MINISTRY OF HEALTH DATA AS REPORTED BY 1700 HOURS 17 July

COVID-19 OUTBREAK IN

DAILY SITUATION REPORT - 122

1.0 KEY HIGHLIGHTS

1. Three hundred and eighty-nine (389) new confirmed COVID-19 cases were reported in the last 24 hours bringing the total number of confirmed cases in Kenya to 12062 cases as of 17 July. Counties reporting new cases are (270), (26), (21), Makueni (14), (11), Busia (9), (9), (6), (4), (3), (3), (2), Turkana (2), Uasin Gishu (2), (1), (1), (1), (1), Taita Taveta (1), Tharaka Nithi (1) and Trans Nzoia (1).

2. Five (5) deaths have been reported over the last 24 hours. The total number of deaths reported since the beginning of the outbreak is 222, case fatality rate (CFR) is 1.8 percent.

3. In the last 24 hours, 345 (134 from health facilities and 211 from home based care) COVID-19 patients were discharged. The total number of recoveries and discharges for COVID-19 stand at 3,983.

4. As of today, forty-three (43) out of 47 counties have reported cases namely: Nairobi (6766), Mombasa (1795), Kiambu (666), Kajiado (651), Busia (613), Machakos (346), Migori (214), Nakuru (176), Uasin Gishu (163), Kilifi (80), Makueni (66), Kwale (55), Taita Taveta (43), Kisumu (40), Garissa (35), (33), (31), (23), Turkana (22), Meru (21), Mandera (20), (20), (19), Kericho (18), (18), Laikipia (17), Murang'a (17), (12), Kakamega (12), Bungoma (9), Kisii (9), (9), Nandi (8), (6), Marsabit (6), Trans Nzoia (6), (5), (4), Embu (2), Kirinyaga (2), Nyandarua (2), Elgeyo Marakwet (1) and Tharaka Nithi (1).

5. Nairobi city and Mombasa Counties have the highest attack rates of COVID-19 at 153.9 and 148.6 per 100,000 populations respectively when compared to 25.4 per 100,000 for the whole country and need enhanced interventions. In addition, the COVID-19 outbreak has so far spread to 92 percent of the counties in the country. Risk communication, laboratory testing and contact tracing have been identified as key challenges.

6. Of the affected counties, only submitted contact tracing Laikipia, Taita Taveta, Muranga, Meru, Kiambu, Turkana, Isiolo, Kilifi, Nairobi, Garissa, Kisumu, Homa Bay, Kisii, Siaya, Busia, Mombasa and Marsabit submitted contact tracing reports.

7. Eleven thousand one hundred and eighty (93 percent) of the 12062 confirmed cases are local transmissions.

8. Among those who filled in their occupation, 485 are healthcare workers with four mortalities.

9. In the last 24 hours, 3545 samples were tested across various laboratories of which 389 samples turned positive for COVID-19. A total of 228,674 cumulative tests have so far been conducted.

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COVID-19 SITUATION UPDATE: 17 July 2020

Total Cases Male = 8143 Deaths =12062 Female = 3919 =222

1.1 Epidemiology Since 13 March 2020 when the first case was confirmed in Kenya, a total of 12062 confirmed cases and 222 have died giving a case fatality rate of 1.8 percent have been line listed. Of these, 11180 cases (93 percent) were local transmissions and 882 (7 percent) are imported cases. The Figure 1 below shows trends of cases Figure 2 shows cumulative caseload. Figure 3 shows number of samples tested by date indicating the positive and negative results. Laboratory test rate currently stands at 4808 samples per 1,000,000 people.

Figure 1: Trends of COVID-19 Outbreak Kenya

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1.2 Cumulative Cases and Mortalities

Figure 2: Cumulative case load

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1.3 Laboratory Testing

Figure 3: Laboratory Tests Conducted by Date Results Were Shared

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1.4 Distribution of Confirmed COVID-19 Cases by Presentation and Presentation of Symptoms among Symptomatic cases Of the 12062 confirmed cases, 1193 (10 percent) presented with symptoms (Figure 4). Cough (55 percent) and fever (43 percent) were predominant presenting symptoms.

Figure 4: Distribution of Presenting Symptoms among Symptomatic COVID-19 Cases

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1.5 Age and Sex Distribution of COVID Confirmed Cases Eight thousand one hundred and forty-three (68 percent) are males and 3919 (32 percent) are females. Majority of the cases; 3922 (33 percent), are in the age group of 30-39 years. Figure 5 below shows age and sex distribution of COVID-19 cases.

Figure 5: Age and Sex Distribution of COVID-19 Cases Kenya

1.6 Characterization of COVID -19 Mortalities Two hundred and twenty-two deaths have been reported so far, 168 (76 percent) being males and 54 (24 percent) were females (Figure 6).

