Navigating COVID Curves: Lessons From Kenya

Published on 9th March 2021

Is this Kenya’s Third COVID Wave?

Since March 2021, Kenya has been recording higher and double-digit positivity rates while conducting more COVID-19 tests than the trend over the December 2020 — February 2021 period. Fears of a third wave have consequently risen. On March 3, 2021, Kenya received the first batch of a million doses of COVID-19 AstraZeneca-Oxford vaccine under the global COVAX initiative. First though, a review of the year-long journey in navigating the resurgent and wavy COVID-19 curves is hereby presented.

Down Memory Lane with Deliverables and Data, not Dates

After a year of studying the trends of the pandemic in Kenya, fifteen other African countries, and sixteen countries representing the world outside Africa, this modelling series has the confidence and excitement of sharing fresh perspectives on the manner and meaning of the COVID-19 curves. 

From just one million COVID-19 cases globally in early April 2020 with a recorded global case fatality rate of 5% and recovery rate of 21%, to more than 117 million cases by March 8, 2021 and a high global recovery rate of 79%, much has changed. For hosting 17% of the global population, Africa’s 3% share of the global COVID-19 cases easily escapes the boundaries of defining a narrow escape. Insights from data and new knowledge may, however, reveal new lessons over time. 

In August and November 2020, the Inter Region Economic Network (IREN), a well-known private think tank located in Nairobi, engaged thought leaders from Africa in virtual forums to discuss the future of the continent in a post-pandemic world. The vaccine race was still on and sentiments around vaccine nationalism were precipitating. The idea of publishing a book entitled The Future of Africa in the Post-COVID-19 World was conceived to do justice to the wealth and wellspring of potent ideas for homegrown solutions that featured at the forums. The coming to fruition of this idea following the imminent launch of the book is inspiring to African thought leaders as it offsets a good part of the heavy weight of victory other regions of the world have posted during the pandemic, vaccines being key. 

It has been an exciting journey of substance and surprises, and of scaling new heights of knowledge on the scale and character of the global pandemic. Inspiration from the developing success of vaccination in Israel gives hope to a world ravaged by a pandemic. On a cautionary note, the high percentage of citizens that should be vaccinated to ensure herd immunity, about 70% according to current knowledge, raises the stakes for African countries with their large populations and slower rates of testing and vaccination.

In the global north, countries such as the UK and Germany went for tighter COVID-19 containment measures in the 2020/21 winter season. In the UK, an instructive point attributed to the Prime Minister asserted that any relaxation of the containment measures was to be decided “by data, not by dates.” The lesson in this statement reinforces that data integrity is critical to charting timely and effective pathways to containing the pandemic. 

New COVID-19 Status Map

On March 8, 2021, the global total had exceeded 117.6 million COVID-19 cases. The global case fatality rate was still rather sustained at 2.2% (compare 2.7% for Africa) and the global recovery rate at 79% (compare 89% for Africa). Compared to the global population, the shares of COVID-19 cases have been disproportionately lower in Africa. At almost 4 million, Africa’s COVID-19 cases on March 8, 2021 makes up only 3.4% of the global total though the continent hosts 17% of the global population. On the same date, Kenya had 2.7% of Africa’s total COVID-19 cases despite hosting 4% of Africa’s total population. Kenya’s COVID-19 status map on March 8, 2021 had a total of 109,164 confirmed cases, 18% of them being active cases following a case fatality rate of 1.7% and a recovery rate of 80%. The serious or critical cases made up 0.4% of Kenya’s active cases, an increase from the recent 0.1% share.

With new variants already confirmed in several African countries including Kenya, the metrics on the share of active and critical COVID-19 cases must take precedence in policy and strategic decisions. Kenya’s active cases on March 8, 2021 made up 6% of Africa’s total active cases, punching above her 4% continental population share on this measure. On the same day, the sum of serious and critical cases in Kenya made up 3% of Africa’s total serious and critical cases.

The map of Kenya’s share of confirmed COVID-19 cases across her 47 counties has consistently been pronounced (red) in the main urban centres, the Nairobi metropolitan area, and along the major transportation routes. On March 8, 2021, Nairobi City County alone had 44.5% of the national tally, followed by Mombasa (8.6%), Kiambu (6.5%), and Nakuru (4.7%). This spatial profiling could inform the level of strictness of containment measures by tiers whenever radical measures have to be advanced.

