Kenya can combat virus, but there are conditions...

As dread takes over the world following the outbreak of the deadly Covid-19, which has killed more than 2,900 people, the focus of Kenyan scientists is not only how to protect people from a possible attack, but also on a little history.

Covid-19 is among the viruses which have crept from bat-filled trees and camel barns and are now threatening man.

The closest Kenya has ever come to a disease of this magnitude was in 2009 with the H1N1 virus, which affected more than 600 people. With nearly 20,000 deaths globally, the Centres for Disease Control and Prevention (CDC) and United States Agency for International Development (USAid) rushed to help Kenya establish an influenza surveillance system.

Scientists now say this surveillance system, if reactivated, and Kenya’s weather may be the country’s saving grace and protection in the face of Covid-19. “Flu and this family of viruses thrive in low humidity and high temperatures such as in the Northern hemisphere, but the tropical climate here has high temperatures and high humidity,” says Dr Isaac Ngere, a medical epidemiologist from Washington State University’s global health programme in Kenya.

Locked out

The respiratory disease was first reported in Wuhan, China, in December 2019 during winter, and the transmission has been reported mostly in colder areas. There are only a handful of cases in warmer places such as Brazil and Algeria that now have a case or two.

Information that weather and an influenza surveillance system might offer hope, comes at the height of messages of doom from reputable public health agencies such as CDC about the possibility of a Covid-19 pandemic. Early last week, a survey published in the Lancet classified Kenya and Tanzania as highly vulnerable and with a weak capacity to handle the illness.

However, Dr Ngere, whose research has been on this family of viruses, had this to say: “We may not experience that many infections in the likely event the virus lands here, but considering our health system, the fatalities in those few cases may be very high.”

Dr Ngere meant that the Kenyan healthcare system is well capable of preventing infections, therefore, in the event the illness finds its way to Kenya, the cases would be minimal. But, it is the country’s ability to cure the illness that he has doubts about.

HealthyNation has learnt that bureaucracy and supremacy battles in the Ministry of Health have thwarted communication to the public about the disease and prevented scientists from using the aforementioned advantages to secure Kenya.

At the onset of the outbreak, sources from the ministry told HealthyNation there were labs at the Kenya Medical Research Institute (Kemri) that were able to handle the diagnosis. They even had the reagents needed to carry out the tests.

However, former Health Cabinet Secretary Sicily Kariuki, the sources said, wanted the tests to only be done at the government-run National Influenza Centre domiciled at the National Public Health Laboratory.

The lab was established in 2006 when Kenya, being on the migratory paths of birds headed to Egypt, reported the country’s first of case of avian pandemic H1N1 influenza. In Africa, H1N1 was more severe in Egypt.

The government also established the Zoonotic Disease Unit within the ministry to coordinate response to diseases that jumped from animals to people — collectively called zoonoses. Zoonoses were, and still are, a big concern.

Sidelined labs

This monitoring also led to the establishment of 26 surveillance sites for any type of influenza in Kenya. The sites are headquartered in the former provincial cities and counties at the borders.

To work in these labs and in response to any outbreak of these diseases, Kenya relied on elite disease responders trained in a 2004 Field Epidemiology and Laboratory Training Programme run by CDC. Then, the programme was only in Kenya and Nigeria and was later expanded to Burkina Faso, Ethiopia, Ghana, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe. It is the graduates of this programme who formed part of a team of 170 healthcare workers sent to West Africa in 2015 to fight Ebola.

However, over the years there were no reported cases of these diseases and the government ignored the national influenza labs. The labs received little to no funding, relying only on donors, and there were no reagents.

Despite the public labs being ill-prepared, and the staff needing more time to rise to the occasion, the former CS is said to have stopped Kemri from offering their facilities to test the samples.

Omu Anzala, a professor of virology at University of Nairobi, says that to test the samples, Kenya needs two reagents — primers and probes — and because these were absent at the Influenza lab, the samples were shipped to South Africa.

The Health ministry had not bought the reagents by the end of last week.

