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Home , Garissa, Kirinyaga County, Meru County

MINISTRY OF HEALTH DATA AS REPORTED BY 1700 HOURS 19 July

COVID-19 OUTBREAK IN

DAILY SITUATION REPORT - 124

1.0 KEY HIGHLIGHTS

1. Six hundred and three (603) new confirmed COVID-19 cases were reported in the last 24 hours bringing the total number of confirmed cases in Kenya to 13,353 cases as of 19 July 2020. Counties reporting new cases are (441), (44), (29), (22), (17), (10), Busia (7), Kisii (6), (6), Makueni (5), Murang'a (3), (2), (2), (1), (1), (1), (1), (1), (1), (1), Tharaka Nithi (1) and Uasin Gishu (1).

2. Nine (9) deaths have been reported over the last 24 hours. The total number of deaths reported since the beginning of the outbreak is 234, case fatality rate (CFR) is 1.8 percent.

3. In the last 24 hours, 682 (health facility 120, home – based care 562) COVID-19 patients were discharged. The total number of recoveries and discharges for COVID-19 stand at 5,122.

4. As of today, forty-four (44) out of 47 counties have reported cases namely: Nairobi (7744), Mombasa (1835), Kiambu (769), Kajiado (694), Busia (635), Machakos (372), Migori (215), Nakuru (195), Uasin Gishu (166), Kilifi (95), Makueni (72), Kwale (56), Taita Taveta (43), Kisumu (41), Garissa (36), Narok (35), (31), Meru (25), Lamu (24), Laikipia (22), Nyeri (22), Turkana (22), (20), Murang'a (20), Kericho (19), (19), (18), Kisii (15), (13), Kakamega (13), Bungoma (12), (9), Nandi (8), (6), (6), Trans Nzoia (6), (5), (4), Embu (2), Kirinyaga (2), Nyandarua (2), (2), Tharaka Nithi (2) and Elgeyo Marakwet (1).

5. Nairobi City and Mombasa Counties have the highest attack rates of COVID-19 at 176.1 and 151.9 per 100,000 population respectively when compared to 28.1 per 100,000 for the whole country and need enhanced interventions. In addition, the COVID-19 outbreak has so far spread to 94 percent of the counties in the country. Risk communication, laboratory testing and contact tracing have been identified as key challenges.

6. Of the counties with active cases only Trans Nzoia, Laikipia, Meru, Kiambu, Isiolo, Kilifi, Nairobi, Garissa, Kisumu, Homa Bay, Siaya, Busia, Marsabit and Kajiado submitted contact tracing reports.

7. Twelve thousand four hundred and sixty-eight (93 percent) of the 13353 confirmed cases are local transmissions.

8. Among those who filled in their occupation, 508 (3.8 percent) are healthcare workers with four mortalities.

9. In the last 24 hours, 5724 samples were tested across various laboratories of which 603 samples turned positive for COVID-19. A total of 238,920 cumulative tests have so far been conducted.

10. Moving forward, in light of the ever-increasing number of cases and to improve data quality, counties shall be expected to submit daily reports that shall encompass (i) Details of deceased COVID-19 cases, (ii) Details of infected health workers, and (iii) County line list.

MOH Kenya /19 July 2020 1 | P a g e

COVID-19 SITUATION UPDATE: 19 July 2020

Total Cases Male = 8929 Deaths =13353 Female = 4424 =234

1.1 Epidemiology Since 13 March 2020 when the first case was confirmed in Kenya, a total of 13353 confirmed cases and 234 have died giving a case fatality rate of 1.8 percent have been line listed. Of these, 12468 cases (93 percent) were local transmissions and 885 (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 5023 samples per 1,000,000 people.

Figure 1: Trends of COVID-19 Outbreak Kenya

MOH Kenya /19 July 2020 2 | P a g e COVID-19 SITUATION UPDATE: 19 July 2020

1.2 Cumulative Cases and Deaths

Figure 2: Cumulative case load

MOH Kenya /19 July 2020 3 | P a g e COVID-19 SITUATION UPDATE: 19 July 2020

1.3 Laboratory Testing

Figure 3: Laboratory Tests Conducted by Date Results were Shared

MOH Kenya /19 July 2020 4 | P a g e COVID-19 SITUATION UPDATE: 19 July 2020

1.4 Distribution of Confirmed COVID-19 Cases by Presentation and Presentation of Symptoms among Symptomatic cases Of the 13353 confirmed cases, 1231 (10 percent) presented with symptoms (Figure 4). Cough (54 percent) and fever (42 percent) were predominant presenting symptoms.

