Covid-19: What it will take to end the second wave

Kenya has been reporting an increased number of Covid-19 cases. Within the past one month, bed occupancy has gone up by 140 per cent. At the same time, the positivity rate has jumped to an average of 16 per cent over in the same period.

According to the National Multi Agency Command Centre on Covid-19, this represents over 15,000 new cases in October alone, and about 300 deaths.

Following these high numbers, the Health ministry has warned that Kenya is dealing with a second wave of Covid-19 infections. These rising numbers have dimmed the hopes that fuelled Kenya into a form of normalcy.

But even as hopes surged September that the virus curve had flattened to a positivity rate of below five per cent, there were doubts among people on the accuracy of the ministry’s data and the low numbers of the tested samples. These doubts stemmed majorly out of the embezzlement scandals that have rocked the procurement of equipment to aid the fight against Covid-19.

The case of Tanzania has further exacerbated claims that Kenya should have embraced an approach similar to that of its neighbour. But Dr Moses Masika, a virologist at the University of Nairobi (UoN), disputes this.

“It is difficult to judge the situation in Tanzania without any official data. If we are to go by what happened in countries like Brazil whose leaders took a similar posture, then we can say that Kenya’s action to control the virus was better than taking none,” said Dr Masika. He further cautioned that with Sars-Cov-2 being a new virus, what has been working for one country may not necessarily work for the other.

Kenya was at a greater risk of the virus than her East African sisters, Rwanda and Uganda. “We were more exposed to risk due to the level of international travel into the country as compared to our landlocked neighbours. The cases had to be more here than in Rwanda or Uganda,” he said. When put shoulder to shoulder, the situation in Rwanda, Uganda and Kenya has varied widely due to risk levels, population size, geographical size and spread and amount of travel, with Kenya being ahead of the pack in the East African region.

In the first quarter of 2020 when the virus spread from China to Europe and America, the rest of the world took either of two different approaches. Some countries instituted measures to control the virus, and others such as Sweden and Tanzania chose to let the virus take its course.

Sweden’s Covid-19 strategy involved voluntary social distancing and voluntary work from home. There was no strict lockdown. By July, Sweden had the highest death rate relative to population size in Europe. Out of a population of 10 million, over 5,500 people had died from the virus. By October, the country had over 102,000 cases and over 5,900 deaths.

Unlike Sweden and Tanzania, Kenya took the cautious approach of restricted movements, school shutdown and night curfews. According to Dr Thumbi Mwangi, a researcher and infectious disease epidemiologist at UoN, the fast response to the pandemic after the first case was reported in March was a good move.

“It allowed us to significantly slow down the establishment and spread of the disease within the country, and bought us time to prepare and learn about the disease,” Dr Mwangi, who is also a researcher at the Paul G Allen School for Global Animal Health at the Washington State University, told HealthyNation. 

Kenya is currently witnessing high numbers at the same time that Europe is witnessing the second wave of the virus. By October 14, the UK, Czech Republic and the Netherlands instituted stricter measures. In France, night curfews were reintroduced for the capital city Paris. Europe is now recording an average of 100,000 daily coronavirus cases. This is the highest daily number recorded since the start of the pandemic.

According to Dr Mwangi, Kenya’s rising daily numbers are partly due to the inability to effectively inspire the public to adhere to the non-pharmaceutical public health responses, the disconnect between Covid-19 protocols and the actions of leadership, including the potential super-spreader events like political rallies.

To get a better grasp of how Kenya has compared towards flattening the curve, HealthyNation examined data on Kenya’s pandemic status versus that of a few countries that have been hailed for their handling of the outbreak: 

Current Covid-19 status

The World Health Organization estimates that the coronavirus may have infected one in 10 people across the world. This equals 10 per cent of the global population. It means that out of a population of 7.7 billion, 700 million people have been infected.

Global:

According to the Johns Hopkins University Covid-19 dashboard, there are more than 48.1 million confirmed cases globally. The US leads in both the number of confirmed cases and deaths. It has over 9.5 million confirmed cases and over 233,000 deaths.

The US is followed by:

1.    India with over 8.3 million cases

2.    Brazil with over 5.6 million cases       

3.    Russia with over 1.6 million cases

Africa:

Data from the Africa Centers for Disease Control and Prevention shows the continent has over 1.8 million cases, more than 1.4 million recoveries and over 43,000 deaths. South Africa leads in the continent’s coronavirus dashboard with over 730,000 cases. It is followed by:

1.    Morocco with over 230,000 cases

2.    Egypt with over 108,000 cases

3.    Ethiopia with over 98,000 cases

Kenya                     

The first Covid-19 case in Kenya was confirmed on March 12. Since then, more than 600,000 people have been tested. Out of these, over 42,000 people have been confirmed positive. Over 31,000 people have recovered. Over 790 people have succumbed to the virus.

In September, data showed that positive cases averaged at between 300 and 150 and an average positivity rate of four per cent. The cases spiked October.

A study by the Kenya Medical Research Institute (Kemri) Wellcome Trust and the Health ministry suggested the country had reached its infection peak before the end of July. A total of 34 to 41 per cent of residents were infected by this stage.

This study, published in September in the journal MedRxiv, suggested that other parts of the country would reach their peak within two to three months from this peak. This suggests that these areas may see higher numbers up until December.

South Korea

South Korea is one of the countries closest to the epicenter of the Sars-Cov-2 that has been praised for the way it handled its coronavirus crisis. The country with over 51 million people reported its first case on January 20. Daily Covid-19 numbers remained relatively low. They started peaking in early February and reached a peak of 909 infections per day by February 29. From March 3, the daily infections started falling and remained below 600 per day. Within eight weeks the numbers had fallen to single digits. South Korea had officially flattened the coronavirus curve.

