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The low numbers that point to a deep problem in Covid-19 testing

By Dr Mercy Korir and Daniel Wesangula | May 17th 2020 at 00:00:00 GMT +0300

Rose Wangari being tested for Covid-19 using a special oral swab inserted inside her mouth at Beafra Medical Center in Eastleigh South. [David Gichuru/Standard]

The Ministry of Health has fallen critically short of the estimated number of Covid-19 tests it hoped to have done by now.

Initially, officials from the ministry had said that by this time, some 66 days after the announcement of the first case, the country will have conducted close to 250,000, a number it ought to have hit by end of June.

Current data shows that we are nowhere near this figure, and that it will be impossible for the nation’s testing agencies to get anywhere near this number. As at yesterday, under 38,000 tests had been conducted, just 15 per cent of the target.

The slow testing numbers point to a deeper problem. An ill prepared government. A lethargic procurement process mired with interests from various quarters. A country whose entire public health system heavily relies on donor aid.

When push came to shove on March 13 when we recorded the first Covid-19 case, the country simply buckled, and has not got itself up since.

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These, coupled by the uncertainty that follows the testing period - what happens? Where do you go? What happens to your family? - and the militarization of the Government’s response as well as the hanging burden of meeting quarantine costs individually have all combined to slow down the possibilities of the country emerging from the pandemic any time soon.

Initially, when the virus was confined to China and East Asia, Kenya was relying on South Africa for test results for suspected cases. This process took between 24hrs-72hrs due to the logistics involved in shipping samples via air to a laboratory in South Africa.

But as this happened, the ministry ought not to have been working blind. At the time under CS Sicily Kariuki, public health worked under the guidance of the Coronavirus Contingency Plan, a blueprint of response that had been ready by January. At the time, it seemed Kenya was on the right track and everything needed for response, including the crucial testing infrastructure, was all in place.

On March 6, when the rapid spread of the pandemic became apparent, Cabinet Secretary Mutahi Kagwe, in one of his first acts as minister, again reassured Kenyans that the country had capacity to test for the virus.

Twenty four hours before his announcement though, the virus had landed within our borders, and the authourities were not aware of this until a week later when the country’s Patient 1, Brenda Ivy, presented herself at Mbagathi Hospital.

“Kenyans will live normally, there is no cause for alarm, but there will be some inconveniences,” Kagwe said on Friday March 13, announcing a raft of measures that have now become a new normal.

No specific mention was made in regards to testing for the virus, a step that the WHO through its Director General Tedros Adhanom Ghebreyesus, had indicated as being the key to containing its spread.

“The most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate. So I have a simple message for all countries – Test, Test, Test,” Dr Ghebreyesus said at a WHO press briefing, three days after Kenya announced its first case.

“You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”

At the time, Kenya was relying on very few diagnostic test kits from WHO and the Africa Centre for Disease Control.

By March 17, Kagwe announced that between the Kenya Medical Research Institute (Kemri) and the National Influenza Centre (NIC), 111 tests had been carried out since the surveillance and preparedness for Covid-19 by the Ministry began early in the year.

Soon after this, travel bans from countries with a high number of confirmed cases were introduced, only citizens and foreigners with valid resident permits were allowed in on condition of self-quarantine.

This, however, quickly changed when on March 23, Kenyans coming in to the country would be placed on government mandated mandatory quarantine at their own cost, an exercise which ultimately contributed in an increase of the number of confirmed cases.

Documents seen by Sunday Standard show that as at March 26, when the Ministry was preparing to do mandatory testing of everyone in quarantine, the Kenya Medical Supplies Authority (Kemsa) had a total of 6,000 lab sample collection kits and lab test kits.

These were distributed to the NIC (1,500), Kemri headquarters (2,100), Kemri Alupe (600), Kemri Kisumu (900), Kemri Kericho (900) and Kemri Kilifi (600) to facilitate the ‘mass testing for persons under mandatory quarantine, who had arrived in the country by March 25, in line with WHO testing guidelines’ as later announced by Kagwe on his March 28 daily briefing.  

