were all medically stable. 

At Gulu Main Prison, UPS with technical support from MoH and WHO set up a treatment unit that provided care and treatment for inmates with non-severe COVID-19 disease. It is also here that new prisoners spent 14 days of observation before admission to other prisons in the sub-region. 

Following the evacuation of the Amuru prison, the facility was disinfected and locked down for 28 days. The disinfection followed WHO guidance, protocols and Standard Operating Procedures (SoPs) under Infection Prevention and Control (IPC). 
 
In the subsequent days, risk communication and psychosocial activities were rigorously implemented targeting inmates, prison wardens, their families and neighbouring communities. This brought about calmness and allayed anxieties and fear and at the same time enhanced observance of the Standard Operating Procedures (SOPs) for the control of the spread of the infection to the community. Three key behaviours were promoted i.e. correct and consistent use of facemasks, regular handwashing with soap and water and maintaining a physical distance of not less than a meter. 

"I felt better when the WHO Specialist talked to us. She professionally answered all my questions and I got the courage to face Corona”,  Solomon the inmate said later as the Amuru operation closed. The family of the infected Prison Officer was given utmost attention since it was not evacuated to the institutional quarantine centre due to maintenance constraints.

Distribution of facemasks to all inmates and staff of Amuru Prisons was another critical intervention. Initially, many inmates had no masks as they were yet to access government-supplied ones. Arrangements were made and masks immediately provided to all. 

For over three weeks, WHO consultants mentored health workers and staff of Amuru prisons on IPC and COVID-19 case management. This was emphasized not only to offer the best possible care to patients but also to ensure maximum protection for health workers.   

“I now feel competent to treat the COVID-19 patients after being mentored in case management and IPC. This being a new disease, it was a scaring situation and I was afraid to risk my life,” said Oscar Owacgiwu, a Clinical Officer and Team lead of Gulu Main Prison treatment facility as he thanked WHO for the technical support. Later, WHO provided SoPs on IPC, Personal Protective Equipments and other materials to enhance readiness at Amuru Prisons.

The staff of Amuru Prisons were also trained on health worker surveillance and a system was put in place to ensure daily assessment for high-risk exposure. “I wonder how we would have handled this crisis without WHO! I am highly grateful to WHO for supporting the facility and no prisoner has lost his life,” said the Officer in Charge Gulu Main Prison. 

For disease surveillance, 49 inmates were identified as primary contacts. They were evacuated and admitted to the institutional quarantine at Gulu Main Prison. Eventually, seven of these tested positive and were admitted to the treatment facility. 

The rest of the prison staff at Amuru Prison along with other families and community members who were identified as primary contacts were quarantined and tested periodically over 14 days. Luckily, none of them developed an infection during the follow-up period and were subsequently discarded as contacts. The local leadership and Village Health Teams also played a major part in ensuring home quarantine for contacts and prompt reporting of suspicious cases to health authorities.

“I applaud WHO for the technical and logistical support given to our isolation unit at Gulu Main Prison. The capacity building of my staff motivated us to open up more treatment centres in the region. The risk communication team did a great job to talk to the inmates to ensure that they understand why isolation was needed. We, however, kindly request partners to support all treatment units with personal protective equipment such as masks, gloves, disinfectants, soap etc. because the battle has just started”, says Mr. Idiba Yoweri, the Gulu District Health Officer.

The COVID-19 incident at Amuru Prison was an eye-opener for Uganda. Such settings require special attention given the many people they host in usually limited spaces. The response interventions mounted by UPS, MoH and WHO ought to be emulated especially as COVID-19 cases are recorded in other prion facilities and similar settings throughout the country.