MINISTRY OF HEALTH DATA AS REPORTED BY 1700 HOURS 16 June

COVID-19 OUTBREAK IN

DAILY SITUATION REPORT - 91

1.0 KEY HIGHLIGHTS

1. One hundred and thirty-three (133) new confirmed COVID-19 cases were reported in the last 24 hours bringing the total number of confirmed cases in Kenya to 3,860 cases as of 16 June. All cases are Kenyans and all cases are local transmission. Counties reporting new cases are (85), (27), (8), Busia (5), (2), (2), (2), (1) and (1).

2. One (1) death has been reported over the last 24 hours. The total number of deaths reported since the beginning of the outbreak is 105, case fatality rate (CFR) is 2.7 percent.

3. In the last 24 hours, forty (40) COVID-19 patients recovered and were discharged bringing the total number of recoveries and discharges for COVID-19 to one thousand three hundred and twenty-six (1326).

4. As of today, thirty-nine (39) out of 47 counties have reported cases namely: Nairobi (1778), Mombasa (1125), Busia (323), Kajiado (124), Kiambu (115), Uasin Gishu (61), Migori (45), Kilifi (43), (35), Machakos (21), Taita Taveta (21), (18), (17), (16), (16), Turkana (15), (14), (12), (11), (9), (6), Murang'a (6), (4), (3), Makueni (3), (2), Kisii (2), Laikipia (2), Meru (2), Narok (2), (1), Elgeyo Marakwet (1), Embu (1), (1), Kirinyaga (1), (1), Nandi (1), (1), and Trans Nzoia (1).

5. Mombasa and Nairobi City Counties have the highest attack rates of COVID-19 at 93.1 and 40.4 per 100,000 population respectively when compared to 8.1 per 100,000 for the whole country and need enhanced interventions. In addition, the COVID-19 outbreak has so far spread to 83 percent of the counties in the country. Risk communication, laboratory testing, and sub-optimal support to sub – national level for investigating alerts and contact tracing have been identified as key challenges.

6. Three thousand four hundred and ninety-eight (91 percent) of the 3860 confirmed cases are local transmissions.

7. Of the 2,193 contacts under follow-up 2,106 (96 percent) were followed up today

8. In the last 24 hours, 3,255 samples were tested across various laboratories of which One hundred and thirty-three (133) samples turned positive for COVID-19. A total of 121,956 cumulative tests have so far been conducted.

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COVID-19 SITUATION UPDATE: 16 June 2020

Total Cases Male = 2650 Deaths =3860 Female = 1210 =105

1.1 Epidemiology Since 13 March 2020 when the first case was confirmed in Kenya, a total of 3860 confirmed cases and 105 have died giving a case fatality rate of 2.7 percent have been line listed. Of these, 3498 cases (91 percent) were local transmissions and 362 (9 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 2564 samples per 1,000,000 people.

Figure 1: Trends of COVID-19 Outbreak Kenya

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1.2 Cumulative Cases

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 Of the 3860 confirmed cases, 451 (12 percent) presented with symptoms at the time of diagnosis (Figure 4). Cough (47 percent) and fever (40 percent) were predominant presenting symptoms (Figure 5).

Figure 4: Distribution of Confirmed COVID-19 Cases by Presentation

1.5 Presenting Symptoms among Symptomatic COVID-19 Cases

Figure 5: Distribution of Presenting Symptoms among Symptomatic COVID-19 Cases

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1.6 Age and Sex Distribution of COVID Confirmed Cases and Deaths Two thousand six hundred and fifty (69 percent) are males and 1,210 (31 percent) are females. Most of the cases; 1,230 (32 percent), are in the age group of 30-39 years. Figure 6 below shows age and sex distribution of COVID-19 cases. One hundred and five deaths have been reported so far, 76 (72 percent) being males and 29 (28 percent) were females (Figure 7).

Figure 6: Age and Sex Distribution of COVID-19 Cases Kenya

Figure 7: Distribution of Case Fatalities by Age and Sex

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1.7 Distribution of Confirmed COVID-19 Cases by County and Transmission Classification Of the 3,860 cases, 1,778 (46 percent) are from followed by with 1,125 (29 percent) as shown in Figure 8. Mombasa County has the highest attack rate of 93.1 per 100,000 population followed by Nairobi City County at 40.4 per 100,000 populations (Table 1).

