By The International Center for Policy and Conflict
The Ministry of Health confirmed the first case of COVID-19 in Nairobi on March 12, 2020 following the outbreak of the disease in China in December 2019.
On April 6, 2020, President Uhuru Kenyatta ordered the first containment measures by restricting movement in and out of Nairobi, Mombasa, Kwale and Kilifi Counties and imposed a dusk-to-dawn curfew for all but essential service providers.
On Saturday, June 6, he announced that nationwide lockdown measures will remain in place until July 6, in an attempt to limit the spread of the Coronavirus .
Restrictions on road, rail, and air movements in and out of the Nairobi Metropolitan Area and Mombasa and Mandera Counties were also extended for 30 days.
On July 6, President Kenyatta lifted the inter-county movement restriction measures.
The efficacy of the restrictions has however, been dulled by the steep rise in the number of COVID-19 infections in recent weeks.
President Uhuru Kenyatta has convened a special Summit with the Council of Governors scheduled for Friday July 24, 2020 to review status of COVID-19 in the country.
The number of cases has been alarmingly rising steadily in last the two weeks. The partial lockdown was implemented to stop the spread of the pandemic until such time as alternative prevention strategies could be put in place and to ready health services.
Neither objective has been achieved. Not only did the partial lockdown not stop new infections, as has been achieved elsewhere, but testing and tracing at scale was not implemented as promised and the country’s health systems are in no position to cope with a widespread outbreak.
The number of positive coronavirus tests is rising, even though there is no disclosure of where the testing is happening.
The national government has managed the crisis poorly and thrown the containment and management of suppression and control of this crisis to county governments and Kenyans. This underpins the centrality of a devolved health system.
The statement by Education Secretary Prof George Magoha on the non-opening of schools this year is the first direct public admission of government failure in managing the pandemic.
Under the guise of opening the economy, the president lifted orders on cessation of movement in and out of Nairobi, Mandera and Mombasa.
It was an acknowledgment that the mini-lockdowns had failed as people were travelling across the country and causing a spike in infections.
After closing schools for three months, shutting down flights, closing bars and restaurants, reducing social contact to the absolute minimum, Coronavirus infections are marching on unfettered.
This confirms that these measures have not been used to isolate all the infections for treatment and management. The time gained by these measures was squandered because no community health interventions were activated.
Testing has not followed a discernible logical pattern after abandoning the testing of health workers and spot ‘mass testing’.
The fears that hospitals would be overwhelmed have been debunked after it emerged that over 70% of detected infections were asymptomatic and did not require hospitalization.
The failure to build or upgrade hospital facilities and establish testing capacities and capabilities in the counties means that, if infections exploded and sent old and vulnerable people into hospital admission, the carnage seen elsewhere will have docked in the country.
After careful scrutiny of how COVID-19 spreads, one can conclude that its spread is uneven within a country—it is not linear. A country might experience many ‘outbreaks’ across its territory spreading unevenly.
There has to coherent and synchronized data collection and analysis both at local and national levels to really understand what is going on.
To get the correct picture of what is happening i.e. increasing numbers; one has to correctly pool the data. So far there is sufficient body of knowledge and evidence on effective containment and management of COVID-19 response.
The response has four components namely, ramped up testing; efficient contact surveillance tracing systems; social distancing and hygiene and capacitated health systems and health workers.
Further, countries that have shown resilience in succeeding have demonstrated high degree of openness and transparency.
These countries used the cessation of movement in the ‘epicentres’ of coronavirus infection to: expand, train and deploy healthcare and public health workforce; implement a system to find every suspected case at community level; ramp up production capacity and availability of testing; identify, adapt and equip facilities to be used to treat and isolate patients; develop a clear plan and process to quarantine contacts and focus the whole government and resources on suppressing and controlling COVID-19.
Why these actions? Because aggressive measures to find, isolate, test, treat and trace are not only the best and fastest way out of extreme social and economic restrictions; they are also the best way to prevent them.
The required health system response to COVID-19 broadly falls into these two areas; prevention and treatment. The two are closely interlinked and there are severe shortcomings in both. On the prevention side, interventions include social distancing as well as rapid testing, contact tracing and quarantine.
These require massive upscaling to have a preventive effect. Prevention also involves public health interventions separating the infected from uninfected people.
For its part, treatment requires that health services address the needs of COVID-19 patients while at the same time protecting health service workers and non-COVID-19 patients.
Nevertheless, for this to happen there has to be rapid turnaround of test results. In the absence of this, all patients awaiting results need to be treated as potentially COVID-19 positive.
This in turn requires staff to have full personal protective equipment when treating all patients but the public sector facilities aren’t able to reliably provide personal protective equipment.
COVID-19 patients also need expensive hospital-based care together with steady supply of oxygen, ventilators as well as a variety of medications. It is unclear how testing and tracing infrastructure is to be expanded.
The biggest problem is that, there is limited money set aside to mitigate the effects of COVID-19 which is made worse by lack of transparency on how funds borrowed from development partners are being spent.
Curiously, nobody including government officials can give a proper account of how the money that has been borrowed so far has been spent.
This is a major omission that has caused less meaningful impact in containment of the spread of the virus. Consistent with this mishandling of the pandemic to date, there is no evidence of COVID-19 response strategy.
Any disease prevention can only succeed if resourced at sufficient scale to avoid the catastrophic demand for critical care services for which no preparation will be sufficient.
Kenya is fighting the Coronavirus more blindly than when the first infection was detected.