The testing was to begin on March 29. 

By then some 833 people had been tested. Kenya was doing an average of 52 tests a day.

Testing for Covid-19 continued at a snail’s pace, with many complaints arising especially from persons in mandatory quarantine citing that they had to tune in to their TV sets like everyone else to find out who had turned positive or not.

One of the most prominent Covid-19 cases, Kilifi Deputy Governor Gideon Saburi, is on record, claiming that he never received any results that showed he tested positive for the virus.

“They just told us to assume that if the Ministry officials had not gotten in touch personally, one should assume that they are negative,” narrated a suspected case quarantined at Nairobi’s Pride Inn Azure hotel.

Danson Macharia, who was asymptomatic the entire time he was in quarantine and isolation, was hard pressed to believe that he had turned out positive because there was no written communication notifying him of the same.

“Sometimes, I wonder if that is my result at all because as you can see, I have no symptoms and I have never had any,” Dr Macharia said while in isolation at The Nairobi Hospital.

Nonetheless, the Ministry of Health continued with its promise to do mass testing, despite the daily number of people and tests actually done being far from “mass”.

But this was soon to change. Or so it seemed.

On April 17, the Government received what it termed as the “key to Kenya's ability to mass-test the public”. A consignment of 200,000 testing and sampling tubes from China, arriving at the Jomo Kenyatta International Airport (JKIA) aboard a Kenya Airways Dreamliner.  

Five days later on April 22, Kagwe, while declaring that they had a target of 250,000 tests by end of June, indicated that they had deployed 25,000 testing kits for this activity.

He further explained that short falls of testing seen in the country was “because of global supply chain challenges” but they intended to achieve the 250,000 tests by doing 100,000 community tests in 20 hospitals in 16 regions in addition to population based surveillance.

But as these lofty promises were being made, something else was shaping the country’s response. The novel coronavirus had become a budget line in the country’s official books of account. Billions were earmarked for the response. Donors came forth with monetary support. The World Bank offered easy access to loans. These billions brought forth another challenge.

How much has been spent on testing?

The exact number of testing kits purchased by the Ministry of Health remains unclear since the number of cumulative tests carried out indicate that the country is till well within the usage of donated test kits.

The Jack Ma and Alibaba Foundations did three rounds of donations to African countries. In the first round, Ethiopian Airlines helped distribute the equipment, consisting 20,000 laboratory diagnostic test kits, 100,000 medical masks, and 1,000 protective suits and face shields, to each of the African Union Member States.

On April 6, an announcement of the second round of additional medical supplies to all 54 countries of Africa was made.

These included 500 ventilators, 200,000 sets of protective clothing and face shields, 2,000 thermometers, one million swabs and extraction kits, and 500,000 gloves.

In round three, according to the African Union, the donation included 4.6 million masks, 500,000 swabs and test kits, 300 ventilators, 200,000 sets of protective clothing, 200,000 face shields, 2,000 temperature guns, 100 body temperature scanners, and 500,000 pairs of gloves.

From these, if equally distributed, in donations Kenya should have received 29,000 laboratory diagnostic kits, 27,000 swabs and 18,000 extraction kits. Added to the 6,000 diagnostic and sample collection kits in Kemsa’s possession and 200,000 testing and sampling tubes from China, testing ought to have been seamless by end of April.

Africa CDC and WHO also made varying donations of diagnostic kits to the country to boost its testing capacity shortly after the first case of the coronavirus was announced by the Ministry of Health. 

Lab Testing Budget

Back to the money. Specifically, a Sh5.3 billion World Bank loan. Of this, some Sh847,251,900 was meant to improve the availability of supplies and equipment needed to respond to Covid-19, other public health emergencies and strengthen the capacity of the MoH to provide timely medical diagnosis for coronavirus patients.

On May 5, Susan Mochache,the Principal Secretary of Health, indicated that equipment and supplies would be purchased through Kemsa and Unicef, utilising Sh1 billion of the World Bank loan.

