Navigating new Covid-19 wave in lockdown crisis

A steady level of Covid-19 infections in April and June, when the Ministry of Health routinely reported four-eight per cent positive cases, helped inform the government decision to reopen the economy gradually.

Following months of partial lockdown, mostly targeting Mombasa and Nairobi counties, and nationwide dusk-to-dawn curfew, President Uhuru Kenyatta announced phased reopening on July 6 that culminated in the partial reopening of schools on October 12.

A few weeks after this, the number of Covid-19 cases began to rise, consistently staying above 14 per cent from the third week of October. The second wave of the pandemic had arrived.

Second wave

Other regions of the world had started experiencing the second wave in early October, associated with the onset of colder autumn to winter seasons.

Europe and the US are particularly severely affected, with the number of positives rising more than two-times above levels reported during the first wave.

The trend of positive cases in the second wave in Kenya is likely to be similar to that being seen in Europe.  Cumulative global data from the World Health Organisation also shows a similar increase in cases but with a modest drop in the proportion of deaths from 2.8 per cent in the first wave to 2.5 per cent in the second.

In Kenya, the proportion of deaths has remained steady at 1.8 per cent in the first and second waves. This means that the number of hospitalisation and deaths in the second wave is likely to increase. There is a real risk that our health care system will soon be overwhelmed.

As one of the most resilient viruses to emerge in decades, Covid-19 will only stop being a global threat when we have a vaccine, or when it has spread to levels of herd immunity within the population.

Global restrictions

Therefore, the global restrictions imposed from the start of this pandemic were and remain intended to slow, but not stop, spread.  Let us keep this in mind as we review how long the second wave is likely to last, and what mitigation measure the government should take. How long will the second wave last?

The pandemic outlook over the next year is that it will come in waves until more than 60 per cent of our population has been infected or vaccinated, achieving herd immunity. Each subsequent wave is expected to be smaller and last shorter as the population with immunity increases.

Once a vaccine is available, likely in early to mid-2021, herd immunity will be achieved within months. Otherwise, we should, at this stage, exercise more personal responsibility and adapt to life with this virus, making social distancing, mask-wearing, and handwashing a trendy lifestyle in our daily activities. And there is probably no good reason for the government to re-impose a lockdown. Instead, we should continue to reopen the economy as planned, including school for all classes as soon as possible.

Lessons from countries like India that imposed complete lockdown during the first wave show that the number of infections grows rapidly once these restrictions are lifted. This is because this virus is here to stay for years to come. It will become a routine disease like common cold or flu.

An important question is how Kenya is doing in terms of community infections as we march towards herd immunity. There is an ongoing survey in Nairobi, conducted by the Health ministry and its partners to answer this question. Trained survey teams are visiting randomly selected households to collect blood and ask a few questions to determine what proportion of our people has been infected since the pandemic started in March. This information will help the government assess the measures it imposed in the first wave and inform the steps to take during this second wave.

The measures President Uhuru Kenyatta announced on November 4 were spot on. Tightening of curfew in hospitality venues, ban on large meetings, and stricter enforcement of social distancing, mask-wearing, and handwashing are perhaps all that is required.  At this stage, managing this pandemic as we work to restore the economic activities is the way to go.

From way back in March, the government has been quite impressive in managing this pandemic, implementing well-thought-out and data-driven measures that effectively controlled the spread of the virus.

The best evidence of how effective these measures were, is the rapid rise in the number of positive cases once these measures were relaxed.  Our biggest threat to managing the second wave is the emerging laxity among wananchi in practising the personal measures that limit spread.

All public places including churches, restaurants and bars, need to enforce health protocols. No mask, no service is a good call!

Njenga is a professor of infectious diseases at the Washington State University (based full-time in Kenya), and chief research officer at Kemri. Osoro is a medical epidemiologist at Washington State University (based full-time in Kenya)