Widespread testing and effective contact tracing, including cases with no or only mild symptoms, are key components of the post-lockdown strategy
By Dr. Andrew Gachii
It is commendable that over 130,000 tests for Covid- 19 have been carried out across various hot spots countrywide given the myriad constraints. It is not in doubt the COVID-19 pandemic has triggered a surge in demand for health services. In response, the government ought to strive to urgently increase their capacity to test, trace and treat COVID-19 patients while also maintaining their essential health services.
While the already developed infrastructure by Ministry of Health to communicate results and manage patients who test positive in inpatient settings is highly commendable, a new approach needs to be developed in a bid to escalate mass testing for containment of the virus to reach over 53 million Kenyans.
By necessity, it is time for all hands on deck. The government must adopt a-whole-of-government, whole-of-society approach to the COVID-19 response, mobilising all available resources to keep health systems functioning. To do so, we must have a policy framework for Private Health Sector Engagement (PSE).
Effective PSE in the current crisis means having the capacity to: Quickly understand what is going on in the private health sector in their country; Select a fit-for-purpose, fit-for-context strategy to engage the private health sector as part of their response; Identify and use the appropriate set of instruments for engagement; and Involve a broad range of private providers of health related products and services, whether they are NGOs, faith-based organisations, individual private practitioners or for-profit businesses, in the national response.
Mass testing, which involves the test-track-and-trace approach, can allow health officials to separate the infected from the healthy and stop the virus from spreading. The logic behind mass testing is suppression — efforts to reduce the infectivity of a pandemic.
Testing, isolating people who are positive from those who are healthy is targeted to reduce the R-naught to less than one. Studies that have been carried out in Wuhan and other places show that, when unchecked, the R0 of Covid-19 is between 2 and 3, meaning that every infected person infects two to three others.
The mass testing in Kenya has been hampered by lack of coronavirus test supplies ending in a long wait that has often caused serious problems in the fight against the disease. Kenya’s biggest challenge for testing has been contact tracing, identifying then alerting people who have been within the infection range of a person confirmed to have the virus.
Drawing on private sector resources and capacity is critical because in low-and middle- income areas, the private health sector provides a significant proportion of essential health services and products to the population.
Unfortunately, contact tracing, which has involved state and local public health departments, has also not been feasible in identifying individuals who may have been infected with the virus and the people they have been in touch with. This may have been the greatest contributor to the rapidly increasing spread of the Covid- 19 infections and fatalities, unfortunately.
Historically, contact tracing was effective in reaching out to individuals infected with communicable diseases such as measles, chickenpox and sexual transmitted diseases. The medics always take necessary actions to prevent the spread of the disease by communicating those in contact. This works best by awareness of how a contagious or communicable disease is spread.
While WHO advises that aggressive measures to find, isolate, test, treat and trace are the best ways to stop the spread of this virus, public health interventions to “flatten the curve” may slow transmission and mitigate peak capacity needs.
With Covid- 19, a strong biomedical workforce must be on standby to provide broad testing in a bid to stop new patients from rekindling a widespread outbreak. This is through a new multifaceted strategy that leverages public-private partnerships, to serve as an extension of public health infrastructure in carrying out mass testing and contact tracing. The collaborative efforts will be coordinated by the national or county government and implemented by both entities until a vaccine is available.
Health providers in private hospitals that are certified and fully equipped with testing equipment should be allowed to conduct tests to speed up the mass testing fully certified and equipped testing equipment to be allowed to conduct the tests to speed up the process.
Due to the huge number of people needed to effectively contain the virus, the private sector is already starting to amplify public health departments. For instance, the Nairobi West Hospital has committed to track patients and report positive tests. With fully equipped sanitizer booth, the hospital ensures over 2000 patients received daily are disinfected to avoid acquiring or spreading Covid-19 infections whereas they go to the hospital for treatment with a different underlying disease. All inpatients at the level 6 facility undergo a free Covid- 19 test.
A Covid- 19 special theatre has already been set up to accommodate patients seeking emergency services but with no known Covid status. While test results are provided within 24 hours, the strict medical protocols aim at safeguarding all patients and personnel. If they test positive, the self-sufficient isolation wards and Intensive Care Units are major facilities to prevent spread of coronavirus.
Based on the demographics across communities in the counties, both public and private health fraternity can play major role in increasing the number of testing as this is the only channel to acquire data and indicators of the virus spread. This level of preparedness and management is aimed at speeding up the process in both national and county levels.
Leveraging in technology will supplement mass testing and contact tracing efforts to create the scale needed in reaching the number of people at risk of contracting the virus. Recently, two Kenyan Youth, Edward Mbogo and Bernard Adongo developed a contract tracing App dubbed Myride Africa used for keeping personal records for passengers using both Personal and Public Service Vehicles. Since the first reported case of coronavirus, it is reported that over 50 matatus have used to Myride Africa App.
Such initiatives are crucial in the containment of the virus bearing in mind the partial reopening of the economy albeit curfew directives and cessations by the government. Use of digital tools will act as enablers in escalating contact tracing efforts to supplement traditional approaches.
With the loss of jobs and poor business operations, this is also an opportune time for the government to consider employing more healthcare workers and digital talents people to enable effective outreach. An estimated 300,000 could assist in contact tracing and mass testing across the country.
There is a lot of stigma and fear of quarantine and isolation when one tests positive, leading many to shy off from voluntary testing or seeking medical attention when they exhibit symptoms. Door- to-door sensitization program is also a methodical approach that would work because both private and public health systems usually have profound ties and trust with the communities they serve. Health care workers will get in touch with the individuals about the need to confidentially get tested and maintain isolation, while asking about their close contacts, extending the chain. With this strategy, all employees, patients and communities are protected and the virus contained.
Hence, incorporating public-private partnerships and other stakeholders, with provision of the resources from the Government to conduct nationwide testing, the main focus is to build solid health systems that would in turn prompt us to fully reopen the country safely.
Just like any other chronic disease, we have to adapt to the fact that Covid-19 has joined the list. In these unprecedented times, we need a multi-sectorial approach that will accelerate the mass testing drive, which will be more manageable in the containment of the virus to combat the rapid spread and reduce deaths.
Modelling studies point to the impact of non-pharmaceutical interventions (NPIs), such as physical distancing, school and university closures, banning of mass gatherings, and remaining indoors, on spreading the number of cases over a longer period to give health systems the opportunities they need to cope with caseloads.
COVID-19 outbreak indicate that business-as-usual service delivery approaches are not sufficient to respond once cluster of cases or widespread community transmission is registered and surge capacity will be needed.
Dr. Andrew Gachii is the Director of Medical Services at The Nairobi West Hospital.
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