County hospitals not yet ready for covid-19 surge, researchers warn

County hospitals are still not ready to handle a surge of coronavirus infections, researchers have warned.

As numbers continue to rise, almost hitting 2,000, experts feel that many county hospitals are yet to meet the required preparation measures to handle Covid-19 patients.

For instance, Dr Geoffrey Kulabusia a medical immunologist at Egerton University, says that a number of counties in the Rift valley and Western Kenya are yet to harmonise their systems to accommodate the rising cases.

Global coronavirus cases surpassed six million on Saturday, according to a Reuters tally, as the respiratory illness claimed more than 367,000 lives worldwide.

CONFIRMED CASES

Kenya reported 123 new cases Wednesday pushing up the total confirmed cases to 1,962 while deaths stand at 64.

Laikipia also became the latest addition to the 33 counties that have so far recorded Covid-19 cases.

Even as most of the cases are concentrated in Nairobi and Mombasa counties where health facilities have been repurposed to have more isolation units and critical care equipment installed in a span of three months, Dr Kulabusia says that the same level of preparation is yet to be replicated in other counties.

“As it is, some counties like Bungoma are not prepared, other than level five hospitals which are already inflated with patients and understaffed. Further, we have very few people trained in [handling] infectious diseases,” argues Dr Kulabusia.

ASYMPTOMATIC

So far, he adds, the country has been lucky that most of the cases reported have been asymptomatic.

“What happens when we have 200 patients in one county and even 10 patients requiring ICU beds at the same time?” wondered Dr Kulabusia.

His worries are supported by a recent study done by a team from the Kenya Medical Research Institute (Kemri) who estimate that Kenya urgently needs an additional 1,511 intensive care unit (ICU) beds and 1,609 ventilators to cater for a possible one million Covid-19 cases.

Currently, the country has only 537 ICU beds and 256 ventilators.

SUBSTANTIAL VARIATION

There is substantial variation in hospital bed surge capacity across counties. For example, under a six months transmission scenario, only 12 per cent of general hospital beds would be available for occupancy by a Covid-19 patient in Tharaka-Nithi, compared to 145 per cent in Trans Nzoia County.  

“Further, only 16 per cent of healthcare facilities in Kenya have pulse oximeters, a vital device for monitoring oxygen saturation and therapy,” states the report.

According to the study done last month, significant gaps exist in Kenya’s capacity for hospitals to accommodate a potential surge in caseload due to Covid-19. The assessment says only 22 out of the 47 counties have at least one ICU unit.

The study also found that apart from Vihiga County, only about two in 10 (22 per cent) of Kenyans live within easy access (considered to be two hours) of a hospital with an ICU unit.

Other counties with relatively good accessibility to an ICU unit are Bungoma, Kisumu, Kiambu, and Nairobi.

CAPACITY CONSTRAINED

From the findings, the capacity of hospitals to absorb increases in caseload due to Covid-19 is constrained by the availability of oxygen, with only 37,216 (or 58 per cent) of the 64,181 hospital beds across all sectors (public, faith-based/NGO and private), across the country are equipped with oxygen supply.  

Additionally, the study also indicates that only 13 per cent of health facilities in the country have the crucial items to support a Covid-19 patient, including medicines, oxygen tubes and inhalers, arguing that more investments will, however, need to be strategically prioritised to focus on strengthening essential services such as oxygen availability first, before higher cost investments such as ICU beds and ventilators.

“It may be more pragmatic for Kenya to first invest in making existing hospital beds functional by providing oxygen and making these devices available before focusing on ICU beds and ventilators,” states the report.

NO SYMPTOMS

The Ministry of Health estimates that between 80 and 90 per cent of the Covid-19 patients do not present any symptoms.

However, Chief Administrative Secretary for Health Rashid Aman said that there are instances where patients picked up as asymptomatic have developed symptoms associated with the respiration infection.

“While most of our cases have remained asymptomatic, we have seen some of the patients in isolation develop some of the symptoms of the coronavirus,” Said Dr Aman during Wednesday’s daily briefing.

The researchers, who included Paul Ouma (Kemri) and Emelda Okiro (University of Oxford, UK), made the assessment under three possible transmission scenarios of 6, 12, and 18 months.

The team mapped out the capacity of hospitals to provide Covid-19 services, using data from the master health facility list (MFL), the harmonised health facility assessment (HHFA), and a survey from the Kenya Health Federation on the number of ICU beds and ventilators available.

MODELLING ESTIMATES

“Modelling estimates predict that about two per cent of the Kenyan population could be infected with SARS-Cov-2 and develop symptoms,” states the assessment posted last month on MedRxiv, an online database for scientific studies run by Yale University and the British Medical Journal.