What you need to know:
- By admitting everyone for at least 14 days, the ministry is killing two birds with one stone: managing infection and preventing community transmission.
- Kenyan laboratories can test upwards of 37,000 coronavirus samples in 12 hours, up from the 600 before full automation this week.
Two confirmed infections in 24 hours, gradual closure of quarantine centres, release of 1,600 people rounded up through contact tracing, and the launch of a laboratory facility with capacity to test upwards of 37,000 samples in a day; is Kenya winning the war on coronavirus faster than anticipated?
It might be too early to predict, but a raft of measures taken by a special team of experts hurriedly scrambled together by the Ministry of Health appear to be changing the trajectory of the coronavirus pandemic in the country, interviews with various heads of the task force and a Sunday Nation study of the infections show.
The greatest influence so far in the war against the pandemic are the containment measures for the hotspot counties of Nairobi, Kwale, Mombasa and Kilifi announced by President Uhuru Kenyatta last week, and mandatory quarantine of the contacts of all confirmed cases.
The disease has infected 191 Kenyans so far and ground to a near halt the country’s nascent economy.
Ms Susan Mochache, the Principal Secretary in the Ministry of Health, who also chairs the National Taskforce on Covid-19, told the Sunday Nation on Saturday that the painful yet important measures appear to be slowing down the rate of infections, and could force a team of data scientists to revise the projections of total contamination in a worst-case scenario for the country.
That, coupled with the roll-out of faster automated testing this week and the adoption of strict quarantine measures at the outset of the pandemic, could be the ultimate game changers in Kenya’s war against the virus.
Ms Mochache’s Covid-19 task force reports to the National Emergency Response Committee chaired by Health Cabinet Secretary Mutahi Kagwe.
The National Emergency Response Committee is one of four streams that report to the National Coordination Committee on the Response to Coronavirus Pandemic that is chaired by Interior Cabinet Secretary Fred Matiang’i.
The others are the Security Preparedness and Response Committee, the County Government Coordination and Food Supply Committee, and the National Economic and Business Response Committee.
An earlier model of the coronavirus infection curve, based on prevailing circumstances at the time, had indicated that the total number of infections could top 10,000 by the end of this month.
The model had also projected that Kenya would have about 1,000 cases of Covid-19 by the end of last week and 5,000 by the end of next week.
“We will definitely revise those numbers in the wake of the containment measures,” said Prof Omu Anzala, an epidemiologist who has led Kenyan research into an HIV vaccine for decades, and who heads the Kavi Institute of Clinical Research at the University of Nairobi.
PHASES OF PANDEMIC
Kenya announced its first case of Covid-19 on March 13, the patient being a 27-year-old with previous travel history to the US.
A week later, on March 20, the number had risen to seven, then to 28 seven days later, on March 28.
It was at this point that mathematical modelling by the Ministry of Health predicted the worst for Kenyans if they did not adhere to a raft of measures introduced by the government, including mandatory sanitisation in public places, halving of passenger capacities in public service transport, and the introduction of a dusk-to-dawn curfew.
A week later, on March 27, Kenya’s confirmed Covid-19 cases rose to 31, then to 122 on April 3, and 191 on Saturday, by when, according to the earlier model, we should have hit at least 3,000 infections.
Prof Anzala and his team of epidemiologists, data scientists and mathematical disease modelling experts believe that, based on current trends, Kenya is at the cluster phase of a pandemic.
There are usually six phases of a pandemic: the investigation interval during which a virus in identified and investigated, the recognition phase during which clusters of cases are identified, the initiation phase during which there is sustained person-to-person transmission, the acceleration interval when the virus infects thousands of susceptible people, and the deceleration and preparation intervals during which the rate of infections plateaus and eventually dies down.
Majority of the cases that have been confirmed so far are linked to histories of travel or contact with infected persons, said Prof Anzala, warning that had there been no quarantine or containment measures Kenya would have quickly graduated to the local transmission stage, during which the disease runs out of control and infects thousands.
Dr Loice Achieng Ombajo, who has been on the frontline of case management at Kenyatta National Hospital, agreed.
As head of the Infectious Disease Unit at the facility, her work places her on ground zero, where hordes of doctors and nurses attend to cases of varying degrees of criticality every day.
