MINISTRY OF HEALTH DATA AS REPORTED BY 1700 HOURS 15 July

COVID-19 OUTBREAK IN

DAILY SITUATION REPORT - 120

1.0 KEY HIGHLIGHTS

1. Four hundred and sixty-one (461) new confirmed COVID-19 cases were reported in the last 24 hours bringing the total number of confirmed cases in Kenya to 11,252 cases as of 15 July 2020. Counties reporting new cases are (248), (97), (20), (15), Migori (14), Busia (12), (11), Laikipia (7), (7), (6), (4), Uasin Gishu (4), (3), Kisii (3), (2), Makueni (2), (2), (1), Meru (1), (1) and Taita Taveta (1).

2. Seven (7) deaths have been reported over the last 24 hours. The total number of deaths reported since the beginning of the outbreak is 209, case fatality rate (CFR) is 1.9 percent.

3. In the last 24 hours, fifty-one (51) COVID-19 patients recovered and were discharged bringing the total number of recoveries and discharges for COVID-19 to 3,068.

4. As of today, forty-two (42) out of 47 counties have reported cases namely: Nairobi (6250), Mombasa (1769), Kiambu (602), Busia (572), Kajiado (526), Machakos (396), Migori (204), Uasin Gishu (158), Nakuru (152), Kilifi (77), (54), Makueni (50), Taita Taveta (42), (34), Kisumu (34), (32), (31), Meru (21), Nyeri (20), Turkana (20), Lamu (19), (19), (18), (18), Murang'a (17), (15), Laikipia (15), (12), Kakamega (11), Kisii (9), (9), (8), Nandi (8), (6), Marsabit (6), Trans Nzoia (5), (4), Bomet (2), Embu (2), Kirinyaga (2), Nyandarua (2), and Elgeyo Marakwet (1).

5. Mombasa and Nairobi City Counties have the highest attack rates of COVID-19 at 146.4 and 142.1 per 100,000 populations respectively when compared to 23.7 per 100,000 for the whole country and need enhanced interventions. In addition, the COVID-19 outbreak has so far spread to 89 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 Laikipia, Machakos, Kilifi, Nairobi, Isiolo, Muranga, Garissa, Kisumu, Homa Bay, Kisii, Siaya, Busia, Uasin Gishu, Kajiado, Mombasa, Kwale, Lamu, Marsabit submitted contact tracing reports.

7. Ten thousand seven hundred and ninety-two (96 percent) of the 11252 confirmed cases are local transmissions.

8. Among those who filled in their occupation, 470 are healthcare workers with four mortalities.

9. In the last 24 hours, 4261 samples were tested across various laboratories of which 461 samples turned positive for COVID-19. A total of 225,495 cumulative tests have so far been conducted.

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COVID-19 SITUATION UPDATE: 15 July 2020

Total Cases Male = 7587 Deaths =11252 Female = 3665 =209

1.1 Epidemiology Since 13 March 2020 when the first case was confirmed in Kenya, a total of 11252 confirmed cases and 209 have died giving a case fatality rate of 1.9 percent have been line listed. Of these, 10792 cases (96 percent) were local transmissions and 460 (4 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 4741 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 and Presentation of Symptoms among Symptomatic cases Of the 11252 confirmed cases, 1144 (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 Seven thousand five hundred and eighty-seven (67 percent) are males and 3665 (33 percent) are females. Most of the cases; 3668 (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 nine deaths have been reported so far, 157 (75 percent) being males and 52 (25 percent) were females (Figure 6).

Figure 6: Distribution of Case Fatalities by Age and Sex

MOH Kenya /15 July 2020 6 | P a g e Among the 209 COVID-19 mortalities, 93 (46 percent) had comorbid conditions, nine (4 percent) had no comorbid conditions, while 107 (51 percent) had missing data as illustrated in Figure 7.

All COVID-19 Mortalities (N=209)

Mortalities with Mortalities with no Mortalities with comorbidities comorbidities missing data 93 (45%) 9 (4%) 107 (51%)

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 (17 percent) and third, those who had diabetes alone (15 percent) as illustrated in Table 1 below.

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

Co-Morbidity Freq. (n=93) Percent (%) 1 Hypertension, Diabetes 30 32%

2 Hypertension 16 17%

3 Diabetes 14 15%

4 Chronic Lung Diseases (Asthma, TB, Lung, and other chest 9 10% related complications) 5 Cancers (Breast, Prostrate, Tongue, Colon) 9 10%

6 HIV/AIDS 4 4%

7 CCF/Cardiovascular Complications 4 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%

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Out of the 42 counties reporting cases, 17 (41 percent) have reported mortalities. Nairobi accounts for half, followed by Mombasa at 68 (33 percent) as illustrated in Table 2.

