What Kenya needs to do better to prepare for the fourth wave of COVID-19

Kenya is struggling with the COVID-19 delta variant, which recently resulted in the western part of the country being locked down. It now threatens the capital Nairobi.

A June 2021 modeling forecast by the Kenya Medical Research Institute warned of an impending fourth wave, with the associated risks of healthcare demand exceeding capacity. The Delta variant is much more transmissible than its predecessors, like the Alpha variant, but it does not appear to cause any more serious illnesses.

The modeling study is a welcome indication of the dangers of the Delta variant. The results should be used to inform both public and private sector preparedness. In other parts of the world, the variant has spread rapidly, even among partially vaccinated, overwhelming health services.

The big worry is how Kenya will fare this time.

The Kenyan government reacted quickly to the three previous waves. But the public has felt a certain amount of pandemic fatigue. And the economy and social life in general have been negatively affected.

Two doses of the main vaccines provide good protection against hospitalization and serious illness. The country’s rollout has so far been limited to COVAX deliveries and donations, and a concerted effort is required to raise more with local and donor funds.

Kenya’s strengths – and the gaps

As of July 29, there were 199,941 confirmed cases of COVID-19 in the country, with 3,895 deaths. Part of the explanation for the low death toll is Kenya’s younger population, with fewer comorbidities and less obesity. But there can be other explanations as well. It is likely that a high percentage of the population has already been exposed to COVID-19 from previous waves and will therefore have some immunity to it.

The government has done some things well. There were and are immediate national measures with a national emergency committee, coherent notices to limit the damage, daily briefings from the Department of Health on case numbers, positivity rates and hospital occupancy, and special treatment facilities.

The health system as a whole has shown resilience after an initial decline at the start of the pandemic, with most health services such as obstetrics now back to normal or near normal. In addition, a nationwide coordination of tests has been initiated, which also includes genomic tests.

Due to the limited supply of vaccines available, only about 2% of the population have been vaccinated. So far, the Astra Zeneca has been the only vaccine available, but others, including Johnson and Johnson and Pfizer, are expected in August. There are ambitious plans to provide donated and locally-sourced vaccines to the entire adult population by 2022.

However, there are areas where there is more need for action, especially in light of a possible fourth wave.

The largest gaps are in the performance of the health system. The oxygen supply is particularly low in the public sector. In addition, there are too few intensive care beds.

And then vaccination efforts need to be stepped up. The procurement of vaccines is restricted to the government. In addition, management is taken over by the government, which distributes its limited supplies to public and selected private entities. As the supply of vaccines grows around the world, allowing the non-public sector to supply them would help increase coverage.

Compliance with mitigation measures like wearing masks and social distancing is limited. There are many myths about COVID-19 and there is a deep skepticism about the threat the virus poses.

Effective responses are also hampered by hesitation over vaccines and government corruption scandals.

What needs to be done

The new Delta variant is a serious threat because it is much easier to transmit. In order to take and enforce preventive measures, swift government action is required.

A great effort is needed to help hospitals test and report results quickly to ensure optimal patient care, especially in the public sector. At the start of the pandemic, the government decided to limit antibody testing to research studies. This limits both clinical care and population monitoring of the prevalence of COVID-19, which would otherwise provide better insight into the nature of the Kenya pandemic and population exposure.

There should be more testing and contact tracing.

In addition, the availability of beds must be better coordinated across the districts and across the country.

The potential for larger congregations to be super-spreaders is a clear problem. Government should bring people and policy makers together and work with communities to reduce complacency, improve education and awareness, and enforce abatement measures.

The vaccination program needs to be expanded and accelerated. Leveraging local knowledge and networks is essential to prepare people and health services for a rapid expansion of vaccination.

Oxygen is the most important aspect of treatment and care. It is important to be able to deliver higher concentrations of oxygen, e.g. B. with a high flow nasal cannula. These are available in some private institutions, but very scarce in public institutions.

During the previous surge in March 2021, few of the public hospitals had adequate oxygen and even private hospitals were running out of supplies. While many of the public hospitals had facilities for generating oxygen, some did not work. Added to this are delays and high costs for medical equipment and spare parts, which are often twice as high as in Europe or North America.

Finally, Kenyans themselves have a responsibility to take precautions and get vaccinated. You should avoid large gatherings such as political rallies.

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