Sunday marked 50 days since the World Health Organization received the first confirmation of a case of Covid-19 in Kenya. So far the country has confirmed 374 cases, and 14 deaths. The government’s approach to contain the virus is a testing and tracing regime that has so far tested 24,784 samples. Furthermore, the government has done a partial lock-down, ordering a dusk to dawn curfew, closure of facilities that work with large gatherings, and an embargo on travel to/from hotspot towns, including Nairobi, and Mombasa. So, because of Kenya’s pre-existing conditions; dense population, tuberculosis, HIV, poor healthcare resources, we knew that we could be really affected. But 50 days in, I am tempted to think that the virus is not as infectious here as it has shown elsewhere.
I found four countries with similar populations to Kenya. After 50 days, on April 24, South Africa had confirmed a total of 3953 cases. South Korea had 7513 cases by March 10. Italy, one of the hardest hit countries, had 9172 cases on 9 March. Colombia had 4561 cases. It seems after 50 days, these countries had at least ten times the cases we have.
So then, has the virus peaked in Kenya? From the daily cases, I don’t notice see a trend yet. Its not possible to tell if cases have peaked. At this point, with the available data, it seems easier to say that the disease is not as dangerous in Kenya. We are not seeing a significant spike in cases. At this stage there are no reports of rising demand in hospitals nor alerts from communities. So, it may seem okay to say the virus is not as dangerous in Kenya, and/or there is some success with the current control protocols.
Nonetheless, last week the government announced news that indicates that is is probably wrong to think the disease is somehow less infectious in Kenya. The first thing is that 70 percent of cases they identified so far are asymptomatic. Secondly, last Saturday, 7 people at Kawangware testing exercise (so called mass testing) were found positive. The 7 were volunteers — random positives not found by government surveillance, but in the population, albeit in a hotpsot location. Asymptomatic cases, a common feature of COVID-19, are hard to identify because they do not present with sickness. They were probably behaving normally in their communities and families. There is likely more asymptomatic people in the population. Some cases, 82 percent of total active cases, based on Worldometers, present with mild symptoms. In an environment where much of the population can not access testing, mild symptoms can be confused with colds and allergies. Such people could also be behaving normally in their families and communities. The WHO has determined a reproduction rate of 2–2.5 for the virus so far, so one person, symptomatic, mild, or asymptomatic can infect between 2 and 3 others. In this case, there is a likelihood that current testing is not uncovering the extent of the novel coronavirus in Kenya.
There’s a race for testing supplies across the world now, obviously. That explains why it is hard for the poorest countries in the world to expand testing. Not only that, the poorest countries do not have substantial medical resources to handle this pandemic. Such countries, Kenya included, are likely going to lag behind in testing throughout. With testing touted as the key to easing lock-downs before a vaccine, Kenya is probably going to be among the last to relax lock-downs. Without adequate testing, we shall not be able to reliably understand the situation in our communities.
The virus is prevalent in our communities at a magnitude we can’t surely know, spreading at a speed we can’t reliably track. In such situation, we can’t be sure that social distancing is enough to protect the most vulnerable. These are elderly and sickly people in low-income communities in Nairobi and Mombasa. A part of the strategy could be for government people to go into communities to identify such people for testing and isolation. Access to healthcare for people in low-income communities is low already. Its not in our habit to seek healthcare for cold-like symptoms. Therefore, government should be proactive about safeguarding the most vulnerable from this disease. For instance, community healthcare workers can follow up on the situations of such vulnerable people embedded in their communities. Government can request to place vulnerable people in safe zones, perhaps hospitalize the sick, without cost. Socio-economic protections are also a key idea in during this time. If government is not sure that the elderly and sick are getting benefits, another idea is to try to find them where they are and provide the support and protections.
While I wanted to investigate for myself if its time to be optimistic about Kenya’s situation, I realize not. We simply don’t know enough. If its possible to expand testing above today’s rate, government should be aiming for that. They should be testing as many as possible. With more tests can the government reliably justify decisions such as opening schools and restaurants. But also, as long as testing can’t cover everyone, there is danger that can’t be quantified. A dynamic plan to protect the vulnerable should be a key part of the strategy until there is a vaccine. Social distancing is one such plan. But is it enough? Without complete lock-down, the communities remain dangerous to the elderly and sickly. Even with the low confirmed cases, a high case/fatality ratio is emerging in African countries. Five percent of all cases have died in Kenya, and these just from those who have been identified. With the situation difficult to assess, the true impact of COVID-19 may be under the radar.