Table 2: COVID-19 Mortalities Disaggregated by County County Frequency (N=209) Percent 1 Nairobi 106 50.7% 2 Mombasa 68 32.5% 3 Kiambu 12 5.7% 4 Kajiado 6 2.9% 5 Garissa 2 1.0% 6 Machakos 2 1.0% 7 Narok 2 1.0% 8 Uasin Gishu 2 1.0% 9 Bomet 1 0.5% 10 Kilifi 1 0.5% 11 Kitui 1 0.5% 12 Laikipia 1 0.5% 13 Lamu 1 0.5% 14 Migori 1 0.5% 15 Nakuru 1 0.5% 16 Nyeri 1 0.5% 17 Siaya 1 0.5%

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COVID-19 SITUATION UPDATE: 15 July 2020

1.7 Distribution of Confirmed COVID-19 Cases by County and Transmission Classification Of the 11252 cases, 6250 (56 percent) are from followed by with 1769 (16 percent) as shown in Figure 8. Mombasa County has the highest attack rate of 146.4 per 100,000 population followed by Nairobi City County at 142.1 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/N County Population (2019 Cumulative Cases per 100,000 o Census KNBS) Cases population 1 Mombasa 1,208,333 1769 146.4 2 Nairobi City 4,397,073 6250 142.1 3 Busia 893,681 572 64.0 4 Kajiado 1,117,840 526 47.1 5 Machakos 1,421,932 396 27.8 6 Kiambu 2,417,735 602 24.9 7 Migori 1,116,436 204 18.3 8 Uasin Gishu 1,163,186 158 13.6 9 Lamu 143,920 19 13.2 10 Taita/Taveta 340,671 42 12.3 11 Nakuru 2,162,202 152 7.0 12 Kwale 866,820 54 6.2 13 Kilifi 1,453,787 77 5.3 14 Makueni 987,653 50 5.1 15 Isiolo 268,002 12 4.5 16 Garissa 841,353 34 4.0 17 Siaya 993,183 31 3.1 18 Laikipia 518,560 15 2.9 19 Kisumu 1,155,574 34 2.9 20 Narok 1,157,873 32 2.8 21 Nyeri 759,164 20 2.6 22 Wajir 781,263 19 2.4 23 Turkana 926,976 20 2.2 24 Mandera 867,457 18 2.1 25 Kericho 901,777 15 1.7 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 Kisii 1,266,860 9 0.7 33 Nyamira 605,576 4 0.7 34 Kakamega 1,867,579 11 0.6 35 Trans Nzoia 990,341 5 0.5 36 Bungoma 1,670,570 8 0.5 37 Homa Bay 1,131,950 6 0.5 38 Embu 608,599 2 0.3 39 Nyandarua 638,289 2 0.3 40 Kirinyaga 610,411 2 0.3 41 Elgeyo/Marakwet 454,480 1 0.2 42 Bomet 875,689 2 0.2 Kenya 47,564,300 11252 23.7

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1.8 Map of Kenya Showing Distribution of Confirmed COVID-19 Cases by County

Figure 8: Distribution of confirmed COVID-19 cases by County

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1.9 Status of Contract Tracing as at Today

Of the 10791 confirmed COVID-19 cases a total of 12,961 contacts have been listed,9209 (71 percent) have completed follow up, 457 (3.5 percent) contacts have tested positive for COVID-19. 8204 (76 percent) of the 10791 cases are pending contact listing (Fig 9). Nairobi (2393), Kiambu (334), Mombasa (270), Kajiado (252) are among the counties with active cases pending contact listing (figure 10)

Figure 9: Status of contact tracing

MOH Kenya /15 July 2020 12 | P a g e Below 3 days 4-7 Days 8-14 Days

100% 1 90% 73 55 1 17 4 51 86 1 1 1 80% 31 947 19 4 1 70% 156 3 2 3 3 60% 5 28 151 25 103 40 50% 3 73 1 1 13 7 1 1 1 10 1 7 1 1

891 20 40% 3 91 3 2 9 2 30% 51 82 1 20% 93 2 110 1 1 63 1 3 21 1 10% 2 555 2 10 1 32 10 1 3 2