Some Sh330,375,795 would go towards lab reagents and sample collection kits while Sh196,924,208 would purchase Roche Test Kits, making a total of 526 million shillings towards testing.

One Covid-19 Roche test Kit as budgeted by the Ministry would cost Sh2,500. Some Sh196 million would buy at least 78,000 kits.

A pack of 100 Nasopharyngeal swabs (without media) would cost Sh10,000 per pack.

From its initial budget as at March 30, laboratory needs had been covered, with only a financial gap of Sh1.9 million remaining, the least of all the areas which included human resource, PPE, isolation, quarantine, critical care, operations and logistics.

If this has been done, then the number of tests ought to be much closer to the 250,000 mark at the end of next month.

Globally, Covid-19 testing has been mired in some controversy, with dozens of countries terming test kits imported from China as being faulty. Late last month, India cancelled an order for around half a million rapid testing kits from China, claiming they found them to be faulty.

Closer home, Tanzania’s President John Pombe Magufuli dismissed imported coronavirus testing kits as faulty, claiming they returned positive results on samples taken from a goat and a pawpaw.

Kenya’s testing almost entirely depends on donated test kits from China. The Ministry of Health has steered clear over the ongoing allegations of faulty kits.

Simple message for all countries – Test, Test, Test,” Dr Ghebreyesus said at a WHO press briefing, three days after Kenya announced its first case.

“You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”

At the time, Kenya was relying on very few diagnostic test kits from WHO and the Africa Centre for Disease Control.

By March 17, Kagwe announced that between the Kenya Medical Research Institute (Kemri) and the National Influenza Centre (NIC), 111 tests had been carried out since the surveillance and preparedness for Covid-19 by the Ministry began early in the year.

Soon after this, travel bans from countries with a high number of confirmed cases were introduced, only citizens and foreigners with valid resident permits were allowed in on condition of self-quarantine.

Snail’s pace

This, however, quickly changed when on March 23, Kenyans coming in to the country would be placed on government mandated mandatory quarantine at their own cost, an exercise which ultimately contributed in an increase of the number of confirmed cases.

Documents seen by Sunday Standard show that as at March 26, when the Ministry was preparing to do mandatory testing of everyone in quarantine, the Kenya Medical Supplies Authority (Kemsa) had a total of 6,000 lab sample collection kits and lab test kits.

These were distributed to the NIC (1,500), Kemri headquarters (2,100), Kemri Alupe (600), Kemri Kisumu (900), Kemri Kericho (900) and Kemri Kilifi (600) to facilitate the ‘mass testing for persons under mandatory quarantine, who had arrived in the country by March 25, in line with WHO testing guidelines’ as later announced by Kagwe on his March 28 daily briefing.  

The testing was to begin on March 29. 

By then some 833 people had been tested. Kenya was doing an average of 52 tests a day.

Testing for Covid-19 continued at a snail’s pace, with many complaints arising especially from persons in mandatory quarantine citing that they had to tune in to their TV sets like everyone else to find out who had turned positive or not.

One of the most prominent Covid-19 cases, Kilifi Deputy Governor Gideon Saburi, is on record, claiming that he never received any results that showed he tested positive for the virus.

“They just told us to assume that if the Ministry officials had not gotten in touch personally, one should assume that they are negative,” narrated a suspected case quarantined at Nairobi’s Pride Inn Azure hotel.

Danson Macharia, who was asymptomatic the entire time he was in quarantine and isolation, was hard pressed to believe that he had turned out positive because there was no written communication notifying him of the same.

“Sometimes, I wonder if that is my result at all because as you can see, I have no symptoms and I have never had any,” Dr Macharia said while in isolation at The Nairobi Hospital.

Nonetheless, the Ministry of Health continued with its promise to do mass testing, despite the daily number of people and tests actually done being far from “mass”.

But this was soon to change. Or so it seemed.