She told the Sunday Nation that, while some patients have needed hospitalisation, majority of them did not and were only put on painkillers and antibiotics to manage the symptoms.
Her biggest concern has been the development of case definition guidelines to determine severity of infections, triage procedures to determine whether or not to admit or test for coronavirus, and when to discharge.
“Currently, because there isn’t much pressure on the healthcare system, we are admitting everyone,” she said, adding that those mandatory admissions are also part of the strategy to contain the virus because sending mildly sick people back home would risk community transmission.
By admitting everyone for at least 14 days, therefore, the Ministry of Health is killing two birds with one stone: managing infection and preventing community transmission.
“People react to this virus differently,” said Dr Ombajo. “While one might have it but not show any symptoms, we don’t know how those who will come into contact with the infected person will react to the same virus. It could be a matter of life or death, and that is why we are admitting everyone.”
The team of experts who lead the Covid-19 task force is seeing these small triumphs as the beginning of successful pushback against the disease.
Behind the scenes, they are running the government’s effort to stop the spread of the virus, aided by a network of doctors, data engineers, security experts, laboratory scientists and supply chain logisticians who work round the clock.
From various offices in the city, the team has been carrying non-stop surveillance, manning an emergency operations centre, building the capacity of health workers and volunteers in the counties, managing quarantine facilities, testing thousands of samples, and developing guidelines for case management.
“They are the foot soldiers in this battle,” said Dr Mochache. “Their job is to ensure total surveillance of the Covid-19 situation in the country and advise the ministry on the next critical steps to take to contain the pandemic.”
By Saturday, almost a month since the virus was first confirmed in the country, the team had traced more than 2,300 contacts of those infected with the virus, all of whom had been placed under mandatory quarantine.
More than 1,600 of these have been released after testing negative to the virus, said Prof Matilu Mwau, an infectious disease scientist who is leading laboratory work on the virus at Kenya Medical Research Institute.
“Because of our earlier investments in HIV testing infrastructure, we now have better testing capacity than most European countries,” said Prof Mwau, adding that “by leveraging on the HIV testing infrastructure and designing software that understands coronavirus reagents, Kenya had overcome the challenges of a disintegrated global health supply chain”.
As a result of this, Kenyan laboratories can test upwards of 37,000 coronavirus samples in 12 hours, up from the 600 before full automation this week.
Motivated by the increased throughout of the laboratory infrastructure he manages, Prof Mwau said Covid-19 could be the unwanted catalyst that speeds up Kenya’s journey towards universal health coverage.
“Innovation is the motor that drives the future of Kenya’s health preparedness,” he said, referring to quick innovations by the task force such as the development of software to aid the laboratory testing of coronavirus, the creation of a digital dashboard to monitor supplies, and the adoption of mass public awareness and behaviour change campaigns.
But all these innovations and policy guidelines will amount to nothing if humankind continues its dalliance with wildlife, warned Prof Anzala.
An alarming number of diseases, including Covid-19, the swine flu pandemic of 2009, the Zika virus that ravaged the Americas and Ebola in West Africa, have been linked to pathogens that have for centuries been contained in the wild.
Scientists have warned that more than 75 per cent of emerging infectious diseases are zoonotic in origin, meaning they jumped from wild animals to humans. Prof Anzala said Kenya is leading research into this area through the One Health approach.
Prof Anzala and his team of researchers have been looking at the interaction and disease linkages between humans, animals and the environment for years.
Now, he said, they are “looking into the future” and examining the possibilities of local healthcare facilities dedicated to the management of such pandemics.
Dr Nduku Kilonzo, who heads the National Aids Control Council, and who is now managing the resource mobilisation committee of the Covid-19 task force, said all these measures rely on fast and efficient deployment of resources.
More than Sh1 billion has already been spend on the management of the pandemic, including kitting of front line personnel, equipping of isolation centres, and purchase of testing kits.
Some of that money has also been spent on training of healthcare workers and other personnel in the trenches against the virus.
These include doctors, nurses, police officers, prison warders, National Youth Service personnel, and community health volunteers, said Dr Philip Muthoka, who heads the capacity building stream of the task force.