Figure 6: Distribution of Case Fatalities by Age and Sex

MOH Kenya /17 July 2020 6 | P a g e Among the 222 COVID-19 mortalities, 121 (55 percent) had comorbid conditions, 15 (7 percent) had no comorbid conditions, while 86 (39 percent) had missing data as illustrated in Figure 7.

All COVID-19 Mortalities (N=222)

Mortalities with Mortalities with no Mortalities with comorbidities comorbidities missing data 121 (55%) 15 (7%) 86 (39%)

Figure 7: Flow diagram of COVID-19 mortalities

One third of the COVID – 19 mortalities had both hypertension and diabetes as comorbid conditions. Second are COVID-19 mortalities who suffered hypertension alone (21 percent) and third, those who had diabetes alone (14 percent) as illustrated in Table 1 below.

Table 1: Distribution of Co-Morbid Conditions among COVID-19 Mortalities

Co-Morbidity Freq. (n=121) Percent (%) 1 Hypertension, Diabetes 39 32% 2 Hypertension 25 21% 3 Diabetes 17 14% Chronic Lung Diseases (Asthma, TB, Lung, and other 4 11 9% chest related complications) 5 Cancers (Breast, Prostrate, Tongue, Colon) 11 9% 6 HIV/AIDS 4 3% 7 CCF/Cardiovascular Complications 5 4% 8 Hip Replacement 2 2% 9 Liver Disease 1 1% 10 Head Injury 1 1% 11 Kidney Disorders 2 2% 12 Intestinal Obstruction 1 1% 13 Aplastic Anemia 1 1% 14 Paraplegia, Myelitis 1 1%

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Out of the 42 counties reporting cases, 18 (43 percent) have reported mortalities. Nairobi accounts for half, followed by Mombasa at 68 (31 percent) as illustrated in Table 2.

Table 2: Distribution COVID-19 Mortalities by County

County Freq. (n=222) Percent (%) 1. Nairobi 113 50.9% 2. Mombasa 69 31.1% 3. Kiambu 12 5.4% 4. Kajiado 8 3.6% 5. Nakuru 3 1.4% 6. Garissa 2 0.9% 7. Machakos 2 0.9% 8. Narok 2 0.9% 9. Uasin Gishu 2 0.9% 10. Bomet 1 0.5% 11. Kilifi 1 0.5% 12. Kisumu 1 0.5% 13. Kitui 1 0.5% 14. Laikipia 1 0.5% 15. Lamu 1 0.5% 16. Migori 1 0.5% 17. Nyeri 1 0.5% 18. Siaya 1 0.5%

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COVID-19 SITUATION UPDATE: 17 July 2020

1.7 Distribution of Confirmed COVID-19 Cases by County and Transmission Classification Of the 12062 cases, 6766 (56 percent) are from followed by with 1795 (15 percent) as shown in Figure 8. Nairobi city County has the highest attack rate of 153.9 per 100,000 population followed by Mombasa County at 149 per 100,000 populations (Table 3).

Figure 8: Distribution of confirmed COVID-19 Cases by County and transmission classification

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Table 3: County Attack Rate per 100,000 Population

S/ County Population (2019 Cumulative Cases per 100,000 No Census KNBS) Cases population 1 Nairobi City 4,397,073 6766 153.9 2 Mombasa 1,208,333 1795 148.6 3 Busia 893,681 613 68.6 4 Kajiado 1,117,840 651 58.2 5 Kiambu 2,417,735 666 27.5 6 Machakos 1,421,932 346 24.3 7 Migori 1,116,436 214 19.2 8 Lamu 143,920 23 16.0 9 Uasin Gishu 1,163,186 163 14.0 10 Taita/Taveta 340,671 43 12.6 11 Nakuru 2,162,202 176 8.1 12 Makueni 987,653 66 6.7 13 Kwale 866,820 55 6.3 14 Kilifi 1,453,787 80 5.5 15 Isiolo 268,002 12 4.5 16 Garissa 841,353 35 4.2 17 Kisumu 1,155,574 40 3.5 18 Laikipia 518,560 17 3.3 19 Siaya 993,183 31 3.1 20 Narok 1,157,873 33 2.9 21 Nyeri 759,164 20 2.6 22 Wajir 781,263 19 2.4 23 Turkana 926,976 22 2.4 24 Mandera 867,457 20 2.3 25 Kericho 901,777 18 2.0 26 Kitui 1,136,187 18 1.6 27 Murang'a 1,056,640 17 1.6 28 Vihiga 590,013 9 1.5 29 Meru 1,545,714 21 1.4 30 Marsabit 459,785 6 1.3 31 Nandi 885,711 8 0.9 32 Nyamira 605,576 5 0.8 33 Kisii 1,266,860 9 0.7 34 Trans Nzoia 990,341 6 0.6 35 Kakamega 1,867,579 12 0.6 36 Bomet 875,689 4 0.5 37 Bungoma 1,670,570 9 0.5 38 Homa Bay 1,131,950 6 0.5 39 Tharaka-Nithi 393,177 1 0.3 40 Embu 608,599 2 0.3 41 Nyandarua 638,289 2 0.3 42 Kirinyaga 610,411 2 0.3 43 Elgeyo/Marakwet 454,480 1 0.2 Kenya 47,564,300 12062 25.4

