Meet the technical team informing virus control decisions

In order to contain the spread of the new coronavirus, several teams have been set up to advise on the actions to be taken. One of them, the National Covid-19 Task Force, is providing the data and other technical details that eventually inform the decisions that the President makes 

Early this month, Kenyans anxiously expected President Uhuru Kenyatta to reopen the economy, but he did not.

He said this was due to the increase in the number of Covid-19 infections and the lack of preparedness in the counties.

The President’s decision was guided by the members of the National Covid-19 Task Force chaired by Health ministry Principal Secretary Susan Mochache and Director-General Patrick Amoth. The team advises the National Emergency Response Committee (NERC), which in turn advises the President.

The task force is a technical organ that acts as a coordinating working group. It has about 80 people comprising members from development partners and others sectors.

From their technical advice, the President mandated different sectors, including education and religion, as well as the counties, to come up with business resumption protocols as the country prepares for reopening.

In the next two weeks, President Kenyatta will turn to these men and women (technical team) for advice on whether to reopen the country or continue with the strict measures and protocols put in place to check the spread of the coronavirus.

They are in charge of different sectors including Covid-19 testing, borders, contact tracing, case management, mortuary monitoring and projection of cases in the country.

Dr Patrick Amoth, co-chair of the task force

Dr Amoth says that the bulk of work on whether to open or not lies with the counties.

“When we are satisfied that the counties have done a good job, we will advise the president to open the economy.” This, he said, will only happen after the counties have handed a report based on what they were advised to do by the President.

Counties have to strengthen case management units, rapid response teams have to be in place to facilitate contact tracing, the public and social health measures be functional by ensuring that masks, sanitizers are given to vulnerable communities, and stop gatherings. They have a department for infection and prevention control and a functional laboratory to conduct the testing.

“If these measures are put in place together with a good monitoring system in the counties, then we can advise the president to open up but until these are in place, then we must not open,” Dr Amoth said.

“We have not reached our peak and it is difficult to open when the cases are increasing. You will simply be inviting more cases and since it is a new virus and not much is known about it, we have to be careful,” Dr Amoth said.

He said it is not a must that the country opens fully but can gradually open schools and churches and where physical distancing is a problem, reopening can wait.

However, he said, the opening might not entirely depend on scientific evidence but political forces as well.

“My role is to advise the Health minister, Mutahi Kagwe and the National Emergency Response Committee (NERC), who later advises the president, the advice can either be taken, ignored or rejected but this will depend on the President,” Dr Amoth said.

Principal Secretary, Susan Mochache, Co-chairs, National Covid-19 Task force

Members of the Taskforce are drawn from an inter-disciplinary group of experts in diverse fields of health and works closely with other multi-agency teams within the Government

“We have come up with different departments that meet weekly to receive reports from its work-streams and their sub-committee,” said Mochache.

Since the formation of the Task Force, they have come up with ways of monitoring COVID control and prevention strategies to ensure application of advisories and in keeping with global standards and spread of the disease in Kenya. They also develop a robust laboratory testing and quality assurance policy to inform the laboratories in the face of ramped up testing and the global shortage of testing kits and reagents.

“We have given the counties Sh5 Billion to the counties to enable them prepare to have in place necessary required equipment since the opening revolves around them,” said the PS.

In the next two weeks, she said they will turn to the taskforce to look at the general preparedness in the country and help advise on the measures to be taken after the expiry of the ongoing restrictions imposed to control the spread of the virus.

Dr Francis Kuria, Incident commander, Contact tracing and data management

Dr Kuria is in charge of all the persons who have come into contact with the positive case and ensures they are closely monitored and tracked using their mobile numbers

Dr Kuria acknowledges that the process is working but is expensive. Tracing and calling one person cost Sh50 and on average one person has about 15 contacts and millions of people are being traced.

It is very difficult to trace all the responders because as the numbers keep growing, the more we lose many people.

If you have missed one digit, the contact is lost and this, he says, has happened on several occasions.

“You cannot trace everyone,” he says.

As of last week, the department was tracing about 8,317 contacts and many have been missed out which has consequences.

When a contact is missed, definitely, a track is lost.

There is widespread disease in the community, which means the more the positive cases, the more people to be traced. The reopening will be pegged on the impact of the disease or whether the disease trends are going to overwhelm the health system.

Human resources when it comes to contact tracing is a big challenge.

We only have four employees while the remaining 28 are volunteers.Management of volunteers is not an easy task, they are not motivated all the time, these hampers the work,” he said.

The department has trained people at the county level to cascade contact tracing and have since come up with their emergency response centre.

If we open up with the poor contact tracing at the counties, will they able to contain the virus? Are they able to contact everyone?

Prof Omu Anzala, case management,

He ensures that all the guidelines including management of patients, health care workers have the knowledge on how to handle positive patients, donning and doffing of the kits are written down.

