Lake region ‘headed the India way’

Medical experts have warned of a possible “India-like situation” in Lake Victoria region after Covid-19 infections surged more than 200 per cent in two weeks amid a shortage of testing kits and community aversion to vaccination and containment measures.

The region, for months spared the ravages of the pandemic, has in recent days become the national hotspot, with positivity rates higher than the national average. In the last six days, for instance, the number of confirmed Covid-19 infections per day surged from less than 50 at the start of the year to an average of 150, indicating a threefold increase.

On Tuesday, a Ministry of Health report noted that 270 people in the region had contracted the virus in the last 24 hours of testing.

The majority of the cases were in Kisumu (102), Kericho (77), Busia (18) and Nyamira (12).

Lake Region Economic Bloc (LREB) is made up of 14 counties that not only share ecological zones but are also closely tied by history and trade.

The counties are Bungoma, Busia, Homa Bay, Kakamega, Kisii, Kisumu, Migori, Nyamira, Siaya, Trans Nzoia, Kericho, Bomet, Nandi and Vihiga.

Among the most affected by the recent surge in infections are urban centres in Kisumu, Kisii, Bungoma and Kericho, as well as the transport corridor running from the Rift Valley town of Nakuru to border towns in Nyamira and Busia.

While infections have generally been low in the more rural counties, recent data shows that the positivity rate is rising as populations ease off containment guidelines such as wearing masks, avoiding crowds and cutting unnecessary travel.

It is not clear yet what is causing this surge in infections and the extent of community transmission, but interviews with medical experts painted a picture of a region waiting to implode.

While previous measures by the national government to stop spread of the virus have been designed to protect upcountry regions from the hotspots of Nairobi, Mombasa, Kiambu and their environs, there are fears that the next lockdown, if it comes, could be to protect the city and the rest of the country from this new pain point.

This concern is informed by the fact that these 14 counties export labour to the city and beyond, and also sit along major transport corridors that extends from the port of Mombasa to the Great Lakes region.

Prof Khama Rogo, chairman of the Committee of Eminent Persons on Covid-19 Advisory, Control and Socio-Economic Impact Mitigation in the LREB, said yesterday that, if nothing is done quickly to reverse the trend, the region — as well as the rest of the country — could face a surge in infections that would overrun health facilities and infrastructure.

“This is extremely worrying,” said Prof Rogo, a career medic and scholar who has practised in three continents, and who won the Kenya Lifetime Service Achievement Award for Excellence and Quality Health Care in 2019.

“Every surge in infections since the pandemic started has been worse than the previous, but this new wave appears to be running out of control.”

It is not clear yet whether a new variant could be causing the surge in infections as doctors were yesterday reluctant to discuss the matter, but it is important to note that the more virulent Indian variant of the virus was discovered here early May.

The common variables for transmission here have been the worrying porous borders, the clogging of the transport corridor, and general indiscipline as far as observance of safety protocols is concerned.

Dr Shem Otoi Sam, a member of the LREB advisory committee and an infectious diseases modelling expert attached to the Covid-19 Recovery Alliance, noted that the Indian variant “appears to be the only new variable” in the greater scheme of things.

However, on May 12, the Ministry of Health said genomic sequencing at the time had shown that there was no community spread of the variant, and that only 20 cases of the strain had been confirmed in the country.

Of the 20, 15 were travellers who had flown into the country from India, where the virus has been ravaging through populations for two months now.

The Asian giant’s coronavirus death toll surpassed 250,000 last week, with more than 4,000 people dying daily and cumulative case load rising to more than 23 million, the second-highest after the United States. While the pandemic is easing in major cities, the virus appears to be running unchecked in the country’s vast rural hinterland, where two-thirds of its people live.