On April 17, the Government received what it termed as the “key to Kenya’s ability to mass-test the public”. A consignment of 200,000 testing and sampling tubes from China, arriving at the Jomo Kenyatta International Airport (JKIA) aboard a Kenya Airways Dreamliner.  

Five days later on April 22, Kagwe, while declaring that they had a target of 250,000 tests by end of June, indicated that they had deployed 25,000 testing kits for this activity.

He further explained that short falls of testing seen in the country was “because of global supply chain challenges” but they intended to achieve the 250,000 tests by doing 100,000 community tests in 20 hospitals in 16 regions in addition to population based surveillance.

But as these lofty promises were being made, something else was shaping the country’s response. The novel coronavirus had become a budget line in the country’s official books of account. Billions were earmarked for the response. Donors came forth with monetary support. The World Bank offered easy access to loans. These billions brought forth another challenge.

So how much has been spent on testing?

The exact number of testing kits purchased by the Ministry of Health remains unclear since the number of cumulative tests carried out indicate that the country is till well within the usage of donated test kits.

The Jack Ma and Alibaba Foundations did three rounds of donations to African countries. In the first round, Ethiopian Airlines helped distribute the equipment, consisting 20,000 laboratory diagnostic test kits, 100,000 medical masks, and 1,000 protective suits and face shields, to each of the African Union Member States.

On April 6, an announcement of the second round of additional medical supplies to all 54 countries of Africa was made.

These included 500 ventilators, 200,000 sets of protective clothing and face shields, 2,000 thermometers, one million swabs and extraction kits, and 500,000 gloves.

In round three, according to the African Union, the donation included 4.6 million masks, 500,000 swabs and test kits, 300 ventilators, 200,000 sets of protective clothing, 200,000 face shields, 2,000 temperature guns, 100 body temperature scanners, and 500,000 pairs of gloves.

Testing budget

From these, if equally distributed, in donations Kenya should have received 29,000 laboratory diagnostic kits, 27,000 swabs and 18,000 extraction kits. Added to the 6,000 diagnostic and sample collection kits in Kemsa’s possession and 200,000 testing and sampling tubes from China, testing ought to have been seamless by end of April.

Africa CDC and WHO also made varying donations of diagnostic kits to the country to boost its testing capacity shortly after the first case of the coronavirus was announced by the Ministry of Health. 

Back to the money. Specifically, a Sh5.3 billion World Bank loan. Of this, some Sh847,251,900 was meant to improve the availability of supplies and equipment needed to respond to Covid-19, other public health emergencies and strengthen the capacity of the MoH to provide timely medical diagnosis for coronavirus patients.

On May 5, Susan Mochache,the Principal Secretary of Health, indicated that equipment and supplies would be purchased through Kemsa and Unicef, utilising Sh1 billion of the World Bank loan.

Some Sh330,375,795 would go towards lab reagents and sample collection kits while Sh196,924,208 would purchase Roche Test Kits, making a total of 526 million shillings towards testing.

One Covid-19 Roche test Kit as budgeted by the Ministry would cost Sh2,500. Some Sh196 million would buy at least 78,000 kits.

A pack of 100 Nasopharyngeal swabs (without media) would cost Sh10,000 per pack.

From its initial budget as at March 30, laboratory needs had been covered, with only a financial gap of Sh1.9 million remaining, the least of all the areas which included human resource, PPE, isolation, quarantine, critical care, operations and logistics.

If this has been done, then the number of tests ought to be much closer to the 250,000 mark at the end of next month.

Globally, Covid-19 testing has been mired in some controversy, with dozens of countries terming test kits imported from China as being faulty. Late last month, India cancelled an order for around half a million rapid testing kits from China, claiming they found them to be faulty.

Closer home, Tanzania’s President John Pombe Magufuli dismissed imported coronavirus testing kits as faulty, claiming they returned positive results on samples taken from a goat and a pawpaw.

Kenya’s testing almost entirely depends on donated test kits from China. The Ministry of Health has steered clear over the ongoing allegations of faulty kits.

 

Covid 19 Time Series

 


WHO Kemri Covid-19 Mass testing
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