45 under virus watch as medics track patient’s last contacts

Tuesday March 24 2020
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A health worker wearing a protective gear prepares to disinfect the matatu in which the first Kenyan Covid-19 patient travelled to Ongata Rongai. PHOTO | YASUYOSHI CHIBA | AFP

By ELIZABETH MERAB
By PATRICK LANG'AT

On your way to Maasai Lodge in Ongata Rongai, Kajiado County, you will not miss, on your left, an imposing sculpture of a lion the size of the full-grown animal, complete with a mane. On it are engraved the words ‘Simba Drive’.

A right turn on this road that is full of potholes leads you to a Deliverance Church, and another right turn takes you to five-storey Rima House, an apartment block with two and three-bedroom units.

This is the ground zero where Kenya’s first positive coronavirus case happened – the king of the jungle, the lion of Ongata Rongai, unable to tame the virus that has so far killed over 5,000 around the world and infected more than 140,000 others.

The patient, a 27-year-old Kenyan woman, had come to see a male friend who is a tenant at the house.

SEVEN IN THE HOUSE

Neighbours told us that the number of people living in the house was about seven at the time the woman was visiting.

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Oblivious that she had contracted coronavirus at the time she had taken a flight from Ohio in the US to Nairobi, the young woman went ahead to disembark from the British Airways flight, pass through immigration desks at the JKIA, exit the airport in a taxi to Rongai, and make several trips to and from Rongai using public transport.

As she went about her business normally, she may have passed on the virus unknowingly, putting an unknown number of people at risk. Researchers studying Covid-19 have found that over 10 per cent of patients are infected by someone who has the virus but does not show symptoms yet.

NIGHT OUT

On Wednesday night, as the friends were preparing for a night out, the woman, who had flown in from the United States via London on March 5, felt “weak and tired”, according to neighbours the Sunday Nation talked to. She called a taxi and was taken to hospital.

On Friday, Health Cabinet Secretary Mutahi Kagwe confirmed her as the country’s first coronavirus patient.

“Of all the places, this virus chose our apartment on a dirt road deep inside Ongata Rongai? We always thought it would start at the airports or something like that. But here? This was never in our wildest thoughts,” a tenant at the apartment said.

GLOBAL PANDEMIC

Until last week, Kenyans thought they were immune to the ongoing global coronavirus pandemic – then Mr Kagwe’s Friday bombshell threw the country into a frenzy. In the wake of the flurry, a team of 25 has been tasked to look for the needle in a haystack – every last person who came into contact with the young woman. And for the next 14 days, theirs will not only be the most expensive exercise, but also the most gruelling. The responsibility to reassure the country that they have tracked down everyone rests on their shoulders.

The Rapid Response team comprises officials from World Health Organization, Amref, the Red Cross, Centers for Disease Control and Prevention, University of Nairobi, World Bank, Kenya Private Sector Alliance, and the national and county governments.

On Saturday they had made some headway by tracking 45 people who had mingled with the young woman. Of these, 22 Kenyans were placed under quarantine at the Mbagathi Isolation Unit, where samples were drawn from their bodies and taken for testing.

SELF-QUARANTINE

The other 23, Dr Mercy Mwangangi, the ministry’s chief administrative secretary said, were asked to self-quarantine.

“Specimens from these contacts are currently undergoing testing at Kenya Medical Research Institute’s laboratories,” said Dr Mwangangi.

The 23 of mixed nationalities are said to have come into contact with the unnamed patient while on the flight from London.

Dr Mwangangi said the passengers are being monitored.

“We have also traced and advised them to undertake self-quarantine for 14 days. The ministry’s rapid response team will follow up on them on a daily basis until the 14 days are over,” she said.

FUMIGATED

Meanwhile, in Rongai, public health officers from the ministry and the county government fumigated the apartment block where the patient lived. The team also sprayed a bus that the patient is said to have travelled in when commuting between Rongai and the city’s Central Business District.

Led by the deputy director of public health, Dr Felix Lagho, the officers visited the patient’s apartment with a team from the ministry to lead a disinfection exercise. Dr Lagho told journalists that they were targeting furniture, corridors and surfaces, and that these will be “thoroughly disinfected”.

While tracing the 45 was easy, the team’s real challenge will be looking for an unknown number of people who have potentially been exposed to the virus. And that challenge also exposes the lack of preparedness to address the pandemic.

ALL NOT SCREENED

First, the government had not screened all the tenants of the apartment at the time we visited. And, apparently, there was just no plan for it, yet.

“The government has trained personnel and equipped them with the right gadgets. If need be, the personnel will come to screen them (tenants). But as far as we are concerned, there is no cause for alarm,” Dr Lagho said.

Pressed to state specifically whether the “no cause for alarm” meant no screening for the tenants, Dr Lagho said: “No cause for screening. Is that clear?”

He asked Kenyans and the tenants to observe strict personal hygiene, avoid handshakes and use alcohol-based hand sanitisers.

He also insisted that there was no need to lock down the area for a few days for monitoring, but asked the tenants “to visit the county isolation unit if you have a running nose or a fever”.

The Kajiado County government has identified and equipped Ole Kasasi Health Centre, not far from the apartment, as an isolation centre.

A video posted online showed two young men being directed to a waiting ambulance by masked men in white aprons minutes after the positive coronavirus case was announced. However, tenants said that besides those who occupied the house the woman had visited, the rest of the houses were neither examined nor screened.

MASKS, SANITISERS

The few tenants who came out to see what was happening were only handed masks and hand sanitisers and told to protect themselves.

A close friend of the woman told the Sunday Nation from her hospital bed in Mbagathi that she was picked by an ambulance at 6:30pm. “I can’t tell the number of people picked by ambulance in our neighbourhood. But I think we were close to 30,” she said. “They picked all the people, especially those who lived in our apartments and the neighbouring building. My fear is that we might not have had the virus but have been infected by some of the people we are mixing with here.” By the time we went to press, she was still waiting for her laboratory results.

Ongata Rongai is a sprawling neighbourhood dominated by a burgeoning middle-class. Although largely located within the Nairobi metropolitan zone, it does not fall within the administrative boundaries of the city and is separated from Nairobi by River Mbagathi.

Its offering of modern shopping centres such as Maasai Mall, Quick Mart and Times Arcade, and a number of hotels are heavily populated, especially on weekends.

UNIVERSITY

On Friday Africa Nazarene University, which is located in the Rongai Ole Kasasi area, suspended on-campus classes in the wake of the virus confirmation.

Contact tracing is not a new subject in the world of public health. The techniques are often employed to track down and put on treatment people who may have been exposed to Tuberculosis (TB) bacteria. “We usually carry out contact tracing and from the exercise, we are normally able to get 80 to 90 per cent of the people a patient interacted with,” explained Dr Marianne Mureithi, a medical microbiologist and acting chair of the department of medical microbiology at the University of Nairobi. Dr Mureithi notes delayed and ineffective contact tracing can contribute to the extensive transmission of a disease.

Besides looking at that patient’s travel history, the team had to follow the woman’s movement since she got into the country, determining that she took a bus within the city.

“The team will need to quarantine anybody who came as close as six feet to the patient,” she explained.