0%

Kilifi

Kitui

Isiolo

Busia

Nyeri

Wajir

Lamu

Meru

kwale

Nandi

Narok

Vihiga

Migori

Garissa

Nakuru

Nairobi

Kisumu

Kajiado

Laikipia

Kericho

Kiambu

Turkana

Nyamira

Makueni

Mandera

Kirinyaga

Transzoia

Murang'a

Mombasa

Machakos

Kakamega

Nyandarua

Trans Nzoia Trans Uasin Gishu Uasin TaitaTaveta Figure 10: Number of days’ cases pending contact lasting

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COVID-19 SITUATION UPDATE: 15 July 2020

2.0 KEY ACTIONS

2.1 Coordination ➢ The National Emergency Response Committee on Coronavirus met after which the Cabinet Secretary for Health addressed the nation. His speech focused on need to enhance infection prevention and control measures to protect both health workers and patients from nosocomial COVID-19 infections. ➢ In Mombasa County, AMREF Health Africa donated assorted items of personal protective equipment (PPEs), disinfection and thermometers. Discussion were between Mombasa and on cross county contact tracing and response to alerts. How best to involve or engage youth in responding to myths, misconceptions, misinformation and rumours between the two counties. ➢ In Garissa County, a meeting with religious leaders was held to discuss guidelines for safe re-opening of worship places and recommended zoning of worship areas in Garissa Town, meeting with imams and Christian leaders in specific zones, enhancing social mobilization through public address system, distribution of commodities to mosques and churches.

2.2 Case Management and Infection Prevention & Control ➢ In the last 24 hours, 51 COVID-19 patients recovered and were discharged bringing the total number of recoveries and discharges for COVID-19 to 3068. ➢ Of the affected counties with active cases only Nairobi (TNH, KNH, KUTRRH, Avenue Nairobi, MP Shah, AKUH - Nairobi), Mombasa (TUM, CGTRH, Mombasa Hospital), Siaya (Bondo Referral Hospital, Ambira Sub County Hospital), , Taita Taveta (Taveta Sub-County Hospital), Laikipia ( Level V Hospital), Kilifi County ( Sahajanand and Kilifi Isolation Complex), Narok ( Hospital), Garissa (Ifo 2 and Garissa County Hospital), Kericho ( Hospital), Uasin Gishu (MTRH) submitted case management health facility reports.

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, 4261 samples were tested across various laboratories of which 461 samples turned positive for COVID-19. A total of 225,495 cumulative tests have so far been conducted. ➢ Recruitment of laboratory technologists through the World Bank Health COVID-19 Emergency Response Project has been concluded, job orientation successfully done and they have been deployed.

MOH Kenya /15 July 2020 14 | P a g e ➢ The three-day training in IPC and Case Management with clusters of 35 participants in Embu, Kirinyaga, Meru counties have completed training. ➢ RRT/contact tracing and data management training for Kisumu and was completed today, a total of 65 officers were equipped with skills. ➢ Local flights resumed today across the country and surveillance measure have been heightened at airports and counties to monitor all travellers.

2.4 Risk Communication ➢ Bulky messaging: Interactive voice response (IVR) The Safaricom supported system was manned by 50 dedicated agents. The IVR Hits was 11,557 with 5,360 users going through the complete menu interactions. IVR Calls were 1,346 and 1,273 answered. COVID 19 interactions. The members of the public who accessed information through USSD *719# was 83,000. Thirty-five captured as critical. Two calls were transferred to KRCS, most callers were female 69 percent, and most calls came from Kiambu among other counties. The main symptoms reported by callers were fever, headache and difficulty in breathing. ➢ Main stream media: Public awareness on COVID-19 is ongoing through television, radio and print media.

3.0 KEY CHALLENGES ➢ Suboptimal utilization of the integrated digital platform for COVID-19 case investigation form, contact tracing and quarantine. ➢ 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 public health action. ➢ Increasing complacency by community despite established community transmission, this is contributing to some laxity in observing some prevention and control measures such as hand washing and use of face masks. ➢ Emerging reports of personal protective equipment (PPE) of poor quality being distributed to healthcare workers and facilities. The health workers are requesting for standardization of the materials and compliance with sizes of the PPEs. ➢ Weak diagnostic quality assurance system in place. ➢ Emerging evidence of increased nosocomial COVID-19 infections especially among health workers.

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4.0 NEXT STEPS

➢ 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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