Why Kenya’s Covid state is a ticking time bomb

Kenya’s Covid-19 testing rate has gone down, with officials acknowledging a shortage of kits and a shift to targeted testing.

In targeted testing, only people with symptoms of Covid-19 and those who present themselves at hospitals are tested, said Dr Francis Kuria, the director of public health in the Ministry of Health.

Compared with other countries in the region, such as Uganda and Rwanda, Kenya lags in testing for Covid-19, as the highest it has recorded is about 8,000 a day.

False picture

This, experts warn, could provide a false picture and limit knowledge on new cases and trends in infections.

While Dr Kuria understands the concerns, he said the government was working to boost testing.

The Kenya Medical Supplies Authority (Kemsa), he said, had received a consignment of about 650,000 rapid antigen test kits on Monday and distribution was trickling down to counties as from Wednesday.

“I know there has been an issue and we are now trying to distribute more testing kits to counties because they have gone down, particularly the rapid antigen test kits because more antigen testing has been embraced in counties,” he told the Nation yesterday.

“In that regard we are probably going to see higher numbers coming next week.”

There have been fluctuations this month in the number of samples taken for testing, with daily highs of more than 5,000 and lows of about 2,000.

“If you look at the seven-day average, the numbers have not dropped that much,” Dr Kuria said.

Dr Kuria also explained why the government dropped contact tracing as an intervention measure. He said “it would not make public health sense,” as the respiratory disease is now widespread.

“Every pandemic has phases. By the time you have widespread Covid-19 transmission, we replace contact tracing with public health interventions,” he said.

“By the time we have widespread transmission, contact tracing loses value. We only trace close family contacts and rare cases like when there is a new variant as was the case in Kisumu.”

He rejected claims that testing kits could be stuck at the port in Mombasa.

“Test kits arrive by air. I have not seen those that arrive by sea and if there are, I have not heard about it,” he said.

Low testing and minimal contact tracing, said consulting pathologist Dr Ahmed Kalebi, could be a ticking time bomb.

“When we do not test, then this means that a lot of symptomatic cases go unconfirmed as they are undiagnosed, and that sets a dangerous precedent in that contact tracing is not being done because there are no confirmed cases and even when there is, those who are contacts and asymptomatic can’t access the tests,” he said.

He suspects that most of the cases reported daily are those of travellers and clinical patients, probably a larger proportion being tested in private hospitals than in public facilities.

He said Kenya tests an average of 4,000 to 5,000 samples daily, whereas, for example, South Africa, with 58 million people, does 15,000 and Rwanda, with 12 million people, does over 10,000.

Vigorous testing

“If you look cumulatively, we have done only 2.07 million tests this far and Rwanda has done almost 2 million despite having a smaller population,” he said.

Because we are not sure how long the pandemic will be with us, he said, vigorous testing is needed for accurate monitoring and response.

“We are looking at least until 2023 before we can think of Covid-19 as a seasonal mild disease like flu, so until then wide testing is needed to track new surges and address reinfections and variants, especially now that we don’t have vaccination as yet,” he said.

“The diagnostic testing with PCR and antigen tests should be coupled with public health monitoring of variants through genomic sequencing.”