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

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Table 1: County Attack Rate/100,000 population S/N County Population (2019 Cumulative Cases per 100,000 o Census KNBS) Cases population 1 Mombasa 1,208,333 1125 93.1 2 Nairobi City 4,397,073 1778 40.4 3 Busia 893,681 323 36.1 4 Kajiado 1,117,840 124 11.1 5 Taita/Taveta 340,671 21 6.2 6 Uasin Gishu 1,163,186 61 5.2 7 Kiambu 2,417,735 115 4.8 8 Kwale 866,820 35 4.0 9 Migori 1,116,436 45 4.0 10 Kilifi 1,453,787 43 3.0 11 Mandera 867,457 18 2.1 12 Wajir 781,263 16 2.0 13 Garissa 841,353 16 1.9 14 Turkana 926,976 15 1.6 15 Isiolo 268,002 4 1.5 16 Machakos 1,421,932 21 1.5 17 Kisumu 1,155,574 17 1.5 18 Nyeri 759,164 9 1.2 19 Siaya 993,183 12 1.2 20 Kitui 1,136,187 11 1.0 21 Murang'a 1,056,640 6 0.6 22 Nakuru 2,162,202 14 0.6 23 Laikipia 518,560 2 0.4 24 Bungoma 1,670,570 6 0.4 25 Makueni 987,653 3 0.3 26 Homa Bay 1,131,950 3 0.3 27 Marsabit 459,785 1 0.2 28 Embu 608,599 1 0.2 29 Kirinyaga 610,411 1 0.2 30 Elgeyo Marakwet 454,480 1 0.2 31 Narok 1,157,873 2 0.2 32 Kisii 1,266,860 2 0.2 33 Nyamira 605,576 1 0.2 34 Meru 1,545,714 2 0.1 35 Trans Nzoia 990,341 1 0.1 36 Nandi 885,711 1 0.1 37 Kericho 901,777 1 0.1 38 Bomet 875,689 1 0.1 39 Kakamega 1,867,579 2 0.1 Kenya 47,564,300 3860 8.1

MOH Kenya /16 June 2020 8 | 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: 16 June 2020

1.9 Status of Contract Tracing as at Today Of the 3860 confirmed COVID-19 cases a total of 8,481contacts have been listed, 345 contacts (4.1 percent) have tested positive for COVID-19 (Table 2). Of the 2,193 contacts under follow up 2,106 (96 percent) were followed up today. A total of 87 contacts were not reached today across the affected counties. Table 2 shows summary status of contact tracing as of today.

Table 2: Status of Contract Tracing as at Today

Number of Cases % of Cases Contacts Number Pending cases Contacts Contacts Response Positive County forwarded on follow Responded contact without identified finished 14 days rate Contacts to contact up today listing contacts tracing Bomet 2 - - 35 35 0 0 - 3 Bungoma 6 4 67% 12 12 0 0 - 1 Busia 318 300 94% 18 14 4 5 125% 0 Elgeyo Marakwet 1 - - 0 0 0 0 - 0 Embu 1 - - 30 0 30 30 100% 0 Garissa 16 4 25% 94 16 78 78 100% 3 Homa Bay 4 1 25% 93 89 4 0 0% 0 Isiolo 4 - - 105 55 50 48 96% 1 Kajiado 121 43 36% 570 359 211 205 97% 8 Kakamega 2 1 50% 13 13 0 0 - 0 Kericho 2 1 50% 1 0 1 1 100% 0 Kiambu 107 60 56% 347 135 212 199 94% 10 Kilifi 42 25 60% 322 265 57 55 96% 9 Kirinyaga 1 - - 0 0 0 0 - 0 Kisii 2 - - 50 1 49 49 100% 1 Kisumu 17 14 82% 5 0 5 5 100% 0 Kitui 11 2 18% 71 54 17 17 100% 6

MOH Kenya /16 June 2020 10 | P a g e Number of Cases Cases % of cases Contacts Number Pending Contacts Contacts Response Positive County forwarded without on follow Responded contact identified finished 14 days rate Contacts to contact contacts up today listing tracing Kwale 35 24 69% 124 119 5 5 100% 0 Laikipia 2 1 50% 26 0 26 26 100% 0 Machakos 21 16 76% 25 25 0 0 - 0 Makueni 3 1 33% 15 0 15 15 100% 2 Mandera 18 - - 176 176 0 0 - 6 Marsabit 1 1 100% 11 0 11 11 100% 0 Meru 3 1 33% 63 29 34 34 100% 0 Migori 42 25 60% 153 140 13 46 354% 1 Mombasa 1099 693 63% 2136 1727 409 395 97% 127 Muranga 7 4 57% 46 15 31 31 100% 0 Nairobi 1685 975 58% 3082 2413 669 583 87% 159 Nakuru 16 4 25% 310 275 35 35 100% 0 Narok 1 1 100% 0 0 0 0 - 0 Nyamira 1 1 100% 0 0 0 0 - 0 Nyeri 9 3 33% 81 0 81 81 100% 0 Siaya 12 3 25% 82 82 0 0 - 4 Taita Taveta 21 7 33% 79 47 32 32 100% 0 Trans Nzoia 1 - - 10 0 10 10 100% 0 Turkana 16 3 19% 108 53 55 55 1 Uasin Gishu 61 43 70% 109 60 49 49 0 Wajir 16 2 13% 79 79 0 6 3 Total 3727 2263 61% 8481 6288 2193 2106 96% 345

