Fourth coronavirus case announced, Kenya to ration ICU beds

Kenya reported the fourth case of coronavirus yesterday, as it emerged that local hospitals will be forced to deny some patients ICU beds should infections spike.

So far none of the patients in Kenya requires breathing assistance in an intensive care unit. 

Health Cabinet Secretary Mutahi Kagwe said the latest patient, who tested positive at an unnamed private hospital in Nairobi, arrived from London, United Kingdom, on March 9.

Confirmatory tests were done at the National Influenza Laboratory. Kagwe said the patient is stable.

“Tracing of persons who may have come into contact with the patient is ongoing,” Kagwe said.

Kenya has about 400 isolation beds, and about 155 intensive care unit beds according to data from the Managed Equipment Scheme reports. 

The fears about ICU bed rationing come from the disease trajectory in China, the US, and Italy which are already controlling occupancy of such beds. 

According to the World Health Organization, many countries with confirmed cases report a sharp spike, before the curve comes down.

However, countries can 'flatten the curve' by preventing and delaying the spread of the virus so that large portions of the population are not sick at the same time.

Kenya confirmed its first case of coronavirus last Friday with President Uhuru Kenyatta on Sunday confirming two more cases — for a total of three, until yesterday.

For the two cases confirmed on Sunday, a total of 36 of their contacts have been traced and a surveillance team is monitoring them.

“A total of 27 persons who had come into contact with the first patient were traced, quarantined and tested. Two of the contacts tested positive for Covid-19. Results of the 25 plus an additional 23 other persons who have been tested have all turned negative,” Kagwe said yesterday.

The CS said that all the 23 cases that were at Mbagathi Hospital have since been cleared to leave the hospital and asked to self-quarantine at home.

So far, laboratories at the Kenya Medical Research Institute and the National Influenza Centre have tested a total of 111 cases since this pandemic struck in the country, he said.

Kagwe said it is time Kenyans started taking the virus with the seriousness it deserves as it is a threat to the country and the economy.

Italy had 100 cases on February 23 and now has 28,000, forcing it to ration ICU beds for critically ill patients.

Last week, Italy announced coronavirus victims will be denied access to intensive care if they are aged 80 or older or in poor health should pressure on beds increase.

Yesterday, Kagwe said the fact that Kenya started by reporting one case on Friday but the number has now shot up to four is a prediction that going forward Kenyans ought to prepare for more numbers.

Countries are forestalling a medical disaster through extreme measures such as social distancing, banning public gatherings and limiting visitors from affected regions.

Kagwe said self-quarantine is mandatory and everyone coming into Kenya from a country affected by coronavirus must follow the order or risk being jailed.

He said in order to mitigate economic loss, cargo vessels can come into the country so long as they are disinfected at the point of dispatch and the crew quarantined.

"There will be Kenya after coronavirus. For the UN headquarters, diplomats travelling to the UN, families and children can come in provided they also take measures," he said.

On the issue of skyrocketing prices of sanitisers, Kagwe has advised Kenyans to instead buy soap with which to wash their hands. By doing that, they will reduce the demand for the sanitisers, hence cutting the price, he said. 

He called on manufacturers, however, to produce more so as to meet the rising demand.

In addition, plans are in place in partnership with the Water ministry to ensure uninterrupted water supply in the country to increase sanitation.

“We will talk about the bills and money later. This is a matter of life and death so let us make sure we open the taps,” Kagwe emphasised.

He advised parents to ensure children stay at home to avoid getting exposed to the virus.

Medics who spoke to the Star say if Kenyans take the measures announced by  President Kenyatta seriously, the country can flatten the curve and avoid overwhelming the health sector.

Head of  Moi Teaching and Referral Hospital in Eldoret Dr Wilson Aruasa said the majority of Covid-19 patients are treated without the need for hospitalisation. 

"Less than one per cent of the patients end up in the ICU," he told the Star.

An ICU crisis would only happen if the country registers a huge number of infections.

"Those who are mild and require isolation will be isolated at home and monitored. Only when they deteriorate will they be hospitalised," Dr Aruasa said.

"Those hospitalised will be placed in isolation wards and will be monitored by well-trained health workers."

He said most of the treatment is supportive because, like most viral diseases, Covid-19 has no cure.

"We are going to manage their symptoms. Most viral diseases will be self-limiting in the long run and will clear up in a few days," he said.

 "We support the body to make sure it is well-hydrated, there's no fever and the patient is not in pain. If they have serious breathing problems, we take them to the ICU."

ICUs are not necessarily for patients on the verge of dying, but for those who need ventilators, blood pressure support, medication and close monitoring by doctors and other healthcare staff.

Dr Ali Mohammed, a Nairobi pharmacist affiliated to Jubilee Insurance, said most patients experience dry fever and fatigue, and 80 per cent of them do not need hospitalisation.

"When it reaches the lungs there are difficulties in breathing and that's why some people are taken to ICU," he says. 

"Eighty per cent of people recover without needing any hospitalisation or treatment."

Dr Ali says the death rate in most countries is about 0.3 per cent but globally, the fatality rate has been placed at 3.7 per cent.

"This is because some countries have higher death rates because of older populations with co-morbidities like diabetes," he said.

In Italy, the percentage of patients in intensive care reported daily between March 1 and 11, has consistently been between nine per cent and 11 per cent of patients who are actively infected, according to the Lancet journal.

However, researchers are optimistic the trend in Kenya might be different because of the early precautions taken like social distancing and closing schools.

(edited by o. owino)