How did this happen?

Fast interventions:

·  One week after confirmed case: Government contracted medical companies to develop coronavirus test kits for mass production.

·  Two weeks after the confirmed case: The country produced more than 100,000 test kits daily.

Targeting and Testing

·  Shincheojin Church of Jesus was identified as a super spread and emergency measures were imposed.

·  With mass production of test kits, mass and targeted testing was launched.

·  By April 1, 300,000 tests had been conducted for a capita rate of more than 40 times that of the US.

·  By the end of April when the first wave of Covid-19 ended, the country had slightly over 24,000 cases and slightly over 425 deaths.

Second wave

In June, South Korea admitted that it was going through the second wave of the coronavirus.  Clusters of new positive cases emerged from nightclubs and the capital Seoul. Churches and political rallies were singled out as the main spreaders. This led to the banning of nightclubs, bars, rallies and church gatherings. In October, these restrictions were eased, and within 24 hours, 84 new cases were reported.

In measures aimed at stopping the second wave of infections, all arriving visitors in the country are required to take a two-week self-isolation period and a Covid-19 test within three days of arrival. Visitors arriving from risk countries such as Singapore, China, the UAE and Indonesia are now required to produce a Covid-19 negative test taken within 72 to 96 hours prior to their arrival. This negative test is followed up by a second test upon arrival.

New Zealand

New Zealand reported the first case of Covid-19 on February 28. By May 13, the country had 1,503 laboratory-confirmed cases and two probable cases. The majority of these cases were imported, with 55 being imported and 459 being import-related. “The transmissions were spread across the country. The highest incidents were in popular tourist areas while large transmission events such as weddings led to chains containing multiple age groups,” said a Lancet Public Health report on how New Zealand handled the pandemic.

Containment

In the first wave, the country embarked on rapid testing and case management. Between January and May, New Zealand tested 150,000 out of a population of five million people. Testing focused on people with symptoms, tracing and testing of both close and casual contacts. This reduced the time from onset of symptoms to notification from about 10 days to two days. “People isolated from the community faster at an average of about two-and-a-half days before the onset of illness,” the Lancet report said. New Zealand had one of the most stringent nationwide lockdowns in the world. The lockdown shut down all public venues and the majority of shops in the country. Only pharmacy shops and supermarkets were spared. This lockdown was instituted when positive cases crossed the 100 mark.

Second wave

New Zealand was the first country in the world to declare that it had managed and contained all cases of Covid-19. The declaration made in early August saw the country lift its coronavirus restrictions. 

But, in mid-August, New Zealand went back to lockdown. This was after several members of one family tested positive. The family had no history of travel. The second lockdown was eased in early October, at a time when New Zealand had a total of 1,861 confirmed cases, 1,799 recoveries cases and 25 deaths. According to the Lancet report, New Zealand’s ability to contain the virus was attributed to fast and strict lockdowns, swift testing and tracing, and clear communication from the political and health leadership.

Rwanda

Rwanda recorded the first case of Covid-19 two days after Kenya’s first case. By October 13, Rwanda was yet to open schools and bars, including bars inside hotels and restaurants.  Although the country has since resumed international travel, its borders are still closed except for returning citizens and residents and cargo. The country’s national parks can only be visited once a tourist presents a negative Covid-19 test. The country has also been running a night curfew from 10pm to 4am. Currently, Rwanda has slightly over 4,940 cases and 33 deaths. This represents a death rate of 0.3 per cent.

According to WHO, Rwanda was better prepared to cope with the coronavirus due to its past experience with the threat of the deadly Ebola disease. “The response was swift, well organised and effective,” said WHO’s epidemiologist in Rwanda Dr Vedaste Ndahindwa. In 2019, Rwanda shut down its entry points with the neighbouring Democratic Republic of Congo after the Ebola outbreak of 2018. In addition, Rwanda launched screening points and community awareness campaigns. The measures the country instituted to control Covid-19 were an advancement of those it had launched in 2019 to stop the Ebola threat from spilling into the country. “Rwanda did not start from zero. It only expanded capacity for the measures been instituted against Ebola,” said Dr Ndahindwa.

A virologist’s take on Kenya’s handling of the pandemic:         

Kenya got some things right and in other areas it could have done better. According to Dr Masika, this is what Kenya got right and wrong:

What Kenya got right

1.    Stopping all international flights: This helped reduce the number of incoming infected people. Kenya being a regional transport hub, the risk was bigger for it than for other countries in the region, except Ethiopia which has more air traffic (about twice the number of passengers that Kenya has per annum). Reducing incoming visitors reduced the seeding rate which slowed the onset of the outbreak.

2.    Social and physical distancing: This came in many forms – closing schools, locking down hotspots such as Nairobi and Mombasa, reducing the number of passengers in public transport vehicles.

3.    Mandatory use of masks: This reduced the risk of virus spread between people.

4.    Contact tracing and testing: There was a level of contact tracing and testing, which helped stop further spread of the virus.

What Kenya got wrong

1.    Communication: Initial communication from the Health ministry to the public was very slow.  

2.    Testing: Kenya could have tested far bigger numbers. Testing results from 600,000 people form a more useful dataset.

Kenya’s greatest strength

Collaboration: This is what has worked for Kenya. No single measure or player can be said to have single-handedly controlled Covid-19. There was a willingness and ability from the ministry to bring together a diversity of people to help control the virus. These have included medics, economists, social scientists, philanthropists, communication experts, IT experts, and the public.

The disparity in numbers

Inevitably, Kenya is reporting fewer cases than the actual numbers, but this is the case in any nation in the world, regardless of the level of testing. The remedy could be to test everyone as China has been doing, which Kenya cannot achieve.