The 7Ts of Disaster Governance

Insights from the last one year of this COVID-19 research series have made it urgent for Africa to consider consolidated lessons in the efficacy of these 7Ts: timing, testing, tracing, trust, transparency, training, and transdisciplinary research. As a continent which a year later is still carousing in the glory of escaping the COVID-19 doomsday predictions, there is real danger in losing caution as leaders and citizens relax. The bigger mandate is to translate the lessons arising from COVID-19 into structured and long-term disaster governance and support systems. Timely response informed by adequate data from testing and technologically leveraged tracing techniques has been a key feature in the success of countries in containing COVID-19. The tracing of the first case of COVID-19 in Germany to a saltshaker in a restaurant in Bavaria is a sterling example of the pinpointed triumph of spatially leveraged technologies in disaster management. 

The science-policy interface must be made stronger through efficient research and development (R&D), which requires not only adequate funding but also frugality in spending and utilising the allocated resources. Quality training to increase the stock of homegrown competencies and robust business models to anchor the place of Africa in the community of solution providers cannot be overemphasised. Like COVID-19, the increasingly complex, borderless and interconnected problems facing the world today dictate the engagement of transdisciplinary approaches, a key consideration for any progressive education and training in the post-pandemic era. Gaining public trust through effective communication and transparent government processes is critical to the much-needed collective, participatory approach to managing common disasters. The following examples drawn from Kenya will shed more light on the arguments. 

Kenyan Examples, Scalable Lessons for Africa

For reasons that this research has attributed largely to delayed response and low sampling and testing efficacies, the surge in COVID-19 cases in Kenya this modelling series simulated to happen after the December festivities and subsequent school reopening in January 2021 was 21% higher than the confirmed total of 100,773 cases as at January 31, 2021. This was the highest difference between the simulated and confirmed end-month totals for Kenya since this modelling series started in early 2020. Noteworthy however, the period January — February 2021 saw a significantly reduced testing rate in Kenya, leading to a stagnation in the long-term daily average population-normalised testing rate at 66–67 tests per million people per day. It was not until March 7, 2021, that this rate increased to 68.

Kenya’s observed positivity rate took a consistently downward trend from 12.4% on December 2, 2020 to 2.6% at the end of January 2021. By the end of February 2021, pandemic fatigue and normalcy bias had set in. The majority lowered their guard as compliance rates with COVID-19 containment protocols plunged. With the first batch of a million doses of COVID-19 vaccines already in Kenya, extra caution and awareness creation are necessary to avoid any further lowering of guard and agitating the curve upwards. The reported high percentage of citizens to be vaccinated for herd immunity, about 70%, makes the vaccination route a long-term containment measure as opposed to an instant panacea.

Some insights into the key parameters guiding this research series

Why normalise the COVID-19 tests? 

This modelling series has been calculating and applying the long-term daily average population-normalised COVID-19 tests for countries, in terms of tests per million people per day. This normalised measure of COVID-19 tests by countries removes the bias of wide variations in country population sizes and the dates on which they started testing for COVID-19. The resulting metric gives a fair performance indicator for cross-country comparison. It doesn’t matter that Rwanda has a quarter of Kenya’s population and Kenya’s population is a quarter Nigeria’s, or that they started testing on different dates.

Key country examples on testing capacity

By February 22, 2021, Kenya’s effective testing rate on this normalised indicator, just 67, was far below the rates for Morocco and South Africa (421 for each), India (393), Brazil (369), Rwanda (216), or Ghana (80). It was, however, a bit higher than Uganda’s (55) and Ethiopia’s (52). No country in Africa had reached anywhere near the advanced economies in the global north on this indicator. Israel had scored 3439 tests per million people per day on this measure by the same date, ahead of the UK (3256), the USA (2639), France (1977), Russia (1935), Canada (1533), or Germany (1299).

Sampling and geodemographic diversity

The needs-based testing that Kenya has adopted has become public knowledge. The choice of this kind of testing can be attributed more to a deliberate coping strategy due to limited testing capacity than to the full rigour of scientific sampling. The geodemographic diversity of Kenya, like for most other countries, calls for adequate and stratified population-targeted sampling and testing to draw nearer to the true picture on the ground.

