What you need to know:
- Doctors will be forced to make gut-wrenching decisions on who to treat and how to distribute services in wards, and these decisions could mean life or death for patients.
- But the hundreds of Kenyans sneaking through police roadblocks and ignoring curfew guidelines do not understand these risks.
A group of eight fake mourners bought a coffin, strapped it onto the roof of a car, and hired a driver to take them from Nairobi to Homa Bay to escape the coronavirus containment measures in the city.
Along the way, they told police at roadblocks that they were transporting a body for a funeral and they were quickly waved through. They had a fake burial permit from Mama Lucy Hospital in Nairobi.
They lied their way through the 380 kilometres from the city to the small town on the shores of Lake Victoria on Tuesday last week, but when villagers saw the coffin strapped on their car, they gathered to mourn with them.
However, neighbours got curious and demanded to see the body. Then hell broke loose and they alerted police.
Coronavirus tests on them returned a positive result for the driver, and now the rest are in quarantine as detectives track and trace people who might have come into contact with them from Nairobi to Homa Bay.
The irrationality of the fake mourners illustrates a growing level of indiscipline that is putting the lives of millions of Kenyans at risk of contracting coronavirus.
Apart from faking deaths, others are bribing government officials to escape from quarantine facilities, faking emergencies to avoid curfews or break travel restrictions, and marketing all manner of bogus concoctions as cures for Covid-19, the disease caused by the virulent coronavirus technically known as SARs-Cov-2.
That irrationality is spreading the disease and putting the lives of about 28,000 at risk, Health Cabinet Secretary Mutahi Kagwe announced Saturday, signalling how missteps by the population could plunge the country into medical anarchy in the coming weeks.
Mr Kagwe, who spoke on behalf of the National Emergency Response Committee, said the country has now gone into red alert mode as infections rise steadily.
He announced an additional 16 positive cases, bringing the total number of confirmed infections to 262. “We could lose as many as 28,000 Kenyans unless we start taking safety measures seriously,” warned Mr Kagwe.
“This is not a time for cat-and-mouse games. The number of deaths that will be recorded will depend on our level of discipline. By now, you should have noticed that the higher the samples the higher the number of new cases. This speaks both to the urgency to test as many Kenyans as possible, and for every Kenyan to assume the next one is positive and therefore take precautionary measures.”
Of the new positive cases, 15 are Kenyans and one a foreigner. Twelve are males and four females aged between 23 and 84.
The 84-year-old is a herbalist who had claimed to have a cure for the condition.
In what could indicate that we are in the deadly phase of community transmission, none of the 16 has a history of travel, and none emanated from the numerous quarantine centres across the country.
Nairobi and Mombasa still recorded the highest number of cases, with each harbouring nine and five, respectively.
The remaining one is the driver on the bogus funeral mission to Homa Bay. Seven more patients were discharged from hospital Saturday, bringing the number of those cured of the virus to 60.
However, two more patients died, raising the tally of deaths related to the virus to 12.
Mr Kagwe said the ministry had noted with concern non-factual food and nutrition information being shared on social media platforms on the healing effects of certain foods or drinks.
“This is not the time to confuse our people or to engage in publicity theatrics. While we encourage acts of charity, we advise Kenyans to get factual public health information from credible sources, such as professional healthcare providers, the Ministry of Health, and the World Health Organization,” said the CS.
In the continuing fight against Covid-19, the task force has emphasised the importance of proper nutrition, hydration and physical activity, saying consumption of a healthy diet and regular physical activities help to strengthen one’s immune system, lower the risk of chronic illnesses and infectious diseases, and also speed up recovery from illnesses.
SECTOR IN JEOPARDY
But, even as he talked about what Kenyans need to do to save the 28,000 who could die from the virus in the coming months, Mr Kagwe appeared well aware of how a surge in patient numbers could strain existing medical infrastructure and put medics to the test.
Early last week, for instance, a patient from a private hospital in Nairobi developed breathing problems that doctors suspected to be related to Covid-19.
Because they did not have an isolation centre or a free ventilator, they referred the patient to a public hospital, where doctors watched in despair as the patient died, as the available ventilator was hooked to a younger accident victim.
A similar scenario also happened at a level five hospital, where clinicians were forced to leave two patients in the general ward when they desperately needed a ventilator and there was only one available.
All the patients had developed respiratory distress from lung problems and a decision was made to pick one over the rest.
As cases of Covid-19 rise and spread to counties via the irrationality of some Kenyans, doctors will be forced to make gut-wrenching decisions on who to treat and how to distribute services in wards, and these decisions could mean life or death for patients.