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COVID-19 SITUATION UPDATE: 16 June 2020

2.0 KEY ACTIONS

2.1 Coordination ➢ The Cabinet Secretary for Health addressed the nation on 16 June 2020: O He appreciated Kenyans for following the Ministry of Health’s guidelines on the containment measures for COVID-19. O He directed that the hours of business for restaurants will be up to 7:30 PM henceforth O Operators are advised to adhere to the protocols as provided for by the MOH which includes (i) All restaurants must screen for temperatures at the entrance of the premises (ii) Provide Handwashing stations and soap at the entrants for client’s use (iii) Provide sanitizers at strategic places within the premises (iv) All clients entering establishments must wear face mask including food handlers (v) Provide adequate space for social distancing (vi) All restaurants workers must be tested. ➢ The Nairobi Metropolitan Services Health Department and WHO had an introductory bilateral meeting today. It was noted that NMS is leading in the number of COVID 19 case load and the key areas of focus include: (i) Expanding isolation bed capacity to 1000 (KMTC, Mbagathi, Moi Girls and Pumwani), (ii) Rolling out Home Based Care units, (iii) Scale up targeted testing in hot spots, (iv) Contact tracing and capacity/ training for the many staff engaged on COVID-19 response (v) Engagement of public private partnership mechanisms and (vi) Resource mobilization. The NMS Health Department has adopted an incident management system and will establish a COVID19 emergency committee. ➢ In , following up on the Kilifi County Health Management Team meeting hed on Monday 15th June 2020, in which concerns were raised on the level of infection prevention and control measures at the Sajaahanad Isolation Centre in a five member team was constituted to visit the facility with the Kilifi South Sub County Health Management Team. During the visit: The facility team complained that patients’ samples are not collected as scheduled by the SC RRT. The facility has not received any other results, despite samples being collected and there is discontentment among the clients who are threatening the staff. The investigating team noted that, even though clients had been separated by gender and cohorted by status, this was not adhered to and clients were mixing freely. There is no proper donning area identified, hence every team chooses any area perceived to be conducive for the procedure and frequented by staff and clients. Some used PPEs are disinfected/decontaminated around the doffing area, transported near the laundry area to be washed which was not recommended. The manner for the hazardous waste disposal also fell short of the guideline’s recommendations. The staff residential areas needed more improvement. The taskforce concluded that the facility

MOH Kenya /16 June 2020 12 | P a g e poses risks for possible contamination of the both the clients/patients and staff due to either infrastructural design deficiency and or failure to practice effective infection prevention and control measures, The facility, still can only be used as a quarantine facility as opposed to be an isolation centre for not more than 20 clients. ➢ In Mombasa County, a planning meeting with the County Health Management Team and WHO on testing of healthcare providers of private and public health facilities. In addition, the CHMT and the Coast General Management Team decided to relocate the Abott machine from the haematology section of the laboratory.

2.2 Case Management and Infection Prevention & Control ➢ In the last 24 hours, 40 COVID-19 patients recovered and were discharged bringing the total number of recoveries and discharges for COVID-19 to 1326. ➢ In , there are 22 cases including 5 HCWs in the isolation center at Macalder Sub-County Hospital. The county RRT are following up two additional cases. ➢ In Mombasa County, six healthcare providers who tested COVID-19 positive are from Mvita Clinic and Railways Dispensary. Contact listing and follow up for them and their evacuation to designated isolation centers is ongoing. ➢ In Migori and Kisumu Counties, resupply of testing kits and PPEs have ensured commodity security. Sample collection is going on at Isebania PoE and results are relayed in a timely manner- mainly on Tuesday, Thursdays and Saturdays. In addition, Migori County is conducting trainings on home-based care and handling of dead bodies for healthcare workers this week. This through the support of Afya Halisi. Further, the County Health Management Team is keen to adopt the incident management system to enable efficient operations.