From mid-February 2021 as the model shows, the positivity rates have been on an upward trend, mostly staying above 5% from early March. Going by the experience gained from the previous wavy attack styles of the COVID curve, expecting the third wave and preparing to contain it adequately is not just a good idea, but the pragmatic minimum for a country that has lost a whole school calendar to the pandemic and widened the existing inequalities in access to education amidst crippling structural divides in human and infrastructural resources. Young learners are expected to be back home for holiday in March, hence the unavoidable movements across the country. It is, therefore, not the time to relax the routine COVID-19 containment measures or for citizens to lower their guard.

Probable scenarios within the model boundaries

The model takes into account the total cases confirmed in Kenya and the increasing positivity rates from January 14 to March 8, 2021. January 14 was the simulated peak of the previous curve at 103,188 cases, a theoretical figure which came to be 4.6% above the actual 89,771 cases recorded in Kenya on that date. The simulations are expected to remain within 10% of the actual cases. Learning from the past trends, two model scenarios have been generated in Kenya’s COVID-19 model:

1.    Business as usual (BAU) assuming the trend from January 14 — February 26 would maintain, simulating 115,896 cases on March 31, 2021

2.    Upper trajectory assuming the rising trend from February 26 continued, simulating 137,675 cases on March 31, 2021

Implications for Kenya and Overall Lessons for Africa

Six key points emerge as important lessons from this discourse. Though the points have mainly originated from examples in Kenya, they are applicable across the board to managing the pandemic in Africa and the future of the continent in a post-pandemic world. 

1.    Facing the third wave — better safe than sorry

The wavy nature of the pandemic, studied over the last one year in this series, makes an upcoming third wave a highly likely yet inconvenient fact to face and adequately prepare to deface using all the proven containment measures: mask wearing, hygiene, social distancing, and adequate population-targeted sampling, tracing and testing. If the latest emerging trend in Kenya’s COVID-19 cases continues, it is possible to record a third wave rising to between 115,000 and 138,000 cases by March 31, 2021. Similar models can be developed for specific cases across Africa to support timely containment decisions. 

2.    Testing efficacy — data integrity is critical

The recent increase in Kenya’s COVID-19 testing rate from late February 2021 is laudable. Adequate sampling, tracing and testing produces the data essential to knowledge-based and effective calibration of containment policies and strategies. Data integrity is critical, as is the building of public trust in the pandemic containment processes.

3.    Spatial justice — are urban centres the hotspots or simply the most tested?

The COVID-19 map of Kenya has for long displayed the key urban centres as the hotspots of the rising number of cases. This outcome could inform extra care to help reduce transmissions in these areas, but it could also challenge the testing protocol adopted with respect to its spatial representativeness over the year. Data integrity remains critical to accurately timing and calibrating the containment measures against the resurgent pandemic. This lesson is transferrable to other country scenarios. 

4.    Visualisation — how to influence the modern demographic

Communication is increasingly becoming visual, making visualisation techniques key to influencing behaviour change among the dominant demographic of this era. It is important to leverage COVID-19 data collection techniques and processes with location-based intelligence from spatial mapping. This step will help improve public engagement using mapped visual evidence at scale.

5.    Curfew extension — a reasonable middle-ground for health and economy

For an economy recovering from the shocks of COVID-19 while facing the possible resurgence of its curve, softer movement restrictions such as relaxed curfew hours deserve to be retained as stricter enforcement of public health protocols take precedence. Reviving the economy is key, but even more so is protecting health for all with a keen awareness of the likely choices of the nation’s young and socially active citizens if all restrictions are removed.

6.    School holidays — parental and community care to improve

Besides controlling mass gatherings as witnessed in many political rallies across Kenya, a big positive difference is expected if parents and the local community will assist their children, who are supposed to be back from school for holiday, to ensure compliance with all COVID-19 containment measures. A surge in cases is likely to grow worse if children and young learners engage in super-spreader activities while out of school. Complete removal of the curfew will be a highly tempting trigger of such activities.

By Nashon Adero.

The author is a lecturer at Taita Taveta University (Kenya) and a geospatial and systems modelling expert with vast experience in policy research and analysis. He has edited the soon-to-be launched book: The Future of Africa in the Post-COVID-19 World. 

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