I think we need to look at things from the beginning. The coronavirus was imported into Kenya through travel by plane. When it got here, most people infected were travellers. We put in measures meant to prevent its transmission. We locked down, restricted movement and gatherings. I think those things worked. By September, we had minimal cases. Our hospitals were not parked with people with pneumonia and the healthcare system was able to cope with numbers that we were seeing at the time.
Then we said: “Let us relax things a little bit.” We allowed people to travel and to gather. Very importantly, we allowed pubs and bars to open and political meetings to take place. There were consequences, which we are calling a new surge. It is however really all about how we behaved. Had we continued to behave the way we were behaving, in May or June, there would have been no new surge. The potential for a surge would have been there but there would not have been a new surge. For me, top of my list was opening of bars and pubs and allowing gathering – political meetings, funerals weddings and such. This is what caused the spike in infections that we are seeing.
In bars, for example, people get closer to each other, shout and speak loudly, which increases the transmission of the coronavirus. That is where our second surge came from. In the absence of a vaccine, a large proportion of the population would get infected, and most would develop immunity - the so-called herd immunity. For now, we do not know if herd immunity would be real and how long it would last. What is certain is that the number of sick people and those dying would rise rapidly. In my opinion, we should rethink the gatherings and reinvigorate mask wearing. This what we can do as a country to control the infection as we wait for the vaccines to be rolled out.
Human beings are interesting. As a practising physician, I meet many people who do not believe that this virus is real. Some people say: “I have not seen anyone with Covid-19.” To be sure, that has changed because few people have now been touched by the pandemic through family or friends. There are, however, people who still believe it will not affect them.
On the other hand, wearing a mask, distancing and frequently washing hands are not the easiest things to do. It takes discipline to be able to say: “I will wear a mask, avoid public gatherings and keep away from people.” These are difficult protocols for everybody including ordinary people and politicians. We like to drink and to socialise. We all however must ask ourselves: “Will it be me in a ventilator one day?” Those are the kind of decisions we need to make at individual levels, and unfortunately, a lot of us are choosing to ignore the protocols.
That is where the government comes in. If people ignore doing what is desirable for the public good, then you must force it on them. We will not see a situation where 90 per cent of people do the right thing. It does not happen anywhere, especially in our situation, which is a democratic order where people have a choice. In areas of the world where people are used to different kinds of governments bordering on authoritarianism, there is a tendency for people to behave in a certain way. Where people have confidence in their government and government means everything, people behave differently.
Taiwan and China are good examples. China is a huge country of more than 1.2 billion people, but they brought infections down to less than 10 deaths or non per day. Kenya, with 50 million people, is still reporting more than 17 deaths daily. It boils down to attitude towards government. In China, if the government says: “Do not do it,” nobody does it, but in Kenya, if the government says: “Do not do it,” we ask: “What is government?”
I would say that it is our leaders who need to change their attitudes. If politicians led in the wearing of masks and in telling people that there is a health crisis, people would follow. Even better, they should put desks with masks and hand washing points during their public rallies. That would get people to change their attitude towards the pandemic. However, when people see politicians ignoring the protocols, they feel cheated. Leadership by example is what people need. The truth is that there is a health crisis. For the last two weeks, I have been taking care of people with Covid-19. At one time in November, all ICU beds in Nairobi were full. That is a massive health crisis in my view.
We need to inculcate a culture of discipline and it starts by having a disciplined political force. The politicians in this country will have to begin behaving differently. If that happens, the rest of the population with follow suit. This is what has worked in countries such as Taiwan, Singapore, and Japan. In Taiwan for example, people did not have to wait for the government to tell them to wear masks. The moment they knew that they had an aerosolised infection (an infection transmitted through the air) they all started wearing masks. That is the culture we need to inculcate here. If we had a culture where everyone was wearing a mask, you would find it odd to go to a meeting without wearing one. But if the culture is the opposite, you find you are the odd person out if you wear a mask!
Home-based care has its place. If you look at the severity spectrum of Covid-19, 80 per cent of people, all over the world will have no symptoms and they will not even know they are infected. 10-15 per cent will have mild symptoms such as a mild headache, runny nose, and some discomfort but they are generally healthy. Then there is the 5 per cent that, whether we like it or not, must be in a hospital. They need oxygen, doctors, nurses, and monitoring. Lastly, there is the 1 per cent who will die. This is what is happening in Kenya now. If you look at all the infections and those who die and those who survive, we are at about 1 per cent or slightly less than 2 per cent. These are the people overwhelming our health system. We need to cater for that group. We need to make sure there is oxygen in all our hospitals where people seek care. It needs to begin with a health centre, not just in a hospital. We need to have gradations of oxygen delivery. The system must be prepared for that and if we will not resort to more restrictions. We have not prepared adequately for that group.