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

MOH Kenya /19 July 2020 5 | P a g e 1.5 Age and Sex Distribution of COVID Confirmed Cases Eight thousand nine hundred and twenty-nine (67 percent) are males and 4424 (33 percent) are females. Most of the cases; 4341 (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 thirty – four deaths have been reported so far, 178 (76 percent) being males and 56 (24 percent) were females (Figure 6).

Figure 6: Distribution of Case Fatalities by Age and Sex

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Among the 234 COVID-19 mortalities, 126 (54 percent) had comorbid conditions, 22 (9 percent) had no comorbid conditions, while 86 (37 percent) had missing data.

All COVID-19 Mortalities (N=234)

Mortalities with Mortalities with no Mortalities with comorbidities comorbidities missing data 126 (54%) 22(9%) 86 (37%)

Table 1: Distribution of comorbid conditions among COVID-19 mortalities

Co-Morbidity Freq. (n=126) Percent (%) Hypertension 68 56% Diabetes 58 48% Heart conditions 11 9% Cancer 10 8% Kidney conditions 6 5% HIV 5 4% TB 5 4% Road traffic accidents 3 2% Asthma 2 2% Pneumonia 2 2% Anemia 2 2% Hip replacement 2 2% Pregnancy 1 1% Arthritis 1 1%

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Distribution COVID-19 Mortalities by County Out of the 44 counties reporting cases, 20 have reported mortalities. Nairobi accounts for 119 (51 percent), followed by Mombasa at 73 (31 percent) as illustrated in Table 2.

Table 2: Distribution COVID-19 Mortalities by County County Freq. (n=234) Percent (%)

1 Nairobi 119 50.85% 2 Mombasa 73 31.2% 3 Kiambu 12 5.13% 4 Kajiado 9 3.85% 5 Nakuru 3 1.28% 6 Garissa 2 0.85% 7 Machakos 2 0.85% 8 Narok 2 0.85% 9 Uasin gishu 2 0.85% 10 Bomet 1 0.43% 11 Kilifi 1 0.43% 12 Kisumu 1 0.43% 13 Kitui 1 0.43% 14 Laikipia 1 0.43% 15 Lamu 1 0.43% 16 Mandera 1 0.43% 17 Migori 1 0.43% 18 Nyeri 1 0.43% 19 Siaya 1 0.43%

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1.7 Distribution of Confirmed COVID-19 Cases by County and Transmission Classification Of the 13353 cases, 7744 (58 percent) are from followed by with 1835 (14 percent) as shown in Figure 7. Nairobi City County has the highest attack rate of 176.1 per 100,000 population followed by Mombasa County at 151.9 per 100,000 population (Table 1).

Figure 7: Distribution of confirmed COVID-19 Cases by County and transmission classification

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Table 1: County Attack Rate per 100,000 Population

S/N County Population Cumulative Cases per o (2019 Census KNBS) Cases 100,000 population 1 Nairobi City 4,397,073 7744 176.1 2 Mombasa 1,208,333 1835 151.9 3 Busia 893,681 635 71.1 4 Kajiado 1,117,840 694 62.1 5 Kiambu 2,417,735 769 31.8 6 Machakos 1,421,932 372 26.2 7 Migori 1,116,436 215 19.3 8 Lamu 143,920 24 16.7 9 Uasin Gishu 1,163,186 166 14.3 10 Taita/Taveta 340,671 43 12.6 11 Nakuru 2,162,202 195 9.0 12 Makueni 987,653 72 7.3 13 Kwale 866,820 56 6.5 14 Kilifi 1,453,787 95 6.5 15 Isiolo 268,002 13 4.9 16 Garissa 841,353 36 4.3 17 Laikipia 518,560 22 4.2 18 Kisumu 1,155,574 41 3.5 19 Siaya 993,183 31 3.1 20 Narok 1,157,873 35 3.0 21 Nyeri 759,164 22 2.9 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 19 2.1 26 Murang'a 1,056,640 20 1.9 27 Meru 1,545,714 25 1.6 28 Kitui 1,136,187 18 1.6 29 Vihiga 590,013 9 1.5 30 Marsabit 459,785 6 1.3 31 Kisii 1,266,860 15 1.2 32 Nandi 885,711 8 0.9 33 Nyamira 605,576 5 0.8 34 Kakamega 1,867,579 13 0.7 35 Bungoma 1,670,570 12 0.7 36 Tana River 315,943 2 0.6 37 Trans Nzoia 990,341 6 0.6 38 Tharaka-Nithi 393,177 2 0.5 39 Bomet 875,689 4 0.5 40 Homa Bay 1,131,950 6 0.5 41 Embu 608,599 2 0.3 42 Nyandarua 638,289 2 0.3 43 Kirinyaga 610,411 2 0.3 44 Elgeyo/Marakwet 454,480 1 0.2 Kenya 47,564,300 13353 28.1

