The government on Sunday ruled out mass testing, even as the Health ministry outlined its testing prioritisation strategy and the country recorded eight more cases of Covid-19 infections.
In a statement read on his behalf by Chief Administrative Secretary Mercy Mwangangi, Cabinet Secretary Mutahi Kagwe said there are now 270 cases of people who have tested positive for the virus.
Dr Mwangangi listed people who will be tested first as healthcare workers in isolation centres and in hospitals generally, people in places that have reported many cases, such as the Kenya Ports Authority (KPA) and the locations that those workers went to, and areas in Nairobi County — which account for more than 80 per cent of the cases.
“All healthcare workers and other first responders directly interact with many people,” Dr Mwangangi said. The targeted mass testing began early this week, with samples being collected from KPA and densely populated areas like Kibera.
The Ministry of Health’s strategy is similar to USA’s Centers for Disease Control and Prevention (CDC), which also prioritised high-risk patients, specifically those over 65 and those suffering from other health conditions – such as diabetes – that make them vulnerable.
Public health experts have hailed this selection and added their list to those that the Ministry of Health should also focus on given the phase that the virus transmission is at — CS Kagwe said that nearly half of the cases (44 per cent) are local transmissions, and the CDC attributed a quarter of the spread to asymptomatic cases.
Dr Patrick Oyaro, a public health and HIV tracker, told 254breakingnews: “Asymptomatic people may not have any symptoms and look fine but they have the virus and will infect many others.”
Dr Oyaro considers these people potential “super-spreaders”. He explained: “They come into contact with many people such as those working in supermarkets, drivers of buses and matatus.”
The capacity of Kenya to run tests has never been in question: the labs, the machines and people to run them are there, and cases have been reported where there were shortage of samples.
To the Kenya Medical Research Institute (Kemri) centres in Nairobi, Kisumu and Kilifi, CS Kagwe has announced that Kenyatta National Hospital and Moi Teaching and Referral Hospital are now able to test.
It is no wonder that the samples analysed have increased from about 300 cases per day to 1,330.
Epidemiologist Mark Nanyingih says the challenge has been bringing the samples to the labs. The ministry has been relying on contact tracing, which is finding people who had contact with a positive case.
“In a system where there is little self-reporting, maybe due to stigma, contact tracing is how you will get those samples, but this is a laborious process where people literally walk and call contacts,” said Dr Nanyingih.
To this challenge, Dr Mwangangi said that the ministry will involve community health volunteers to help in active case finding, contact tracing and community surveillance. The Ministry of Health database records that there are 63,350 CHVs.
Sample collecting is a specialised skill that has been left to public health officers and the team from Kenya Field Epidemiology and Laboratory Training Program (FELTP), an elite group of ‘disease trackers’ trained by a CDC-run programme established in 2004.
Sam Kariuki, a professor in microbiology and the head of research at Kemri, explained that doing so involves placing a sterile swab at the back of a patient’s nasal passage for several seconds to absorb secretions.
The swab is thin — less than three millimetres in diameter at its tip. After a sample is collected, the swab goes into a liquid-filled tube for transport to the labs.
In the lab, the scientists use a technique called polymerase chain reaction (PCR), where they extract viral genetic material called RNA from the sample and uses it to produce another strand of DNA that the PCR machine makes thousands or millions of copies of so that the scientists get enough that can be analysed.
However, until last week when Kenya procured some from China, there has been a shortage of swabs and reagents for collection kits which slowed this process down.
Philanthropists such as the Gates Foundation and Unicef have used their financial muscle to help countries like Kenya procure these reagents.
Some health experts have argued that to preserve the reagents, testing should not be performed on patients who are already showing signs of Covid-19.
At the moment, the Ministry of Health is pooling many tests and running them together in the labs as this is cheaper.