Health experts poke holes in Kenya’s Covid-19 strategy

Gikomba Market

Traders go about their business at Gikomba Market on March 28, 2021, some without face masks and while defying the social distancing requirement for curbing the spread of Covid-19.

Photo credit: Lucy Wanjiru | Nation Media Group

Health experts have poked holes in the government’s Covid-19 strategy and warned that it could fall apart and end up like the Indian situation.

The Ministry of Health’s efforts are random, haphazard and reactionary without accurate data and planning.

“I am afraid if there is no deliberate and transparent effort made to correct the current approach, we may find ourselves hard hit like India,” said Dr Ahmed Kalebi, a consultant pathologist.

The ministry has been announcing Covid-19 cases daily, helping policy makers to track the progress of the fight. The numbers have informed directives, policies and containment measures.

Dr Kalebi said the “wild fluctuations” in positivity rate “points to a misleading representation of the reported data”. It could swing from five or six per cent to 12 per cent the next day, back to eight per cent and then over to 10 per cent the next. It’s highly unlikely that such wild variation represents the true situation on the ground, he said. Such kind of data could blindside the ministry to a rising positivity rate and fail to intervene in a timely manner as the caseload goes up.

The picture painted is conflicting when the caseload is down, which is equally misleading to guide an appropriate response.

Dr Kalebi said the situation could be as a result of data from test results submitted in the past 24 hours of samples collected “on varying dates rather than those taken over the past two to three days”.

The ministry should be disclosing the positivity rate by counties and disclose when the samples were collected in order to provide a more accurate picture.

“We need a proactive, deliberate and strategic approach; not with the varying and skewed data presented daily,” said Dr Kalebi.

Asymptomatic patients

He urged the government to publish accurate data and explain what should be done to bend the curve. He warned of a risk of loss of trust in the data, which could result in complacency when there is a call to stringent measures.

“We have to be aware of the circuit breaker action which must remain high on alert. But this will depend on the availability of data on infections, hospital admissions and viral sequencing,” said Dr Githinji Gitahi, the Amref Health Africa chief executive officer.

“Kenya has not been doing adequate genome sequencing. The government should invest in this because the pandemic can be controlled through new information on the variants,” he added.

Dr Bernard Muia, a public health expert, said although Kenya has done well in controlling the pandemic, “the positivity rate may not say anything if the sample size is not representative”.

“The positivity rate is based on testing samples and a consistent size will give us a true picture of how the curve will look like tomorrow so as to be able to inform the measures that should be taken,” he said.

He said the find, test, trace and isolate module remains the best to handle the pandemic. However, testing and tracking is low.

When the pandemic started, the module was actively followed, with thousands of people going to quarantine for 14 days after suspected exposure. Today, most of the listed facilities remain empty, with only a handful of people (travellers) in some.

Home-based care

With a directive that asymptomatic patients should isolate at home, many more people could be exposed to the virus. Unfortunately, follow-ups are not being done. “Being based at the community where this condition is rampant, I would expect the isolated cases to be visited by the disease surveillance team to ascertain that there is no spread of the disease to other members in the families and community. To change the chain of transmission, we must find, test, trace and isolate,” said Dr Muia.

The strategy was decentralised and with counties lacking resources to do so, it has become difficult. Dr Gitahi said there is need for proper home-based care and isolation protocol so as to enable proper monitoring of such cases. It should include use of pulse oximeters to monitor oxygen levels of patients at home.

“Countries are doing their best to handle the situation by preventing transmission of the virus and the variants too, there is no new strategy for new variants,” said Dr Gitahi.

Initially, a huge part of the strategy involved the public health and social measures of social distancing, wearing of face masks, hand hygiene and treatment.

“These measures will not end unless we get a variant that may not be spread through close contact or wearing of face masks. Going forward, we will stick to these measures, more so for us in the developing world. We have seen how difficult it is to access the second dose of the vaccine,” said Dr Patrick Amoth, the acting Health Director-General.

The government has deployed rapid testing kits at the points of entry and will enhance surveillance to detect new virulent variants or strains of Covid-19.

“The strategy we are going to deploy is what we had before for Covid-19 —  the public health and social measures, in addition to enhanced surveillance at the points of entry, deployment of antigen testing and genomic sequencing,” said Dr Amoth.

Although the availability of vaccines has become a big issue globally, inoculation of the adult population is part of the strategy.

Dr Rashid Aman, Chief Administrative Secretary at the MoH, said they had also stopped flights from India and the UK.

The government has also expanded the list of countries whose travellers must undergo 14-day mandatory quarantine upon arrival.  All arrivals are supposed to fill in the Covid-19 health surveillance form available online.

“Kenya should also accelerate the Universal Health Coverage to address bed capacity. If we have adequate beds in our health system, there will be no need of locking the economy,” said Dr Gitahi.

There is also a need to accelerate reforms at the National Hospital Insurance Fund to ensure a majority of Kenyans can access services.

The State should also reform the Public Finance Management Act of 2012 to give health facilities financial autonomy. “Facilities cannot handle the situation if they lack the autonomy should the situation evolve like it did in India. As we prepare for the next surge, which is inevitable, we should look into that,” said Dr Gitahi.