MINISTRY OF HEALTH DATA AS REPORTED BY 1700 HOURS 23 July

COVID-19 OUTBREAK IN

DAILY SITUATION REPORT - 128

1.0 KEY HIGHLIGHTS

1. Seven hundred and ninety-six (796) new confirmed COVID-19 cases were reported in the last 24 hours bringing the total number of confirmed cases in Kenya to 15601 cases as of 23 July 2020. Counties reporting new cases are (539), (63), (57), (37), Migori (26), (15), (11), Uasin Gishu (11), Laikipia (9), (7), Busia (6), (4), Kisii (3), Murang'a (2), (2), Embu (1), (1), (1) and Trans Nzoia (1).

2. Three (3) deaths have been reported over the last 24 hours. The total number of deaths reported since the beginning of the outbreak is 263, case fatality rate (CFR) is 1.7 percent.

3. In the last 24 hours, 378 COVID-19 patients recovered and were discharged bringing the total number of recoveries and discharges for COVID-19 to 7135.

4. As of today, forty-four (44) out of 47 counties have reported cases namely: Nairobi (9157), Mombasa (1874), Kiambu (970), Kajiado (811), Busia (668), Machakos (569), Migori (249), Nakuru (240), Uasin Gishu (191), (96), Makueni (72), (56), Narok (55), Nyeri (55), Kisumu (44), Taita Taveta (43), Kericho (42), (38), Laikipia (35), Siaya (33), Meru (31), Murang'a (31), (25), Kisii (22), (22), Turkana (22), (20), (19), (14), (14), (12), (10), (9), (8), Nandi (8), (7), Trans Nzoia (7), (5), Nyandarua (5), Embu (4), Kirinyaga (3), Tana River (2), Tharaka Nithi (2), and Elgeyo Marakwet (1).

5. Nairobi city and Mombasa Counties have the highest attack rates of COVID-19 at 208.3 and 155.1 per 100,000 population respectively when compared to 32.8 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 inadequate financial support to sub – national level for operations have been identified as key challenges.

6. Fourteen thousand seven hundred and fourteen (97 percent) of the 15601 confirmed cases are local transmissions.

7. In the last 24 hours, 6754 samples were tested across various laboratories of which Seven hundred and ninety-six (796) samples turned positive for COVID-19. A total of 256,060 cumulative tests have so far been conducted.

8. 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) Detaisls of deceased COVID-19 cases, (ii) Details of infected health workers, and (iii) County line list. As at 23rd July 2020, all the affected counties submitted their daily reports except Nairobi and Kiambu Counties.

9. There is a notable drop in utilization of the integrated digital reporting platforms for Epi Week 29. Of note is that some counties, such as Machakos, Homa Bay, Isiolo, Mandera, Marsabit, Bungoma and Meru have never utilized the systems inasmuch as the Ministry gave a directive three weeks ago to transition to a digital platform.

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COVID-19 SITUATION UPDATE: 24 July 2020

Total Cases Male = 10292 Deaths =15601 Female = 5309 =263

1.1 Epidemiology Since 13 March 2020 when the first case was confirmed in Kenya, a total of 15601 confirmed cases and 263 have died giving a case fatality rate of 1.7 percent have been line listed. Of these, 14714 cases (94 percent) were local transmissions and 887 (6 percent) are imported cases. The Figure 1 below shows trends of cases. Mandatory quarantine was instituted on 25 March 2020 with testing of all quarantined people starting on 29 March 2020. 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 5383 samples per 1,000,000 people.

Figure 1: Trends of COVID-19 Outbreak Kenya

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1.2 Cumulative Cases and Deaths

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 15601 confirmed cases, 1338 (9 percent) presented with symptoms (Figure 4). Cough (54 percent) and fever (41 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 Ten thousand two hundred and ninety-two (66 percent) are males and 5309 (34 percent) are females. Most of the cases; 5056 (32 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 sixty – three deaths have been reported so far, 196 (75 percent) being males and 67 (25 percent) were females (Figure 6).

Figure 6: Distribution of Case Fatalities by Age and Sex

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Among the 263 COVID-19 mortalities, 131 (50 percent) had comorbid conditions, 14 (5 percent) had no comorbid conditions, while 118 (44 percent) had missing data as illustrated in Figure 7.

All COVID-19 Mortalities (N=263)

Mortalities with Mortalities with no Mortalities with comorbidities comorbidities missing data 131 (50%) 14 (5%) 118 (44%)

One third of the COVID – 19 mortalities had both hypertension and diabetes as comorbid conditions. Second are COVID-19 mortalities who suffered hypertension alone (23 percent) and third, those who had diabetes alone (17 percent) as illustrated in Table 1 below.