The conflict led to the flaunting of the four World Health Organization components against which a country is judged for its preparedness to handle a disease such as Covid-19. These indicators include risk communication, which is timely, open information about a disease, and the transparency about the country’s preparedness.

The ministry has remained tight-lipped about the disease, only giving periodical information. Experts within the ministry have been barred from talking to journalists or posting information about the disease on social media.

Earlier, Health Director-General Patrick Amoth told HealthyNation the ministry procured 5,000 pieces of protective gear for health workers in readiness for the disease. These included masks and gloves for those at the airport as well as additional goggles, special protective overalls and boots for those who would be dealing with confirmed cases.

However, a spot check at the airport showed immigration officers without the basic masks even after they had been trained by the national task force on basic hygiene.

Costly miscalculation

Had the public been made aware of this training of health workers and immigration officers at the airport, this information might have allayed fears fuelled by misinformation. The task force even ordered a change of the air conditioners at the airport.

The ministry has also set aside isolation sites at Kenyatta National Hospital and Coast General Hospital in Mombasa. There are also quarantine sites for suspected cases in Mbagathi Level Five Hospital and at government houses in Ngara. However, apart from the first four scares that were later found to be negative, these sites have not been used despite Kenya allowing passengers from China.

When a plane landed from China with 239 people last week, the ministry issued a statement that enraged Kenyans after the passengers were asked to “self-quarantine”.

In a presser on Thursday last week, Health Chief Administrative Secretary Rashid Aman said: “Self-quarantine means staying in a room and not leaving.”

In the meantime, CDC reported that the US, which has a more resilient health system than Kenya, had banned entry of people from China. The country also added a mandatory quarantine for those who had been to the Hubei Province.

On self-quarantine, Dr Ngere says this is risky, given the socio-economic issues that compound Kenya’s vulnerability. “How many Kenyans can afford masks or handwashing liquids? Our level of sanitation is also low,” he said.

Njenga Kariuki, a professor of virology and an expert in infectious diseases, says due to the airborne nature of mode of transmission, such miscalculations could be costly, but added that this should only be an issue of concern not alarm.

Between China and Kenya, there are daily flights because of the trade relationships between the two countries. “Some estimates have ranked Nairobi sixth among African cities receiving the highest volumes of travellers from the high-risk cities in China,” says Dr Edwin Barasa, a health economist and director of Kemri-Wellcome Trust Nairobi programme.

Despite this, Prof Kariuki, who once worked as the Africa head of labs of CDC and had interacted with coronaviruses, says Covid-19 may be spreading fast, but it is not as serious as its brothers in the family of viruses: the severe acute respiratory syndrome (Sars), which was reported in 2003 in China or the 2012 Middle East respiratory syndrome (Mers) in Saudi Arabia.

CDC defines coronaviruses as a large family of viruses that cause respiratory illnesses and include those that cause Sars, Mers and the common cold.

Sniper’s scope

Now more than ever, scientists have their eye on where these viruses came from. Bats are implicated as the source of most coronaviruses, but Mers came from dromedary camels.

The bad news is that Kenyans’ appetite for meat and farming takes them closer to these deadly viruses. Kenya’s population as at 2019 was 47.6 million. So many mouths to feed especially with proteins.

Unchecked real estate is also a problem with buildings coming up in the middle of forests or animal paths. Nature fights back directly when elephants trample people in Laikipia or indirectly through these viruses.

Eric Fevre, professor of veterinary infectious diseases at International Livestock Research Institute (ILRI) in Kenya and the University of Liverpool in the UK is even more fearful of this indirect retaliation.

“These viruses are often sleeping dogs which should be left to lie, but through this exchange they come out from their natural host to a new and a weak host: the human being,” says Prof Kariuki.

He adds that coronaviruses have the ability to find other microorganisms and “marry” them to create novel versions of themselves in a process called “reassortment”. “From that marriage, another monster that will neither be understood by scientists nor be sensitive to the available vaccines may emerge”, he says.

And as scientists play catch up, the monster kills, like Covid-19 is doing now.