During his press briefing on Friday, Health Cabinet Secretary Mutahi Kagwe veered off script and stared straight into the cameras as he has been doing while addressing Covid-19 issues.
He had emerged from Afya House bearing some semblance of good news: There was no positive coronavirus test in 24 hours since his last briefing.
But the minister’s face conveyed none of these good news. In fact, the contours on his forehead deepened.
“The fact that we have not announced any additional cases today does not mean everything is okay,” he said.
Perhaps various data models were running in his mind, all of them painting a grim picture of what the future holds. In two weeks, the number of coronavirus patients rose from one to 38 -- a 3,700 per cent jump.
But this was not the scariest statistic in his mind. Neither is it the scariest number that is keeping members of the National Emergency Committee up at night. The thing that has thrown the government into panic is the future projections of the havoc that the virus can cause.
That though has forced the government to issue a raft of directives, including the recalling of medical staff on leave, the suspension of elective procedures in hospitals as well as hiring of new staff in anticipation of the grim possibilities that lie ahead.
The government’s cautiousness should scare you too.
An early study published by the New England Journal of Medicine on the early transmission dynamics of Covid-19 indicate that we are at the beginning of what might be a long journey that will test our healthcare system to its limits and possibly, as has happened in other countries, break it.
First, an understanding of the numbers.
According to the study, the epidemic doubles in size every 7.4 days. The study also says that the infection rate from these initial numbers would be 1:2.2, meaning that one positive test could lead to slightly over two other infections.
“We estimated a rate of infection of approximately 2.2, meaning that on average, each patient has been spreading infection to 2.2 other people. In general, an epidemic will increase as long as the rate of infection is greater than one,” the study reads.
Going by this data, and the fact that most of the reported infections reported were not clustered but were spread in and around Nairobi, Kilifi, Siaya and eventually Mombasa, the true numbers of the infected could be significantly higher.
Following her presentation to hospital, some 23 close contacts of Kenya’s Patient 1 were traced and isolated. Assuming that they already had symptoms and infected two individuals each, the number of possible infections could go up to 56. That is just from one patient.
Officially, the country has 38 positive coronavirus cases, meaning there is the possibility of 2128 infections, a projection that could have informed government’s decision to either quarantine, test or monitor some 1141 individuals as of yesterday.
In its coronavirus action plan done before Covid-19 was declared a pandemic by the World Health Organisation (WHO), the government described the above scenario as the “most likely” of the virus getting into the country.
“Over 1,000 primary contacts of the patient are identified and isolated. Fifty percent (500) 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 projects.
All these happen after the 14-day incubation period of the disease. Today, Kenya is on day 17. The statistics could start piling up.
But this is not the scariest statistic.
The same government action plan predicts a worst-case scenario as well.
“There are unexplained respiratory illnesses reported in a community. Some of the sick will report to the nearby health facilities. Health workers are alerted and there will be initial response. The Ministry of Health is called to investigate the outbreak and it is confirmed as coronavirus,” the action plan reads. “There is high person-to-person transmission in several communities in different counties.”
This worst-case scenario has played out in three separate occasions and locations. In Kilifi, the Deputy Governor Gideon Saburi inexplicably mingled with his constituents and other leaders, disregarding the national directive to quarantine.
That is not all about Kilifi. Yesterday, the town’s Diamond Trust Bank formally announced that its branch within the town is closed.
“Last week, one of our Kilifi branch staff was exposed to to a suspected Covid-19 case that has now been confirmed positive… all the affected staff who were in contact with the staff member were directed to go into isolation for a period of 14 days,” a statement from the bank read.
Interviews by Sunday Standard revealed that the staff, who works within the bank has had close contact with a local politician who tested positive for the disease. By the time we went to press, it was unclear whether the government had embarked on tracing all those who came in contact not just with the bank employee, but the local politician as well. The politician in this case is not the deputy governor.
Explosion of cases
The bank was closed last Wednesday immediately with the approval of Central Bank.
In Nairobi, an engineer returning from South Africa was hospitalised at Aga Khan University Hospital after presenting symptoms that at first were unrelated to coronavirus. However, as his condition deteriorated, tests and further probing showed that he had contracted the virus. Health workers who handled him for the nine days he was in hospital were all exposed to the virus. Repeatedly.
On Friday, CS Kagwe said that 14 medical professionals from the hospital were under quarantine. Based on the Wuhan study, this could mean that up to 30 other people could be infected as a result of interacting with the medical personnel. This number excludes those who interacted with the patient outside the confines of hospital.
The third scenario played out in Siaya County where a Catholic priest, Father Francis Oduor, who was from an overseas trip mingled with mourners at a funeral in Ugunja and visited other priests before travelling to Nairobi on public transport.
Data from the Ministry of Health shows that Kilifi’s Deputy Governor had some 122 close contacts, all of whom were traced by government.
If half of these, according to estimates from the government’s action plan turn positive, we could be talking of an additional 51 cases, each with the possibility of spreading the disease to two more people.
The numbers could be worse in Siaya where the priest had close contact with 138 people, where 69 people could already have transmitted the virus to a further 151 individuals.
The outcome of such spectacular spread is clear.
“The system will be overwhelmed. There will be a very high number of contacts who will be dispersed across several communities and counties,” the government action plan reads, before concluding: “A national disaster will then be declared.”
Other countries have already walked the path that Kenya is currently on. Recording near manageable numbers in the first three weeks before an explosion in the number of confirmed positive cases which, depending on medical response, might also mean more deaths.
Health facilities under duress in Italy has seen the country’s death toll rise to 9,100, of which 900 were recorded on Thursday.
Lack of beds and personnel shortages are fueling the pandemic. These same reasons have seen Spain’s death toll hit 5,100.
As a response to an anticipated spike in numbers, the United Kingdom has freed up 33,000 beds across the country and is putting up three new temporary hospitals.
Analysis suggests the rate of infection in the UK has been doubling every three to four days. But even this, critics say, may not be enough when the numbers of the critically sick start to peak.
But outside the gloom, Kenyans, like many people in African countries, have the chance to stay ahead of the curve by simply staying home to cushion the already burdened healthcare system and by extension, save lives.
Yesterday, CS Kagwe brought the numbers home when he said that a total of 1141 close contacts of the individuals who tested positive were being monitored.
“The over 1,000 contacts we are talking about are also going to be with another 1,000 contacts elsewhere…if we want to save Kenyans we must do what those who have succeeded in addressing the disease have done. Otherwise, extremely dark times are ahead.
“Let us avoid a total and complete breakout of this disease,” the CS implored.