There are three things in the current Covid-19 discourse that I not only disagree with but which I believe reflect a lack of empathy and a detachment from reality, possibly borne of doubts as to whether the lives of ordinary Kenyans are worth fighting for too hard.
As expected, today the explosion of coronavirus infections in Nairobi is in the informal settlements and slums. The slums were not locked down because, after debates about cash transfer systems and food vouchers and all that, it was probably decided that it was too difficult, would expose troops and police, required to enforce the lockdown, to infection and, therefore, compromise national security. Other than the curfew, folks were asked to wash their hands, wear a face mask and social-distance.
Once again, the language is changing and we are saying that asymptomatic people will be asked to go home and choose whether to spread death or spare their families by self-quarantining until they either get well or become sick enough to qualify for hospital attention. And I ask myself: If you live in a one-room tin shack with your three children, wife and sister-in-law, how do you isolate yourself?
In treatment centres, patients get supplements, are encouraged to take exercise, drink lots of water and eat lemons. They don’t have access to drugs and they have no opportunity to infect anyone else. Back in the slums, life does not beat to that rhythm: There is likely to be no lemons, no regulated hydration, no supplements, no privacy and no social distancing. The temptation to numb the fear of the unknown at the busaa den, thereby infecting countless others, is probably impossible to overcome.
Every effort must be made to reduce the volume of infections by isolating the infected and doing contact tracing. If it means setting up field hospitals, so be it. Mombasa Governor Hassan Joho set up one at the Technical University of Mombasa and it looked really nice and ready for use. Are we saying it was set up by Martians? Why can’t such hospitals be set up in other parts of the country for the management of those with mild or no symptoms? Kenyans pump trillions of shillings into the Treasury. Use some of that money to save lives.
Secondly, I have heard the argument that mass testing is “a waste”. Yet, you can’t really tell the prevalence without a large number of tests. Today, we are doing less than 3,000 tests a day. Some people that I have spoken to think that you need between 10,000 and 15,000 tests a day to establish the status of the disease and therefore be able to take the necessary decisions. In other countries, every decision — including being allowed back to work or checking into a hotel — is led by testing.
We have the capacity at Kemri and the National Influenza Lab to scale up the testing to a level that the country requires. But we can’t seem to get things moving; if it’s not reagents it is something else. Nothing of value is easy to achieve; of course everybody in the world is looking for reagents, of course there is a global shortage, of course it will require ingenuity and innovation to solve the problem. Kenya can’t lapse into its usual lack of initiative when its people are at risk.
People have been talking about the relaxation of restrictions, reopening of schools and a return to normality. How can you take such decisions without testing data? And we don’t always have to use the PCR test, which, even though more accurate, is slower. Why not use some of the rapid testing kits that are in use all over the world and make provisions for the higher margin of error?
In my view, mass and fast testing is not negotiable. And the only way we can safely allow people from high infection areas into the rest of the country is by testing them. And if this requires technology, I am sure our innovative young techies can come up with a quick, mobile-based, cost-effective solution that allows the authorities to track the infection status of an individual and guarantees integrity.
My final beef has to do with the balance between livelihoods and lives in determining whether to open up or not. I have seen studies that strongly suggest that brutal lockdowns in Italy, New Zealand and other places helped to either control the virus or ensure that it did not take hold at all. Countries such as Rwanda, which are very efficient in policing lockdowns and are, fortunately, small, have not had a single death.
Covid-19, with its capacity to infect patients many times, can easily lead to the swamping of health facilities and kill huge numbers of people. It is like a fire. The only way to control it and douse it is by denying it fuel — new victims to infect. Right now, many of us are suffering massive loss of income. But we know that so long as we are alive, we can rebuild.
In this crisis, there are some irreducible minimums: We must fight for every life with everything we have. Decisions must be data-led; meaning we must test on a large scale. And there must be no false equivalencies between livelihoods and lives: Life comes first.