Covid-19: Reopening likely to be gradual and segmented

Kenya, just like other African countries, cannot sustain a prolonged lockdown. As such, the government is contemplating opening the economy.

In a recent announcement, the World Health Organization (WHO) said Covid-19 may not be going away any time soon, meaning that people must learn to live with it.

The WHO also said for countries to reopen, there must have been no reported case of the disease or death for 14 days, suggesting “rapid finding, testing and isolation of cases” to prevent the spread.
However, in line with what other countries are doing, it is expected Kenya’s opening will be gradual and segmented.

A nationwide dusk-to-dawn curfew is still in place while Nairobi, Mombasa, Kilifi, Kwale and Mandera counties remain closed. There is also a localised closure of Eastleigh (Nairobi) and Old Town (Mombasa).

VULNERABLE GROUPS

According to experts, the government needs to put in place measures to ensure there is no spike of the virus if the economy is reopened.

For example, the government may need to adopt the ‘isolate and shield’ approach to protect the vulnerable groups, said Dr Mark Nanyingi, an infectious disease epidemiologist at the Institute of Global Health and Infection, University of Liverpool.

He said the hotspots need to be identified and buffered before the economy can be reopened.

“This is a concept where vulnerable people are shielded from infections without impacting their lives negatively,” Dr Nanyingi said.

According to him, the Ministry of Health needs to identify key risk factors such as underlying medical conditions among the population as well as age to be able to make informed decisions on how the partial lockdown will be lifted.

But the government needs to increase the number of people being tested daily so as to get the real picture of the disease and to know whether the curve is still rising or has reached the peak.

“If we look at how the disease has been evolving in other countries, there is a consistent pattern, which also depends on the measures that have been put in place,” said Dr Nanyingi.

He gave an example of Uganda, which seems to have arrested the situation by testing. By Monday, Uganda had 222 cases.

“If we test a high number as Uganda has been doing, we may be able to get more positive cases because the more we test, the more the cases. Testing is everything because we will be able to know where the cases are increasing,” the epidemiologist said.

“When the testing sample is representative and the positive cases are very few, then we can conclude that we are doing something,” he said.

TRACING MECHANISM

He added that borders need to be closed, considering the current situation in border counties such as Kajiado, Migori and Busia. Kajiado has 52 cases while Migori has 14 cases and Busia 12.

The government also needs to have a robust tracing mechanism and do massive public education on what to do and what not to do, experts have said.
The ministry rolled out targeted mass testing in Nairobi, where at least 3,000 people have been tested in the exercise expected to end on May 31. Unfortunately, tracing of some contacts has been hard because some people have been giving wrong information to healthcare workers.

Dr Lukoye Atwoli, associate professor of psychiatry at Moi University School of Medicine, said there are no magic bullets and only good old-fashioned public health measures will keep us as safe.

“Other than educational institutions and the entertainment sector, I haven’t seen serious enough restrictions to have the socio-economic effects that are being claimed,” argued Dr Atwoli.

According to Dr Thumbi Mwangi, an epidemiologist with the Institute of Tropical Infectious Diseases, University of Nairobi and Washington State University, if the government wants to reopen, it can go ahead but make sure that the health system is functional.

On Monday, the Health ministry said it had trained 11,000 healthcare workers and 60,000 community healthcare workers across the 47 counties.

Also, there are at least 20 testing laboratories, “strategically located in critical areas across the country,” said Health Chief Administrative Secretary Mercy Mwangangi.

“This has reduced the turnaround time from sample collection to receipt of results. Our plan is to have a testing facility in every county,” she said.

The ministry has received ventilators from USaid and established isolation and quarantine facilities in all 47 counties, with a bed capacity of over 5,000, said Dr Mwangangi.