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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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COVID-19 SITUATION UPDATE: 19 July 2020

1.9 Status of Contract Tracing as at Today Of the 13353 confirmed COVID-19 cases a total of 13865 contacts have been listed, 459 (3.3 percent) contacts have tested positive for COVID- 19 (Table 2). 9881 of the 13353 cases are pending contact listing (Fig 10). the counties with highest pending contact listing are: Nairobi (3064), Mombasa (193) among others (Figure 10)

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Below 3 days 4-7 Days 8-14 Days 100% 1 90% 2 1 1 80% 121 3 175 114 7 1356 49 23 4 1 23 1 70% 113 12 12 116 3 2 5 60 5 60% 3 50% 3 2 1 2 1 3 6 1 2 4 9 1 7 1 1 2 4 40% 166 7 922 169 35 159 2 2 30% 5 3 1 54 8 48 17 5 1 1 20% 3 8 1 15 24 786 1 2 10% 85 4 23 1 24 1 29 1 20 29 4

0% 1

Kisii

Kilifi

Kitui

Isiolo

Busia

Nyeri

Wajir

Lamu

Meru

kwale

Nandi

Narok

Vihiga

Migori

Bomet

Garissa

Nakuru

Nairobi

Kisumu

Kajiado

Laikipia

Kericho

Kiambu

Turkana

Nyamira

Makueni

Marsabit

Muranga

Mandera

Kirinyaga

Bungoma

Mombasa

Machakos

Kakamega

Tana River Tana

Nyandarua

Trans Nzoia Trans

Uasin Gishu Uasin

Taita Taveta Taita Tharaka Nithi Tharaka

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COVID-19 SITUATION UPDATE: 19 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. ➢ The PHEOC Incident Management Team note the need to continue providing technical support to counties in addressing gaps noted in RRT, contact tracing and data management particularly the low uptake of the web-based system in counties through a strategy of adopt a county.

2.2 Case Management and Infection Prevention & Control ➢ In the last 24 hours, 682 (health facility 120, home – based care 562) COVID-19 patients were discharged. The total number of recoveries and discharges for COVID-19 stand at 5,122. ➢ Of the counties with active cases 21 out of the affected counties sent health facility reports, these are Nairobi (TNH, KUTRRH, AKUH, KNH, Avenue), Mombasa (CGTRH, Mombasa Hospital), , Taita - Taveta (Taveta Sub-County Hospital), Laikipia ( Level V Hospital), (Sahajanand and Kilifi Isolation Complex), Narok ( Referral Hospital), Garissa ( Referral Hospital), Kericho ( Referral Hospital), , Referral Hospital, Busia (Alupe Sub – County Hospital), , , , , , , , and Tharaka Nithi County. ➢ Thirty-five patients are admitted in ICU across various hospitals today. ➢ Training of HCWs on critical care for COVID-19 cases to start on 20th July 2020. Participants are to be drawn from both public and private health facilities in Migori County.

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, 5724 samples were tested across various laboratories of which 603 samples turned positive for COVID-19. A total of 238,920 cumulative tests have so far been conducted. ➢ Churches reopened over the weekend with same public health measures being observed such and hand sanitization, wearing of masks and hand sanitization

MOH Kenya /19 July 2020 14 | P a g e 3.0 KEY CHALLENGES ➢ In most churches the elderly and children were in attendance in disregard of the guidelines for reopening of places of worship ➢ 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.

4.0 NEXT STEPS

➢ Support to NMS to finalize and consolidate the technical inputs on the RCCE Strategy and support development of the new RCCE Implementation Plan for the metropolis ➢ 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] MOH Kenya /19 July 2020 15 | P a g e