MOH Kenya /17 July 2020 10 | P a g e 1.8 Map of Kenya Showing Distribution of Confirmed COVID-19 Cases by County

Figure 9: Distribution of confirmed COVID-19 cases by County

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COVID-19 SITUATION UPDATE: 17 July 2020

1.9 Status of Contract Tracing as at Today Of the 12062 confirmed COVID-19 cases a total of 13680 contacts have been listed, 459 contacts have tested positive for COVID-1. 8904 of the 12062 cases are pending contact listing, the counties with highest pending contact listing are: Nairobi (2545), Mombasa (224) among others (Figure 10).

Figure 10: Status of contact tracing

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Figure 11: Number of days’ cases pending contact lasting

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COVID-19 SITUATION UPDATE: 17 July 2020

2.0 KEY ACTIONS

2.1 Coordination ➢ The Cabinet Secretary for Health addressed the nation in Murang’a after a fact-finding tour of the county. In addition, the COVID-19 National Taskforce held its regular meeting.

2.2 Case Management and Infection Prevention & Control ➢ In the last 24 hours, 345 (134 from health facilities and 211 from home-based care) COVID-19 patients were discharged. The total number of recoveries and discharges for COVID-19 stand at 3,983. ➢ A weekly webinar hosted by KNH to mentor clinicians, share lessons and experiences connecting over 800 clinicians from the counties and key facilities was held today. The focus was on home-based care (HBC) experiences and observations. In Mombasa, where 109 cases were under HBC and while 29 in admissions. The HBC patients are followed up closely with community-based volunteers and nyumba kumi elders. The monitoring is on daily basis on key symptoms and those identified are referred to isolation. The community engagements approach has improved the public behaviour through use of community health care workers, community elders, and chiefs. Communications on experiences from patient champions has linked the community to the impact of COVID19 ➢ A survey on HCW exposure to COVID 19 infection, carried out by IPC team has shown that, nurses, support staff and peer educators were more exposed. The outpatient department was the most affected indicating a low perception of risk by HCW and poor application of PPEs. There is need for risk assessment and universal use of PPEs for all HCW and support staff.

2.3 Surveillance, Laboratory and Points of Entry ➢ All alerts were responded to and contact tracing continued in all affected counties. ➢ In the last 24 hours, 3545 samples were tested across various laboratories of which 389 samples turned positive for COVID-19. A total of 228,674 cumulative tests have so far been conducted.

MOH Kenya /17 July 2020 14 | P a g e 2.4 Risk Communication ➢ Bulky messaging: Interactive voice response (IVR) The Safaricom supported system was manned by 50 dedicated agents. The IVR Hits was 11,049 with 6.637 users going through the complete menu interactions. IVR Calls were 1,266 and 1,230 answered. COVID 19 interactions. The members of the public who accessed information through USSD *719# was 81,000. Nineteen captured as critical six calls were transferred to KRCS, most callers were female accounting for 70 percent, and most calls came from Embu, Kakamega and Kiambu while those transferred to KRCS came from Kisumu. The main symptoms reported by callers was fever and headache. ➢ Main stream media: Public awareness on COVID-19 is ongoing through television, radio and print media.

3.0 KEY CHALLENGES

➢ Suboptimal contact tracing and delay from counties in submitting reports to PHEOC ➢ The long turnaround time for relying laboratory results to clients in most counties is causing delay in sending people to the isolation and quarantine centres. ➢ Weak diagnostic quality assurance system. ➢ Sub-optimal support to sub – national level for investigating alerts and contact tracing at sub – national level. ➢ Sub – optimal utilization of the integrated data management platforms. ➢ Risk communication messages that may be out of step with the evolving epidemic and interventions. ➢ Complacency by community despite established community transmission ➢ Commodity insecurity at the sub – national level of personal protective equipment ➢ Inadequate assessment of households by RRTs for HBC. High level of normalcy assumed with subsequent failure to follow public health guidelines in major towns

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4.0 NEXT STEPS

➢ Develop a differentiated contact tracing strategy for the country. ➢ Strengthen utilization of the integrated data management system moving forward by incentivizing its use. ➢ Ensure capacity building of the sub – county teams from the remaining 20 counties on rapid response, contact tracing and use of the data management systems. An additional sub – county teams ➢ Strengthen COVID-19 diagnostic quality assurance systems. ➢ Address concern of poor quality of PPEs being distributed to the sub – national level. ➢ Adjust risk communication messages to address emerging issues and the evolving epidemic.

Emergency Operation Center: Telephone: 0729 471 414, 0732 353 535, 0800 721316(Toll Free) COVID-19 Call center: *719# (short message only), 719 (Audio) Email: [email protected]

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