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Covid-19 challenge: Risk-adjusted control and mitigation strategy essential

In Summary

• The Ministry of Health (MOH) is yet to develop such a crucial national policy and guidance document for COVID-19 control.

• Although some crucial protocols, procedures and specific technical area guidance documents have been developed, the lack of an overarching policy framework is a gap.

Health CS Mutahi Kagwe on June 4, 2020.
Health CS Mutahi Kagwe on June 4, 2020.
Image: MERCY MUMO

The number of COVID-19 cases reported in Kenya has surpassed 2,000 mark by the 12th week since reporting the first case. The Kenyan epidemic is gradually progressing towards a peak of new cases. General containment measures are increasingly becoming economically unsustainable. Although social and physical distancing measures appear to have slowed the transmission of the virus, they are exacting a heavy toll on the economy, especially the informal economic and casual labour sector. According to a

2016 World Bank Report, “Informal Enterprises in Kenya”, 95 percent of the country’s businesses and entrepreneurs are found in this sector. Increasingly, cases of COVID-19 are being identified from the informal sector communities in urbanized areas that constitute up to 70% of residents. Residents of informal settlements ignore social and physical distancing measures and prioritize communal livelihood activities to earn incomes for their families.

Despite the increasing numbers of new cases reported, various leaders have expressed a need to ease containment restrictions and gradual opening up of economic activities. The gradual return of economic sectors back to work without compromising gains made in reducing spread requires implementation of a risk-adjusted mitigation strategy.

The management and control of COVID-19 epidemic in Kenya now needs to be devolved and transitioned to robust county responses. A robust COVID-19 surveillance system whose data is acquired and managed by the County Health Services and linked to the national level is required. Most of the counties with reported cases have yet to fully develop robust and functioning public health infrastructure to support scale up of case finding through testing, isolation, and contact tracing. In order for counties to develop well-structured, evidence and standards-based county responses, they require a National COVID-19 Policy and Strategic Framework.

The Ministry of Health (MOH) is yet to develop such a crucial national policy and guidance document for COVID-19 control. Although some crucial protocols, procedures and specific technical area guidance documents have been developed, the lack of an overarching policy framework is a gap hindering structured and coordinated approach at county level. Under such a framework, key stakeholders would be mobilized for an all-of- government and all-of-society response.

A national framework for a risk-adjusted mitigation strategy will guide the counties to develop their own Action Plans based on norms and standards recommended in the strategy. COVID-19 risk should be defined on the basis of the current absolute number of cases, the speed of growth in new cases as well as the estimated levels of community transmission. The unit for COVID-19 risk assessment and control should be the sub-county. Sub-counties should also develop granulated risk profiles at ward, village and specified community/workplace settings. Using color codes to illustrate risk, color coded COVID-19 control zones are generated at each level of the county and aggregated nationally.

A green zone would have no reported cases of COVID-19 while the reporting of a single case in an area makes that area an active zone. When the absolute numbers reach 1-6 cases, the zone is coded yellow. A hotspot or red zone develops when the numbers grow to more than 6 or when the cases double in 3-4 days. Red zones are cordoned off for containment together with an area within a radius of 0.5 km where only essential services are made available. Each containment zone triggers control and mitigation measures from the county health and social services and economic sector transactions in goods, services and movements that are permitted based on consideration of risk level.

A buffer zone is also marked off where people with severe and acute respiratory illnesses (SARI) are checked and monitored at all the catchment healthcare facilities. Asymptomatic frontline healthcare workers in the red and the buffer zones are serially tested for COVID-19 to provide a proxy indicator for the level of transmission in the community as well as the effect of the mitigation measures. Mitigation public health, permitted sectoral economic activities and movement limitation measures have to be implemented in tandem with accelerated efforts to repurpose the health systems to integrate and implement COVID-19 disease management interventions.