Dr Chibanzi Mwachonda, who practices at Coast General Hospital and is the acting secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union, told the Sunday Nation that if the numbers overwhelm the health sector, doctors will be forced to put in place more rigid exclusion criteria for ventilators and admissions.
Dr Mwachonda warned that should patients fall into respiratory distress and are unable to breathe in county or even national hospitals that do not have enough intensive care beds, doctors might have no recourse but to watch them die.
“This is happening even in health systems that are much more robust than ours,” he said.
Large facilities such as Kenyatta National Hospital, Aga Khan University Hospital and Nairobi Hospital have set up “ethical support units” to draft guidelines for healthcare workers to make these life-and-death decisions and not be left grappling with “moral injury”, which causes anguish due to losing patients.
To make those life-and-death decisions, doctors rely on factors like age, the severity of the viral infection, the nutritional status of the patient, and availability of beds and ventilators.
However, lower-level public hospitals, especially those in counties where some Kenyans are taking the virus, have not made the same arrangements.
Kijabe AIC Referral and Tertiary Teaching Hospital, located just a few kilometres out of Nairobi on the road to Naivasha, has six ventilators, two of which are already dedicated to Covid-19 cases.
The facility has set up a committee made up of physicians and non-physician staff to decide who will be hooked to those two ventilators should it come down to it.
Dr Ken Muma, the hospital’s executive director, hopes that social distancing, wearing face masks and other measures announced by the government will work against the virus, or he and his staff will be forced to make desperate decisions.
“Many Covid-19 patients who need a ventilator never recover, as opposed to, say, someone who has had an accident,” said Dr Muma. “Therefore the decision to let just two of the ventilators be set aside for the virus was to acknowledge that there is going to be other patients who need our care.”
NEED FOR VENTILATORS
Survival rates for Covid-19 patients hooked on ventilators vary, but a report from London’s Intensive Care National Audit and Research Centre found that 67 per cent of such patients from England, Wales and Northern Ireland died.
Another study from China reported that only 14 per cent survived under the same circumstances.
The damage that the virus causes to bodies explains why older people with other underlying health issues do not survive.
SARS-CoV-2 attacks the lungs, but the lack of oxygen does not attack the organs alone, it also damages the kidneys, liver, heart and the brain, among other vital parts of the body.
Lungs develop acute respiratory distress syndrome (ARDS), and this is why the patient needs a ventilator in the intensive care unit.
Patients in intensive care also need therapy to keep them moving — raising their arms and legs — so that they do not develop muscle atrophy.
But this therapy is a challenge because SARS-CoV-2 is so infectious that bringing rehabilitation specialists into patients’ rooms is a major challenge.
“So this is why it makes sense to take a younger healthier person into the ventilator than an older person who may also be battling hypertension or diabetes,” Dr Muma told the Sunday Nation.
Clinical officer David Aliba, based at Kijabe, is one of the workers who is expected to observe the new guidelines.
Mr Aliba is trained on emergency medicine, an extra 18 months over the four years that he spent at university.
Unlike his general counterparts, Mr Aliba is able to handle patients in critical care until the doctors arrive for surgeries, and also do other duties that are often left to doctors.
Thanks to the new guidelines, his triage decisions are now a mixture of two: utilitarianism, which gives care to the person who has the most years remaining to live a quality life, and prioritarianism, the “rule of rescue”, which treats the sickest people first.
This, however, is not a Kenyan problem alone. On March 23, researchers and ethics professionals published an article in the New England Journal of Medicine laying down six guiding recommendations for rationing during the Covid-19 pandemic.
In a nutshell, the researchers advised medical professional to maximise benefits; prioritise health workers; not allocate on a first-come, first-served basis; be responsive to evidence; recognise research participation, and apply the same principles to all Covid-19 and non-Covid-19 patients.
For this reason, they noted, “We believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable, and that patients should be made aware of this possibility at admission”.
Dr Eddy Mboya, an intensive care doctor, said the decisions he makes in his daily work are, to put it crudely, a judgement of who lives or dies, but he fears that Covid-19 will force him to relive these soul-crushing decisions over and over again because the system has not changed.
“It kills me inside, especially when it is a child who I know I could have saved but died because of things that should have been provided to me but were not,” he said.
But the hundreds of Kenyans sneaking through police roadblocks and ignoring curfew guidelines do not understand these risks, and neither do the thousands others who are still holding balcony parties, refusing to wear protective masks in public places or to observe the sanitation guidelines issued by doctors.
And these are the people who could kill 28,000 Kenyans in the coming months.
Additional reporting by George Odiwuor, Benson Ayienda and Vitalis Kimutai.