WAR ON CORONAVIRUS

What counties should do to fight Covid-19

Continuous training of all healthcare staff should be offered beyond occasional sensitisation meetings

In Summary

• In their preparedness and response, county governments should use effective strategies.

•  These include implementation of context-appropriate public health measures to slow transmission and control sporadic cases and strengthening of their health systems

Wajir Governor Mohamed Abdi (in white apron) with health workers at the isolation centre at the county referral hospital on Sunday, April 12, 2020.
COVID-19: Wajir Governor Mohamed Abdi (in white apron) with health workers at the isolation centre at the county referral hospital on Sunday, April 12, 2020.
Image: STEPHEN ASTARIKO

The rapidly evolving Covid-19 epidemic in Kenya now approaching 1,000 confirmed cases in close to half the counties, confirms that community transmission is now firmly established.

On April 29, Council of Governors Wycliffe Oparanya said that “all the county governments are prepared and ready to deal with the pandemic”.

This was in response to media concerns over the preparedness of the counties to respond to the ever-increasing threat posed by rapid coronavirus spread.

The future course of the Covid-19 crisis in Kenya is unknown. All indications are that coronavirus is here for the long haul. Kenya must, therefore, 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 the virus by slowing down its spread in their jurisdictions.

In their preparedness and response, county governments should use effective strategies. These include implementation of context-appropriate public health measures to slow transmission and control sporadic cases, strengthening of their health systems to reduce Covid-19-associated morbidity and mortality, and maintenance of essential health services.

In addition, they should ensure health workers are protected and adequate resources are mobilised.

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 learning institutions 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 such as supermarkets/malls, open-air/retail markets, matatu termini, workshops/factory floors, healthcare facilities, police report desks/cells 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 by counseling, dissemination of information materials and linkage to the Covid-19 call centre. Asymptomatic/presymptomatic cases 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. They should also outsource the implementation of selected interventions to competent NGOs and CBOs. These include targeted community testing, case transfers to isolation centres, contact investigation, management of quarantine centres, surface cleaning of communal spaces, managed home-based care for asymptomatic contacts and confirmed cases.

This will reserve the deployment of majority of healthcare workers to their core mandate of maintaining essential services. To cope with the 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 sensitisation meetings. Healthcare workers may act as sources of facility and community transmission. Up to 15 per cent healthcare workers can get infected. Measures to protect them 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 a timely manner. Medical waste management should be improved to ensure the proper management of waste generated from the care of Covid-19 patients. The Ministry of Health guidelines for handling and disposal of bodies of individuals succumbing to Covid-19 disease should be adhered to.

The county governments should develop a Covid-19 strategy, budgeted annual plans and allocations for purposes of seeking additional funding.  The counties should advocate for the amendment of legislation to oblige the 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 centres.

Adungosi is an infectious disease control physician and public health specialist