Writing an advisory to the ministry on what to do when there is a cluster for instance, in Eastleigh and Mombasa and what can be done to contain the spread of the virus.

In regards to case management and disease projection, Prof Anzala, emphasized that the country is doing well and had it not been for the initial measures, the numbers would have been higher.

The restrictions of the movements, masking and social distancing have reduced how fast the infection would have spread in the country. It would have been worse if nothing had been done.

The reopening will depend on how counties are well organized, lifting restrictions in Mombasa and Nairobi when others are not prepared is calling for more problems.

“We insist that counties should be well prepared just like Nairobi in terms of contact tracing, quarantine centers are in place to accommodate more numbers and ensure that all the mitigation factors are adhered to,” he said.

Each county must have all these measures in place. Should they not, then there is no need for reopening. The health care system will be overwhelmed full of the sick patients. When we keep the numbers low, then we are likely to see less deaths.

Again, it calls for personal responsibility, if Kenyans are responsible and disciplined, then we have nothing to fear, we will be good to handle the virus because it is here with us.

“When you are forced to put on a mask and wash your hands, then you have a problem. It is stupid for people start insisting that they want to go to church,” he said.

Dr Jackson Kioko, chair of the facilities preparedness committee

In charge of all the health facilities (isolation, quarantine and county facilities) in the county in response to Covid-19.

Majority of the countries have taken the presidential directive, and as a committee we have been monitoring the level of preparedness.

We get the data from the country to be able to know the number of beds available in the country and how they will be able to manage cases in their counties.

They have identified a total of 77 (seven private and 70 public) health facilities in the 47 counties as covid- 19 hospitals with 2,442 beds with 220 ICU beds for isolation to avoid people mixing and fearing to go to the hospital because they will get infected.

The committee has also identified 36 non-health facilities including Kenya Medical Training College with a total 2500 beds to be converted to admit asymptomatic patients. There is still a gap of 11,000 bed capacity.

A number of counties have done very well and they are ready for reopening

The committee meets every Friday with the county ministers of health, to review the progress and share their challenges.

On Friday, the president told the governors during a summit that the decision to re-open the country's economy will be informed by the level of preparedness by the devolved units to respond to Covid-19 infections.

He said the decision will largely be determined by the counties capacity to effectively respond to new cases of Covid-19 imported into their territories.

"County readiness to respond to new imported cases of infection will largely determine our national readiness to re-open the country as a whole. I say this because the nation is the sum total of all the 47 counties. If the counties have met the necessary thresholds, then the nation will be ready to re-open," the president said.

However, Mr Kioko told the Sunday Nation that as far as the human resource, equipment and facilities readiness were concerned, less than 40 per cent counties were prepared.

Most counties cannot avail or buy all equipment needed in the facilities at the same time.

However, he advises that the economy can open since we are almost at the peak though accompanied by very strong messaging to Kenyans and that they are forcefully forced to follow the law.

“Kenyans tend to forget so fast, was in Kibra the other day and people have forgotten to wash their hands. If they cannot follow the law, then we need to introduce penalties,” Dr Kioko said.

Dr Maureen Kimani, in charge of community engagement.

Her work at the task force is to ensure that the community is sensitized and provided with information about Covid-19 communicated in a language they can understand best.

The community is taken through the public health measures put in place by the Ministry of Health including how to correctly put on masks, the benefits of putting on masks, how to properly wash their hands and social distance are well adopted by the community.

So far, about 12million households have been reached, more so those in informal settlements, the refugees, the people living in arid and semiarid areas.

Through a knowledge attitude and behavior surveys conducted by the Ministry of Health, people are changing their behaviours and they are able to put up hand washing stations outside their homes and putting on masks when in public places.

The department is asking the government to provide masks to vulnerable people in the society so that they do not have an excuse of not putting on masks

Dr Kimani is determined that with the work that they have been able to do in the last three months as far as community engagement is concerned, training community health volunteers on household follow ups and messaging the behavior change information, it is probably a good time to reopen the economy.

Susan Mutua, acting head of Public Health department, surveillance of border entries.

The truckers are one of the risk populations in the country, the major source being Mombasa at the Kenya Ports Authority.

From the guidelines the committee has put in place sample collection centres and designated stop points on the transportation corridors.

Truckers not testing 48 hours before departure as directed, they cannot pass through the borders without certificate clearance hence creating a backlog of about 70 kilometres trucks.

However, with the placement of mobile laboratories in Malaba and Busia, the backlog has reduced to 20Kms in Malaba and five kilometres in Busia.

Ms Mutua is however worried that the number of truck drivers testing positive has not reduced the more samples tested the more positive cases and once the testing started, the country has been able to test about 23,000 samples of truckers and 500 have tested positive.

She said opening of the borders will also be advised by the situation in other countries. Kenya might be doing well and how about the others. It will be difficult to open unless we know the measures put in other countries and whether we are safe.

This is a delicate balance, but the economy has to go on. What I know is that the President will not stop the trade from going on.