The AFP reported last week that many experts believe the official numbers of the dead are an underestimate. India’s story could be Kenya’s story as well in the coming weeks, warned Prof Rogo, drawing parallels between how the two countries on different continents and with different cultures have approached the pandemic. India appeared to be on the cusp of avoiding the worst of the pandemic barely three months ago. But then politicians started holding massive political rallies against the advice of doctors, and soon the vast majority of the 1.3 billion population stopped observing safety protocols and guidelines.

Then, in March this year, hundreds of thousands of Hindu faithful descended upon River Ganges for the Kumbh Mela festival, dipping their bodies in the mighty, iconic river in the belief that its “holy waters” would will cleanse them of their sins and bring salvation.

This annual ceremony had been held for centuries in calmer, safer times, but in the Covid-19 era it was greeted with shock and indignation by the global community.

Majority of those who tested positive of the Indian variant in Kisumu had travelled for the Kumbh Mela festival, sources told Nation.

But, without an express government declaration that the deadly variant is now in community transmission in the LREB region, or even farther afield, it is hard to attribute the surge to it. While the government has indicated that it is conducting genomic sequencing of the virus in target populations in the Kibos neighbourhood of Kisumu where the Indian variant was first detected, the magnitude of the sampling was not clear yesterday.

Also, information on the pervasiveness of this variant remains scant.

“This is extremely worrying,” said Prof Rogo of the lack of clarity on the genomic sequencing. “It is unacceptable.” Prof Rogo’s frustrations stem from the fact that, as chairman of the LREB Covid-19 committee, he is expected to offer guidance to 14 governors on measures to take to contain the virus. But, without adequate, timely and consistent data, he is practically hunting in the dark.

“How many cases have been genomically tested and what are the results?” he posed.  Nation suggested to him that, perhaps, the sequencing has happened but the results have not been made public, to which he responded: “It’d be criminal were someone to be hoarding that information.”

Apart from genomic examination of virus samples from the region, both Prof Rogo and Dr Shem are proposing a ramping up of testing capacity.

Currently, government facilities are using the polymerase chain reaction (PCR) test, which is criticised as being not only slow, but also expensive. The two experts want both the national and county governments to roll out rapid testing as soon as possible.

“A PCR kit costs as much as Sh15,000 while a rapid test one could be as cheap as Sh500,” said Prof Rogo. “What’s more, the rapid tests give results almost immediately, which make them more viable for random sampling.”

In an advisory to LREB, Prof Rogo’s committee warns that “laboratory capacity for testing and genomic determination is abysmally inadequate”, and that the “insistence and reliance on PCR at the overstretched Kenya Medical Research Institute laboratories in Kisumu is ill-advised”.

“Rapid testing is the only affordable option for the region and country. We are not serious when we invoke contact-tracing activities without enhancing our rapid testing capacity,” they warn.

On the traffic congestion in the border towns of Busia and Migori that has been linked to the spread of the virus to the surrounding communities, the committee says this is making the border posts “perpetual Covid-19 hotspots”.

The committee is also warning that the region and the country, generally, does not have the resources to vaccinate a significant portion of the population in good time, and so the concept of developing herd immunity is “a far-fetched dream”.

This matter is compounded by the fact that only 0.3 percent of the globally available Covid-19 vaccines have been sent to developing countries, which means Kenya, like the rest of the continent, could be in the throes of the pandemic for the long haul.

Dr Shem, who has developed an infectious diseases mathematical model that has been trialled in Homa Bay County, is predicting the worst for the region in the coming weeks if the testing capacity is not increased and the public sensitised on the need to observe existing guidelines.

His model, he says, predicts upwards of 800,000 infections nationally by the time the current wave peaks, between June 26 and July 10 this year.

Dr Shem also predicts another peak in October this year, which he says could be far much worse than the current one if recent historical trends — where the next peak is more ravaging than the previous — are anything to go by.

Notably, he says, a lot of the current admissions to hospital because of the virus in the LREB are of people aged below 40, which appears to be in line with the experience in India, where younger populations have been devastated by the dominant variant there.

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