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A full-blown epidemic could kill over 800,000, says study

By Daniel Wesangula | April 14th 2020

Medics attend to a Covid-19 mock patient at Aga Khan University Hospital, Nairobi during a drill conducted to test the hospitals preparedness to respond to Covid-19 mass patient influx.

Between 800,000 and 2 million Kenyans could die from the novel coronavirus should the country get into a full-blown epidemic, a new study by scientists from Amref Health Africa says. 

According to the study released on Good Friday, most of the victims will be those aged above 65 as well as individuals suffering from chronic diseases such as diabetes, hypertension, respiratory disorders, cancer and HIV/Aids.

The projections take into consideration studies already done on the disease that shows the effects of the virus on the aged, individuals with underlying health conditions as well as its effect on different sexes.

Key to these statistics are the estimated number of Kenyans living with underlying health conditions such as heart ailments, hypertension, diabetes, HIV/Aids as well as malnutrition. These might combine with devastating effect to push the death rates to the millions should the disease get to a full-blown crisis such as is currently being experienced in Italy, Europe, the UK as well as the US.

Worst hit

Global trends show that even with the best healthcare systems in the world, 50 per cent of those with severe Covid-19 disease die. Studies conducted in China, Italy and Spain, some of the worst hit countries, show the possibility of death from the disease increases with age, especially after 65 years.

Other than age, the sex of a person also matters since while both men and women can get infected, men tend to have worse disease outcomes. In some places, the proportion of men to women dying from the disease has been found to be 70 per cent.

Kenya, like the rest of the developing world, has a few health peculiarities that may make the pandemic worse. A large part of the population already has underlying chronic illnesses, like heart ailments, hypertension and diabetes, that can make the fatality rate of the Covid-19 even worse.

“The common thread in these diseases that could be predisposing to severe Covid-19 disease is that they compromise organ functioning,” a recent WHO study says.

In a country burdened by all these diseases, the fatality rate of Covid-19 can be devastating. The study, authored by Prof Joachim Osur and peer reviewed internally by Amref scientists, shows that even in a best case scenario, projections for the loss of life are staggering.

If severe diseases only happen in 60 per cent of people above 65 years, who are diabetic, hypertensive, with chronic obstructive airway disease and those suffering from cancer, deaths could be in hundreds of thousands

Data from the last census puts our population at 47,564,296 with those who are 65 years and above making up 3.08 per cent of the population. This translates to some 1,464,980 individuals. Assuming the infection rate of 60 per cent, which is what has been experienced in most populations, it is expected that people over 65 years old who will be infected in a full-blown epidemic will be 0.6 x 1,464,980 = 878,988.

The International Diabetes Federation estimates that 3 per cent of Kenyans have diabetes. The total number of diabetics, those who are aware and those who are not, based on the census results translates to 1,464,980 people.

Again, assuming an infection rate of 60 per cent, the total number of diabetics affected would be 878,988. As far as cancer is concerned, Kenya gets 47,887 new cases yearly and has a prevalence of 86,596. Of these, the Kenya Network of Cancer Organisation estimates that 40 per cent occur in people over 70 years old.

Just like with the other diseases, assuming an infection rate of 60 per cent among cancer patients, the number likely to be affected will be 51,957.

Then there is hypertension, commonly referred to as the silent killer. Last year, the Ministry of Health estimated that 25 per cent of Kenyans could be living with the condition. Only 1 in 6 of the estimated cased have, however, been diagnosed.

Hence, total number of diagnosed hypertensives in Kenya are only one sixth of 25 per cent of the population. This translates to 1,981,845, an infection rate of 60 per cent translates to 1,189,107 people.

Then there is the little matter of the quality of air in our cities that has made it worse for people living with chronic respiratory diseases. Although the number of people in Kenya living with respiratory diseases is not well documented, WHO estimates that it could be as high as seven per cent of the entire population, or in Kenya’s case, 3,329,500 people. A 60 per cent infection rate will mean that 1,997,700 people might contract the disease.

Thus in a full-blown epidemic, a total number of 4,996,740 people could be infected with the disease; a figure that combines the totals of the aged population, known diabetics, those battling cancer, those with hypertension and individuals with respiratory disorders. All these will present severe forms of Covid-19 in a full-blown epidemic.

It is, however, possible that more than one of the determinants of disease severity exist in one person. A person could be over 65 years old diabetic and as well as hypertensive; then the number of people likely to suffer severe disease would be reduced to a fraction of the global figure of 4,996,740. This brings down the number to some 1,665,580 people at risk of severe Covid-19.

With this projection, and still on the assumption of a 50 per cent death rate of those showing symptoms will become severe, the best case scenario for deaths for Kenya would be 1,665,580 x 0.5 = 832,790. This would be a case fatality rate of 2.9 per cent, assuming a 60 per cent infection rate in the population.

Then there is the worst case scenario where complication brought about by the country’s HIV infections as well as malnutrition could add on to the statistics.

“The worst case scenario would be that HIV and malnutrition complicate the situation further adding an additional 2,907,890 people to those over 65 years of age bringing the total number of those at risk of severe disease to some 4,573,470 people,” he says.

Again, working with a case fatality rate of 50 per cent, this will result in some 2,286,735 deaths countrywide.

Speaking to The Standard, Prof Osur, however, said that the number of deaths also depend on how many people get sick at the same time.

“If too many people get sick at once, the health care system gets overwhelmed. This is when deaths rise dramatically,” he says.

Current statistics, however, do not tally with the gloomy study that was released on Good Friday. To date, Kenya has recorded 208 cases and nine deaths.

Detected posthumously

Osur says there might be an explanation for this.

“First, we are not testing enough people to know at which stage of the pandemic we are currently in. Only numbers will tell us how far we are from a full-blown pandemic,” he says.

“But there have been some signs. We have had Covid-19 cases detected posthumously. This shows the numbers could be much higher than we are currently aware of.”

The study, titled The Number of Kenyans Likely to Suffer Severe Illness and Death Should Kenya Experience a Full Blown Covid-19 Outbreak, makes a few key assumptions.

The first is that severe disease will only happen in people with risk factors, while in reality severe disease has been seen even in people without risks.

“Further, the calculations assume that only a maximum of 60 per cent of people in any segment of population gets infected. This has been noted in the West and may not apply in Africa,” Osur says.

The other assumption is that the Kenyan healthcare system will handle the disease in the same way it is handled in western countries and limit deaths to 50 per cent of those with severe disease.

The study recommends that the Ministry of Health continues to institute radical measures to control the spread of the infection.

“Slowing down the rate of infection will help the health system cope better with patient influx and post better survival rates,” says Osur.

Covid 19 Time Series


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