Covid curve: Danger in the good news

A decision to reopen the economy, prompted by falling national daily new cases and positivity rate, might complicate the fight against Covid-19 in many counties that are seeing a sharp growth in caseload, according to a Nation Newsplex analysis of available Ministry of Health Covid-19 data.

Eighteen, or two-fifths, of the 47 counties reported at least a 50 per cent rise in Covid-19 caseload between August 18 and September 16, with six seeing their numbers more than double. Embu County had the highest jump of 326 per cent from 31 to 132, followed by Taita Taveta (164 per cent), Turkana (159 per cent), Kisii (138 per cent), Kitui (132 per cent) and Trans Nzoia (109 per cent).

Queerly high figures

Many of these emerging counties, with high rates of growth in numbers, have been registering just a few cases, but on a more regular basis than before. There are, however, days when they have reported queerly high figures. For instance, on September 8, Kitui posted 54 new cases, more than double Nairobi’s 23.

However, the 2,810 cases from the 18 counties constitute only a tiny share (eight per cent) of the 36,393 Covid-19 cases reported nationally (by September 16) rendering the counties’ virus infection trends insignificant in the national picture that is largely shaped by hotspot counties. Relatively low growth rates in Nairobi (11 per cent), Mombasa (18 per cent) and Kiambu (21 per cent) in the 30 days have translated to a corresponding low national growth rate of 19 per cent that obscures the late take-off in many counties that had reported just a few or no cases until recently.

On Monday, the Ministry of Health warned that the risk of coronavirus infection in Mombasa and Turkana had risen as there seemed to be a surge of Covid-19 cases in the regions.

After confirming few infections for weeks, Mombasa, for instance, recorded 101 cases in four days, prompting the ministry to deploy a team of experts to investigate the developments in the two counties.

Mombasa and Turkana counties, that were on a downward trend, have begun to shoot up in Covid-19 positive cases. "While this might seem like a surge, we have set up a team to find out why that is happening,” Health CAS Mercy Mwangangi said on Monday.

Nationally, weekly test positivity rate has dropped by  more than a half, from 13 to five per cent, in the past two months. Positivity rate, which is the number of tests that give positive results as a share of the number of tests conducted, is a more accurate metric for determining the extent of the spread of infections than observing absolute numbers of positive cases. The Ministry of Health does not announce or publish county positivity rates or a breakdowns of number of tests.

Lifting restrictions

Since the World Health Organization guidelines on lifting of restrictions speak mainly to national trends, a sustained low positivity rate and low number of new infections nationally might open the way for a relaxation of many restrictions that have been put in place since March to slow down the spread of the virus and allow the national and county governments to prepare. This might be in disregard of the low but fast-growing number of Covid-19 cases in parts of the country as well as a lack of preparedness to tackle the pandemic by some counties.

Only seven counties have a minimum of 300 isolation beds as directed by President Uhuru Kenyatta on July 6, according to a technical report prepared by the Ministry of Health in August. Nairobi leads with 1,085, followed by Mombasa (404) and Machakos (371). Kirinyaga County has none while the total number of isolation beds in the country is 7,411 (data from 45 counties) against a target of 30,500. Some 17 counties do not have an ICU bed and only 12 have 10 beds or more.

Talk is already rife among health experts and government officials of the need to be prepared for the second wave of the pandemic as the country is currently being seen to be sliding past the first wave of the pandemic. However, there has been little discussion or exploration of the possibility of a significant part of the country getting past the first wave of the pandemic much later than the hot spot counties.

An accurate state of the country with regard to the spread of Covid-19 can only be guaranteed by sufficient testing capacity. Currently Kenya conducts 14 tests for every positive case and the country had done 9,349 tests per million people by September 16. The World Health Organization recommends that a country should consistently record a test positivity rate of five per cent and a decline in new deaths and cases for 14 days before re-opening. But the standard should be applied in a country or region where there is mass testing. Kenya does targeted testing, with the number of tests conducted per day having declined drastically due to what the ministry says is a difficulty in accessing reagents in the global market. The overall test positivity rate is about seven per cent.

With 20,112 recorded infections, Nairobi accounts for over half of the cases (55 per cent) as at September 17. It is followed by Mombasa with 2,700 and Kiambu with 2,622.

Nairobi and Mombasa counties have the highest attack rates of Covid-19 at 458 and 223 per 100,000 people, respectively, compared to the national average of 77. Kajiado ranks third with 172 cases per 100,000 people. Busia with (132) and Kiambu (108) round off the top five.

Nine in 10 cases are asymptomatic and 98 per cent of the 36,576 infections, were local transmissions.

New infections and deaths peaked seven weeks ago and, currently, there are 12, 317 active cases. Two in three people who contracted the virus have recovered.

Men make two-thirds of the people who have contracted the virus and three in four of those who have died from it. In total, the country had recorded 647 deaths by September 17, of which more than half were linked to co-morbidities, especially diabetes and high blood pressure.

The case death rate in the past month ranged from 1.6 per cent to 1.8 per cent, which is much lower than the Africa average of 2.4 per cent and global average of 3.1 per cent. When population is considered, Kenya is ranked 25th out of 55 African countries, with 12 deaths per million people.