My COVID-19 experience, Jan - June 2020
I have never been luckier in my professional/academic life until when I joined my dream program, Kenya Field Epidemiology and Laboratory Training Program, Kenya (K-FELTP) in conjunction with Moi university School of Public health as a cohort 16 resident in October 2019 to pursue MSc. Field Epidemiology. This is sincerely one of the best scholarship programs for officers in health matters whose dream is in the public health not only in Kenya but worldwide. I hold the golden opportunity with my two hands, indeed I look forward to become one of the best and sought after in the broader discipline of Field Epidemiology, despite my small challenges especially in data analysis using various computer softwares, I however, take one day at a time to perfect my skills and finally shall overwhelmingly meet all the desired program deliverables.
Field Epidemiology and Laboratory Training Program, Kenya, objectively strives among others to;
- Strengthen public health capacity by developing a cadre of health professionals with advanced skills in applied epidemiology and laboratory management
- Contribute to research activities on priority public health problems
- Strengthen national and regional capacity to respond to public health emergencies
- Strengthen national surveillance systems
- Strengthen laboratory participation in surveillance and field investigations
- Improve communications and networking of public health practitioners and researchers
The Corona virus disease 2019Coronavirus disease 2019 which is also called COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease outbreak was first reported in China on 31st December 2019. The World health organization (WHO) declared it a pandemic on 11th March 2020. A total of 723,124 cases were reported globally as on 30th march 2020 with deaths numbering 3,694,071 (CFR 4.4%). Key symptoms include fever, cough, and shortness of breath. Other symptoms may include muscle pain, Productive Cough, diarrhea, sore throat, abdominal pain, and loss of smell or taste. Approximately 80 percent of the cases present with mild symptoms, 15 percent severe Pneumonia, and 5 percent critical progressing to multi-organ failure. Currently in Kenya as at 4th June,2020, there are 2340 cases confirmed out of the 80,000 tests done, 592 recoveries and 78 deaths giving a case fatality rate of 3.33%.
Roles and Activities done
JOMO KENYATTA INTERNATIONAL AIRPORT (JKIA)
The activity at the airport began in late January, where a group of FELTP residents were deployed under the port health in various rotation groups. I was deployed at the various terminals mainly at the international flight arrivals to carry out COVID-19 passenger screening and other communicable diseases of public health importance, this also involved surveillance and collection of specific data on the same. Report submission had to be done daily for onward submission.
Based on case definition on COVID-19 then, passengers who travelled from foreign countries considered high risk had to be screened on board before disembarking from their planes, their temperatures had to be taken where ones whose readings were high above 37.6 degrees Centigrade had to be interrogated further including subsequent monitoring of the same where if no change, the patient had to be isolated at the port health clinic for further advise or appropriate medical attention. Other passengers from countries not considered high risk had to pass through thermo scanners while others were screened using thermo guns just in case it wasn’t possible to use thermo scanners at some designated gates or points.
Other than the COVID -19 activity at JKIA, I equally learnt on how activities at the port health on other diseases of public health importance are surveyed and how data collection and reporting on the same are done. In deed the airport offered me a great insight on how passenger travel and health issues are interconnected. Around mid-march, cohort 16 residents went back to class for some class activities.
On 13th of March,2020, the first corona virus case was detected in the country, as a result we were recalled to beef up surveillance services at the EOC and at the same time sensitized on COVID 19 issues including sample collection. Six of us as the cohort 16 residents were deployed to the rapid response team where we were to carry out among others:
- Respond to alerts raised on suspected cases and contacts of confirmed cases within Nairobi by moving to their physical location, collecting the relevant data on the same and collecting their samples for testing in the labs.
- Giving health education and carrying out risk assessment on the suspected cases families.
- Collection and submission of daily activity report to the group coordinator for onward submission to the EOC.
- Mentoring new members joining the RRT and training of other health workers in the counties on COVID-19 issues especially on the aspects of rapid response activities.
- Being flexible to take up any other additional role and assistance whenever called upon.
On 7th May – 22nd May, 2020, the FELTP formed a team of 3 of us as residents under the team coordinator, Dr. Fred Odhiambo to help carry out outbreak investigation of COVID 19 and to help build the capacities of the counties of Bungoma and Busia in response towards the same. Our main objectives in the activity were
- To support the county in active case search
- To support the county in conducting contact tracing
- To capacity build county Rapid Response Team and data management teams
We had an opportunity to visit port health office at Malaba one stop border point, our main aim was to advise and jointly find a convenient way forward on how to operationalize mass testing of truck drivers who had so far been proved to be a risky group in the spread of COVID-19. We had a lengthy deliberation with management of port health and later with the KRA station manager in his office including the Busia county medical lab coordinator and the county disease surveillance officer. The main challenge that proved to be a hindrance in implementing the mass testing in accordance with the government protocol that had just been developed was lack of parking space for the trailers without interfering with international trade given that the station witnesses a high number of trailers approximately 1000 in number moving to and from Kenya on a daily basis. Other issues like testing turnaround time, limited human resource to carry out sample collection and shortage of testing kits further complicated the issue. However, agreed to operationalize the activity so that other long-term solutions shall be jointly looked into, the KRA agreed to donate a spacious canteen shop to be used as a COVID-19 sample collection facility and other relevant activities of data capture.
Summarily, border counties being high-risk in terms of COVID-19 transmission and infection needs to be specially supported by the national government to carry out timely surveillance and mass testing exercise of the truck drivers and other travellers crossing the borders.
We equally had an opportunity to visit Malaba side of Uganda to check out on how they carry out their mass testing activity, we found out that their efficiency was due to availability of ample parking space and shorter turn around testing time of 1 hour since they had adopted the use of ultra-modern gene x pert platform to test for COVID-19, their systems were equally digitalised to improve efficiency hence minimising the possibility of any delay.
Main challenges encountered include:
- The manner in which COVID-19 operations have been carried out sometimes stigmatizes the general public hence they become so much cautious to volunteer any useful information that is of help i.e. disclosure of contacts or reporting of suspicious cases.
- Limited human resource to enable carry out the activities in rapid response
- Relay of COVID-19 test results back to the clients is a challenge, this has led to a number of complains among clients hence may have an eroded trust on the activity.
- Lack of Psychosocial support for the officers engaged in the activity to enable them cope with the challenges.
- Limited resources and lack of harmonisation of in operations between the border countries in mass testing of truck drivers.
- Being an extra ordinary activity that requires a 24hours standby and sacrifice at extra ordinary hours at times, the government hasn’t considered a special renumeration of officers involved, should the government adopt, it may equally go a long way in boosting the officers’ morale.