What are the critical metrics for progressive policy calibration?

On October 20, 2021, Kenya lifted the 19-month long nationwide curfew. Can this bold move set a precedent with key lessons to inform similar responses in Africa?

If the relatively steady metrics aggregated from the growing body of cross-country COVID-19 data are anything to go by, then different regions and countries can now chart new containment policy responses with bolder moves, a sharp contrast to the cloud of uncertainty that prevailed twenty months ago. The summary of recent performance indicators shared here qualifies the watershed moments of an emerging post-pandemic world.

Monitoring the COVID waves keenly every four months has been a key lesson from the four waves Kenya has already experienced, hence the leading importance of the new month of November in decoding any hidden dangers in the wily and wavy pattern of the pandemic as countries start on major easing of restrictions.

Key Highlights as of October 21, 2021

1. Relative to the global average and other regions, Oceania and North America are fairing badly on the performance indicators for their share of active COVID-19 cases and likelihood that the confirmed cases can degrade into severe (serious or critical) cases.
2. As of October 21, 2021, South America (more than 38 million cases) and Africa (more than 8.5 million cases) still sustained the highest case fatality rates, recording between 0.5% and 1% above the global average of 2%.
3. The ongoing vaccinations globally have heralded hope for coping with COVID-19 like any other disease. Countries have subsequently started easing the strict restrictions that accompanied the initial waves of the pandemic.
4. With her share of active cases reduced to 0.5% and the probability of developing severe cases at 0.01% as of October 21, 2021, Kenya has set a precedent in East Africa by lifting the 19-month nationwide curfew to facilitate economic recovery.
5. The latest trends in Kenya’s COVID-19 curve after recording a total of 250,000 cases, experiencing four ravaging waves, and sustaining a curve that remained more than 10% below the projected business-as-usual (BAU) numbers for more than three weeks could offer critical insights into how to judiciously interpret key signals for progressively calibrating containment policies.

Global Overview

With COVID-19 vaccination continuing globally, the global case fatality rate has stabilised at 2% with a recovery rate of 91% and the likelihood of developing severe (serious or critical) COVID-19 cases at about 0.03%. More than 243 million cases had been confirmed globally as of October 21, 2021 and 7% of them were active cases. This is a sharp rise from just about one million total cases globally in early April 2020.

Continents continued to record different average rates by October 21, 2021. Boasting high vaccination rates, Europe was posting the lowest probability of developing severe COVID-19 cases (0.02%) with a case fatality rate of 2% and recovery rate of 91%. Oceania’s probability of developing severe COVID-19 cases remained the highest (0.13%), followed by North America and Asia (0.04%), then South America and Africa (0.03%).

At a time when Asia was boasting the lowest percentage of active cases (2%) out of the total cases confirmed in the region, Oceania and North America still had the world’s highest percentage in their active cases (19%) — as of October 21, 2021. This share was almost three times the global average of active cases (7%).

The case fatality rates for Africa (2.5%) and South America (3.1%) remained higher than the global average and the rest of the regions: Oceania (1.2%), Asia (1.5%), North America (2.0%), and Europe (2.0%).

Differences in Normalised COVID-19 Testing Rates

Using a selection of thirty countries drawn from various continents, a keen examination of COVID-19 testing rates when normalised by country population and the total length of the testing period provides key comparative insights into the country testing capacities over the last one year. The greatest improvements on this normalised metric have been realised outside Africa: the UK, France, Italy, and Israel are exemplary as shown in the radar plot below. In Africa, similar remarkable improvements on this metric could be noticed in Egypt, Cameroon, and Rwanda.

In terms of the actual scores in Africa over the reference period from September 2020 to October 2021, the top performers on this metric were Mauritius, Morocco, South Africa, and Rwanda. The recession in performance over the period is evident from the plot, Mauritius and China being perfect examples.

As most countries outside Africa continue increasing their testing rates including India and Brazil, the implication is that African countries must not drop the guard even as restrictions get relaxed to allow economies to recover. They still need to enhance testing, tracing, and vaccination rates to cope with and adapt well to the emerging COVID challenges. New variants from random mutations add a crucial layer to the body of challenges, calling for cautious optimism.

Lessons from Kenya’s Fourth Wave

Key insights have been derived from a model of COVID-19 scenarios in Kenya for the period from June to October, 2021. Cross-country modelling experience from April 2020 informed the assumptions, based on testing rates and data-driven calibrations that led to the best-fitting curves with R-squared values of at least 99%.

Kenya’s fourth COVID wave realised a consistent drop in positivity rates from early September 2021. Come October 1, the 249,725 confirmed COVID-19 cases in Kenya were 11.4% below the simulated BAU scenario and 14.7% below the pessimistic exponential trajectory. The actual COVID-19 cases were sustained at more than 10% below the projected BAU scenario for more than three weeks by the time the curfew was eventually lifted, on October 20, 2021. As of October 21, 2021, the active cases made up 0.5% of the total cases and the probability of developing serious or critical cases out of the total cases was 0.013% — below the average globally (0.032%) and in Africa (0.029%).

Conclusion

In contrast to a year before, the availability of vaccinations has given hope to a world recovering from a disruptive pandemic. Vaccines have become a key part of the solution equation, besides compliant behaviour and policy enforcement.

The delicate balancing act of economic recovery while simultaneously ensuring health and safety amid a pandemic can now find important signals in scientific indicators of performance and growing prospects for herd immunity. Beginning with the countries in East Africa, which share similar experiences with Kenya in the regional bloc, the following key indicators should be instructive for gradually easing COVID-19 restrictions in favour of economic recovery:

1. Having a consistent drop in active cases and in the probability of developing severe cases for at least three weeks;
2. Declining positivity rates in a fashion that can see the COVID curves falling at least 10% below the business-as-usual model scenarios for at least three weeks; and
3. A demonstrated increase in public awareness of the dangers of the pandemic and public trust in the recommended containment measures, the rate of uptake of vaccinations being key.

Finally, the real end of the fight is not yet in sight since the measures Kenya has so far taken remain part of learning to dance in the complex waves of COVID-19. Monitoring the COVID waves keenly every four months has been a key lesson from the four waves Kenya has already experienced, hence the leading importance of the new month of November in decoding any hidden dangers in the wily wavy pattern of the pandemic following the major easing of restrictions started in October.

By Nashon Adero (nashon.adero@gmail.com)

The author is a lecturer at Taita Taveta University, a geospatial expert, and a thought leader applying systems thinking and dynamic models to inform policy and predictive mapping and management.