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Nurses at the upgraded wing of Mbagathi hospital in Nairobi. [Elvis Ogina, Standard]
At the tail end of January 2020, a team of technocrats from the Ministry of Health presented an action plan to then Cabinet Secretary Sicily Kariuki for requisite measures to prevent introduction of imported cases of coronavirus into Kenya.

The plan, christened the National 2019 Novel Coronavirus Contingency (Readiness and Early Response) Plan, outlined several possible scenarios that could lead to Kenya reporting its first case of the virus as well as how to tame the scourge.

It is this plan and additional guidelines of the National Security Council, that Kenyans must now zealously root for to ward off the killer disease.

Priority one country

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“The ongoing outbreak has demonstrated the ability of the virus to spread across many continents quickly and the need for strategies and plans for prevention and preparedness for introduction of coronavirus by all countries globally including Kenya,” reads the introduction to the National 2019 Novel Coronavirus Contingency (Readiness and Early Response) Plan.

For the MoH technocrats, it was always a matter of when, not if, the virus got into the country and, crucially, what we must do to get ready for the almost certain eventuality and what the central government must provide, including financial assistance, to make this happen.

At the time, Kenya had already been identified by the World Health Organisation as a priority one country for preparedness of the coronavirus, meaning infection was probable.

On March 11, two and a half months after the presentation of the plan, Health Cabinet Secretary Mutahi Kagwe fielded questions from Parliament’s Health Committee.

“We are Kenyans and this is reality, this is what we are up against. Let’s be honest and let us not bury our heads in the ground like the proverbial ostrich. This is the real thing and this is what we are to grapple with and not just as a ministry but as a country. It is actually true that self-quarantine is what we have to do,” he told Parliament.

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Unknown to him, Kenya’s first person to test positive for the virus had by then been in the country for six days. Soon, the patient would be exhibiting symptoms. A scenario the technocrats had predicted in January was playing out already.

But no one was ready for what came next, and tellingly, resources requested, including manpower and monetary allocations, fell far short than what was needed to prevent an outbreak.

The Afya House team had come up with four different possible scenarios.

Scenario Three, from the Action Plan in our possession, envisions a situation when a coronavirus patient arrives into the country through one of the points of entry undetected, as happened on March 5.

“The case develops signs and symptoms of 2019-nCoV within the local community before seeking medical attention in a health facility. The case interacts with community members and frontline health workers before diagnosis is made,” predicts the Action Plan.

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The plan envisioned that in a scenario such as the one we are currently in, over 1,000 primary contacts would be identified and isolated.

Urgent need

“Fifty per cent (500) may develop the disease within 14 days, 20 per cent (100) progress to severe disease including pneumonia, respiratory failure and five per cent (25) of those who developed the disease die and are safely buried in the community,” the plan estimates. “Several contacts of contacts develop the disease and are isolated in the treatment centres.”

If this happens, then the national and county governments will initiate a response.

“There will be urgent need for more treatment centres, human resource and supplies including personal protective equipment (PPEs), body bags, disinfectants and community sensitisation and mobilisation teams. Approximately 2,000 to 6,000 contacts and contacts of contacts may need to be followed up over a period of three months.”

The technocrats looked at possible scenarios if this happened.

“There will be fear and panic in the community. There will be absenteeism among health care workers and some may threaten to stop work. Similar situations will be occurring across the other socio-economic sectors. Panic purchase of drugs for self-medication and food will increase, which may create shortage,” it states.

“Tourism industry may be affected. Some airlines may threaten to stop flying to Jomo Kenyatta International Airport (JKIA). Some neighbouring countries may contemplate closing their borders. The refugee communities will be demanding for stockpiles as well as health promotion activities. There will be conflicting reports from the media and wild rumors will be spreading creating more panic.”

It may then get worse before it gets better.

“Some communities may threaten health workers in observation and treatment centres. Voluntary migration from affected areas may be witnessed. External technical assistance and resources from outside may not be available immediately. National emergency is declared,” the action plan reads.

Confidential documents from the Ministry of Health show that following the confirmation of one case, it is estimated that between 400 and 600 2019-nCoV cases, 2,000 to 6,000 of their contacts and families may be affected.

The goal of the action plan was to promptly detect and effectively respond to any coronavirus outbreak to reduce morbidity and mortality in the country. The plan ought to have been operational as soon as we reported our first case.

But, through multiple interviews, Sunday Standard has established there were a few gaps between the plan and its actual operationalisation. First, the technocrats assumed our healthcare system is robust enough to deal with what was coming.

“The key assumption is that the identified pre-disaster structures, systems and capacities must be in place before the disaster phase,” it reads.

“The available capacity within the national and county governments, United Nations, the private sector, non-governmental organisations (NGOs), civil society organisations (CSOs) and National Disaster Operations Centre (NDOC) will be able to respond to the outbreak.”

Experts have raised serious concerns about Kenya’s capacity to handle a severe outbreak. Covid-19 is a respiratory illness and in its most serious stages can require patients who develop pneumonia to be put on a ventilator. But there might not be enough ventilators to meet that need if the outbreak becomes too widespread.

Plus, there is the little matter of patients being moved to ICU and HDU if they deteriorate. “Kenya has a capacity of around 200 ICU beds in both public and private hospitals,” Dr Ouma Oluga, the Kenya Medical Practitioners Pharmacists and Dentists’ Union (KMPDU) secretary general said.

A nationwide outbreak will severely stress these resources.

These shortages are however not unique to Kenya.

Free up space

The US, one of the worlds most advanced countries in terms of medical care, estimates that a full blown outbreak would leave the country short of more than half a million.

“US hospitals have about 45,000 beds in their intensive care units. In a moderate outbreak, about 200,000 patients may need to be put in the ICU, but under a more severe outbreak, it could be nearly three million,” the Huffington Post reported earlier in the week.

On Friday, American President Donald Trump announced a Sh5 trillion aid package to fight the virus. In their January proposal, Afya House technocrats presented a budget of some Sh823 million.

Some members of the emergency response team who spoke to Sunday Standard say they only knew of the release from Treasury of some Sh300 million for the response, almost half a billion shillings short of the needed funds.

Just under Sh60 million of this reached the Ministry of Health, the rest absorbed by the other ministries that are part of National Emergency Response Committee.

Meanwhile, on Thursday, Tourism and Wildlife CS Najib Balala announced that Treasury had set aside some Sh500 million to help “restore destination confidence to ensure Kenya remains a preferred travel destination globally”.

In the course of his presidency, President Kenyatta has confronted few national security challenges. Many of these were either terror related or natural disasters of different kinds. From landslides to floods to famines and collapsed buildings, all of which often had a single fix.

But now, Kenyatta faces one of the biggest challenges any Kenyan administration has had to face -- combating and controlling a global pandemic whose rate of spread, and demands on nations’ healthcare system and has brought even the most developed of nations nearly to their knees.

For the President and his government, the reporting of the first coronavirus case in the country has the potential to define his legacy. How his government responds, reacts and deals with the threat will be key to the future.

As government grapples with controlling the virus, people can help by staying home if they are feeling unwell. This, experts have said, will free up space in health facilities to deal with the cases that require hospital attention.

Covid 19 Time Series

 


Sicily Kariuki Coronavirus Mutahi Kagwe World Health Organisation
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