The rapidly evolving COVID-19 epidemic in Kenya rapidly approaching 1,000 confirmed cases in close to half the counties, confirms that community transmission is now firmly established. On 29th April 2020, the Chairman of the Council of Governors, in response to media concerns over the preparedness of county governments to respond to the ever increasing threat posed by rapid spread by COVID-19, stated that “all county governments are prepared and ready to deal with the pandemic”.
The future course of the COVID-19 epidemic in Kenya is unknown. All indications are that COVID-19 epidemic is here for the long haul. Kenya must be prepared for another 18 to 24 months of significant COVID-19 activity. Hot spots will pop up periodically in diverse geographic high density population areas. These patterns will only be broken by an effective vaccine. The short-term goal for the counties, to be achieved in one to two years’, will be achieving control of COVID-19 by slowing down the spread of the epidemic in their jurisdictions. In their preparedness and response, county governments should use effective strategies. These include: 1) implementation of context-appropriate public health measures to slow transmission and control sporadic cases, 2) strengthening of the county health systems to reduce COVID-19-associated morbidity and mortality, 3) maintenance of essential health services, 4) protection of health workers and 5) mobilization of adequate resources.
Enforcement of community-level measures to reduce contact between individuals such as suspension of mass gatherings, the closure of non-essential places of work and educational establishments and public transport limitations should be strengthened. Standard individual level measures such as staying at home, maintenance of personal and respiratory hygiene, physical distancing, routine use of masks and temperature screening in public spaces should be promoted and monitored. Spaces with high human traffic turnover (supermarkets/malls, open-air/retail markets, matatu termini, workshops/factory floors, healthcare facilities, police report desks/cells etc.) must have their contact surfaces regularly cleaned using recommended liquid products.
Fumigation and wide-area spraying are not appropriate tools for cleaning contaminated surfaces. Counties should conduct hotspot mapping of locations with case clusters in order to inform the deployment of targeted community testing. The approach most suitable is door-to-door testing accompanied with counseling, dissemination of information materials and linkage to the COVID-19 call centre. Asymptomatic/presymptomatic cases of COVID-19 or close contacts need not all be isolated in institutional facilities. Managed home-based care with integrated use of ICT should be deployed as a means to reduce the burden on the healthcare system. It is paramount to ensure rights-based contact investigation and proper management. Counties should meet the costs of institutional care in public facilities. Counties should outsource implementation of selected interventions to competent NGOs and CBOs. These include targeted community testing, case transfers to isolation centers, contact investigation, management of quarantine centers, surface cleaning of communal spaces, managed home-based care for asymptomatic contacts and confirmed cases. This will reserve deployment of majority healthcare workers to their core mandate of maintaining essential services.
To cope with expected surge in cases, counties should ensure dedicated COVID-19 treatment facilities are equipped with adequate capacity including well equipped ICU wards. Continuous training of all healthcare staff should be offered beyond occasional sensitization meetings. Healthcare workers may act as sources of facility and community transmission. Up to 15% healthcare workers can get infected.
Measures to protect healthcare workers include regular testing, increasing motivation, provision of personal protective equipment (PPEs), continuous supply of infection prevention materials and special arrangements for travel, accommodation and meals. Forecasting and quantification of required commodities and supplies, their procurement and distribution should be made and undertaken in timely manner. Medical waste management should be improved to ensure proper management of waste generated from the care of COVID-19 clients.
MOH guidelines for handling and disposal of bodies of individuals succumbing to COVID-19 disease should be adhered to. County governments should develop a COVID-19 Strategy, costed annual plans and budgets for purposes of soliciting additional funding. Counties should advocate for the amendment of legislation to oblige NHIF and medical insurance companies to cover and reimburse the costs of taking care of COVID-19 cases whether or not admitted to isolation and treatment centers.