2.3 Surveillance, Laboratory and Points of Entry ➢ In the last 24 hours, 3255 samples were tested across various laboratories of which 133 samples turned positive for COVID-19. A total of 121956 cumulative tests have so far been conducted. ➢ A web – based laboratory data repository system for all COVID-19 testing labs has been rolled out with 10 (37 percent) of the 27 testing laboratories have successfully started to use the system and expected 100 percent rollout by the end of the week. The system allows data from all the testing laboratories to be available in a timely fashion at national level, at 0600 hours daily.

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2.4 Risk Communication ➢ Bulky messaging: Interactive voice response (IVR) The Safaricom supported system was manned by 50 dedicated agents. The IVR Hits was 13583 with 6485 users going through the complete menu interactions. IVR Calls were 1579 and 1538 answered. COVID 19 interactions. The members of the public who accessed information through USSD *719# was 72,000. Twelve calls were captured as critical. The calls were transferred as follows: 61 calls transferred to NASCOP and 7 calls to KRCS, most callers were male 71 percent, most calls came from Nairobi, Mombasa, and Kisumu among other counties. The main symptoms reported by callers were cough and headache. ➢ Digital media: The team were pushing messages to enlighten the public on new protocols for operating restaurant and related eateries with closing hours extended from 1730 hours to 1930 hours. ➢ Main stream media: Public awareness on COVID-19 is ongoing through television, radio and print media.

2.5 Community Engagement ➢ The United Front’s (TUF) mobile PSA van has redeployed into Old Town, Mombasa, to continue the community engagement activities while at the same time perform an assessment of the situation on the ground as far as COVID-19 is concerned. For this assessment, a two-person team was involved; an announcer and the driver. The feedback from this follow up visit is as follows: o The reception was positive but there is still a lot of denial of the pandemic amongst the residents of this area and are becoming indifferent to the pandemic mainly because they are not being sensitized of the danger. o Old Town, Kongowea Market, matatu stages and the ferry crossing being economic hubs, it is often times crowded. This means observing social distancing is very difficult, especially on the streets and business places. o The team has observed that people in Mombasa do have masks with them at all times, however, they don’t seem to be effectively/ properly utilized. People are wearing their masks on their chins or holding them in their hands. This rebellious behavior is largely a response to the heightened enforcement of mask-wearing taken by the government in recent days as opposed to a protective measure against COVID-19. o The message that TUF is carrying with it is that even as people are trying to return to their normal daily routines where proper social distancing is a challenge, they need to try as much as they can to adhere to the set etiquettes such as regular

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hand washing/use of alcohol based sanitizers, proper wearing of masks and avoiding hand greetings/hugs.

3.0 KEY CHALLENGES

➢ In Migori County, patients have stopped seeking services from Nyamaraga Health Center in Kuria East Sub – County as a result of healthcare workers at the facility testing positive for COVID-19. The Ntimaru Sub – County Hospital Management Board have written to the Migori County Health Management Team requesting that healthcare workers who contract COVID-19 should not return to their work stations after recovery, this has further heightened the stigma. ➢ Community health workers and volunteers have been working without stipend and will now be risking even more when home based care is rolled out. It is therefore important to urgently explore how best to incentivise them to ensure successful rollout of home-based care. ➢ Commodity insecurity across a number of counties for PPE and laboratory supplies in some testing laboratories e.g. shortage of reagents for the Cobas® machine in Coast General Hospital molecular laboratory. These have resulted in long turnaround time for relying laboratory results to clients. ➢ An emerging challenge in coordination of isolation and contact tracing in communities that live across county borders. A case in point is link between Kilifi and Health Departments along their border. Seven cases have been confirmed by the Kilifi County team out of nine samples collected at Rabai Slaughter House in Kiwanja Ndege which is located at the border between Kwale and Kilifi Counties. Out of the seven cases, three reside on the Kilifi side while four are at Kwale side. The two counties do not know which of them should do the isolation, quarantine and contact tracing.

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4.0 NEXT STEPS

➢ The PHEOC to liaise with Kilifi and Kwale County Health Management Teams to address the challenges on cases reported who reside along their common border and how best to list and follow up contacts. ➢ The Ministry of Health in collaboration with the WHO plan to build capacities for the counties that have newly been affected by COVID-19 as well as the managers of the quarantine facilities across the country. ➢ The Ministry of Health is rolling out the home and community-based isolation and quarantine protocols across the country to reduce excess loads on the current facilities. ➢ In Migori county, risk communication and community engagement will be enhanced to address the challenges especially for police officers and public health officers on how frontline workers will handle dead bodies. ➢ Plans have been finalized to roll out home based care in the within and training of healthcare workers employed under Universal Health Coverage through support from by USAID Afya-Halisi.

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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