At the end of the day, it all begins with believing and knowing that there is a health crisis. If there is a Kenyan today who does not believe that there is a health crisis, then there is a huge problem. In a health crisis, everyone has a responsibility, individuals, governments, and communities. As an individual, I have the responsibility to do the minimum I should be doing by wearing a mask, washing my hands with soap or sanitising, and keeping social distance. That is an individual responsibility. In this chain of things, some bear more responsibility. Governments have a bigger responsibility. They need to punish those who fail to adhere to protocols and reward those who do. That is how human behaviour works. If people perceive there are no sanctions, then they will not behave in a certain way. The other aspect is the reward. The reward for me wearing a mask and distancing is that I do not get Covid-19. But if I do not perceive that as something that was not going to happen to me in the first place, then I will not do it. All these things can modify behaviour at the individual level.
For us to go back to normal, we need a safe and effective vaccine. Safety must be for the long term. Safety and efficacy are very important in vaccine development. If the vaccine becomes available, it must reach everyone who needs it. If you look at the behaviour of the virus, you need to prioritise certain groups of people. Start with those likely to get the severe disease: the elderly, hypertensives, and diabetics. I would not give it to young children because Covid-19 is not a problem of the young. We are hoping the new vaccines will be rolled out in all countries of the world. What has happened so far is that there has been a bit of a rush, which is understandable because we all want to get back to normal. However, we will still need to know: is the vaccine safe? These are the questions that scientists will have to answer for us. Will they be available, affordable, and accessible to all who need them? We can only wait and see.
I am not a specialist, but these are called RNA and DNA vaccines. The technologies are not exactly new and have been around for more than 10 years. Genes are responsible for making proteins. What scientists are doing is to map out the gene responsible for producing the so-called “spike protein”. If the segment of genetic material is responsible for a certain protein, the idea is to produce something that will make the body produce antibodies against the identified protein (or antigen). The main worry that people have about the technology is that the RNA being used should not integrate with people’s genetic makeup and start modifying their other functions in uncontrollable ways. We have been told that this is not the case.
That is a geopolitical question. Pharmaceutical industries were developed to make profits. Governments sometimes give them money to help make products public good products such as vaccines. Usually, companies must recoup their investment. That is why new innovative products are sometimes sold at very high prices. The high cost is the reason why many countries such as Kenya are not in the frontline of receiving the new vaccines. This is where Africa and other parts of the developing world go wrong. If African countries came together through the African Centres for Disease Control and Prevention (Africa CDC) and pooled money, they could develop similar technologies and be at par with other countries. So, whether we like it or not and unless we lobby, I suspect that by the time we get the vaccine here, it maybe be June or even August next year. How many people will have died from Covid-19 by then? Your guess is as good as mine. The poor tend to be the last online to benefit from new inventions. For all we know, one or two Kenyans will probably get vaccinated by next week when vaccination is set to start in the UK! We, however, can develop mechanisms to ensure that these products get to everybody. We hope that those who are responsible for negotiating international treaties and agreements will really push so make sure that these new vaccines are made available to poor countries like our in shortest possible time, otherwise, if will are going to wait for the natural mechanisms, it will probably be 2023 before the first dose is rolled out in Kenya.
Unfortunately, that is what it will have to be. I have always told people that though a vaccine is important, we really do not know whether from a public health perspective we will have access to a vaccine by June 2021. Our president and other presidents will need to lobby until the vaccine is made available. In the meantime, we have our second “vaccine”: masking, socially distancing and hand washing. If we do that, we will limit deaths.
I want to tell people that the situation has not improved and in the next few months, it has the potential to get worse. In the last several months I have taken care of many people with Covid-19. I have seen the suffering that Covid-19 can cause. I have people who have suffered and recovered from Covid-19 that will no longer be able to do the things that they were doing before because their lungs were destroyed. I would like those who do not believe to visit me. I will show them pictures of the lungs of people who have had Covid-19 and are really suffering today.
The Americans predicted the other day that if 90 per cent of people were wearing masks at all the important times, when you are talking to people, for example, it would bring down the pandemic in the US to halt in two weeks. The same would happen here too is we wore our masks every day, at important times. In two weeks, we would not be talking about 17 people dying of Covid-19.
This is where I would like to appeal to our governments, both National and counties to come up with a mask acquisition and distribution plan. If we really believe we want to make a change about this pandemic in our country, why are we not developing those mechanisms? If you want the population to mask, let the population be provided with masks.
My name is Jeremiah Chakaya, I am a pulmonologist by training. I have been engaged with Doctors for Healthy Living for some time. The kind of public education being carried out by DHL is very important. When I was asked to talk about Covid-19, I realised that it is the largest and most frightening public health threat we are seeing right now in the world. I therefore gladly accepted to be part of this because I want to make a difference in my small way and, at least, provide something that can change the way this pandemic is affecting our country.