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

Co-Morbidity Freq. Percent (n=131) (%) 1 Hypertension, Diabetes 40 31% 2 Hypertension 30 23% 3 Diabetes 22 17% 4 Cancers (Breast, Prostate, Tongue, Colon, Blood) 10 8% 5 Chronic Lung Diseases (Asthma, TB and other chest related 10 8% complications) 6 CCF/Cardiovascular Complications 6 5% 7 HIV/AIDS 5 4% 8 Head injury due to road traffic accident 2 2% 9 Hip Replacement 2 2% 10 Kidney Diseases 2 2% 11 Intestinal Obstruction 1 1% 12 Liver Disease 1 1%

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Out of the 44 counties reporting cases, 19 (43 percent) have reported mortalities. Nairobi accounts for half, followed by Mombasa at 74 (28 percent) as illustrated in Table 2.

Table 2: Distribution COVID-19 mortalities by county County Freq. (n=263) Percent (%) 1 Nairobi 135 51.33% 2 Mombasa 74 28.14% 3 Kiambu 13 4.94% 4 Kajiado 11 4.18% 5 Nakuru 7 2.66% 6 Machakos 4 1.52% 7 Uasin gishu 3 1.14% 8 Garissa 2 0.76% 9 Kisumu 2 0.76% 10 Laikipia 2 0.76% 11 Narok 2 0.76% 12 Bomet 1 0.38% 13 Kilifi 1 0.38% 14 Kitui 1 0.38% 15 Lamu 1 0.38% 16 Mandera 1 0.38% 17 Migori 1 0.38% 18 Nyeri 1 0.38% 19 Siaya 1 0.38%

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1.7 Distribution of Confirmed COVID-19 Cases by County and Transmission Classification Of the 15601 cases, 9157 (59 percent) are from followed by with 1874 (12 percent) as shown in Figure 7. Nairobi city County has the highest attack rate of 208.3 per 100,000 population followed by Mombasa County at 155.1 per 100,000 population (Table 3).

Figure 7: 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/No County Population (2019 Cumulative Cases per 100,000 Census KNBS) Cases population 1 Nairobi City 4,397,073 9157 208.3 2 Mombasa 1,208,333 1874 155.1 3 Busia 893,681 668 74.7 4 Kajiado 1,117,840 811 72.6 5 Kiambu 2,417,735 970 40.1 6 Machakos 1,421,932 569 40.0 7 Migori 1,116,436 249 22.3 8 Lamu 143,920 25 17.4 9 Uasin Gishu 1,163,186 191 16.4 10 Taita/Taveta 340,671 43 12.6 11 Nakuru 2,162,202 240 11.1 12 Makueni 987,653 72 7.3 13 Nyeri 759,164 55 7.2 14 Laikipia 518,560 35 6.7 15 Kilifi 1,453,787 96 6.6 16 Kwale 866,820 56 6.5 17 Isiolo 268,002 14 5.2 18 Narok 1,157,873 55 4.8 19 Kericho 901,777 42 4.7 20 Garissa 841,353 38 4.5 21 Kisumu 1,155,574 44 3.8 22 Siaya 993,183 33 3.3 23 Murang'a 1,056,640 31 2.9 24 Wajir 781,263 19 2.4 25 Turkana 926,976 22 2.4 26 Mandera 867,457 20 2.3 27 Meru 1,545,714 31 2.0 28 Kitui 1,136,187 22 1.9 29 Marsabit 459,785 8 1.7 30 Vihiga 590,013 10 1.7 31 Kisii 1,266,860 22 1.7 32 Bomet 875,689 9 1.0 33 Nandi 885,711 8 0.9 34 Nyandarua 638,289 5 0.8 35 Nyamira 605,576 5 0.8 36 Embu 608,599 4 0.7 37 Trans Nzoia 990,341 7 0.7 38 Kakamega 1,867,579 14 0.7 39 Bungoma 1,670,570 12 0.7 40 Tana River 315,943 2 0.6 41 Homa Bay 1,131,950 7 0.6 42 Tharaka-Nithi 393,177 2 0.5 43 Kirinyaga 610,411 3 0.5 44 Elgeyo/Marakwet 454,480 1 0.2 Kenya 47,564,300 15601 32.8

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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 15601 confirmed COVID-19 cases a total of 14753 contacts have been listed, 481 contacts have tested positive for COVID-19 (Table 2). 11703 of the 15601 cases are pending contact listing (Fig 10). Of the 4387 contacts under follow up 4309 (98 percent) were followed up today

Figure 9: Status of contact tracing

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Below 3 days 4-7 Days 8-14 Days

100% 1 90% 1 9 7 3 1 5 10 5 80% 5 3 1683 70 3 287 2 4 2 70% 4 235 221 110 37 140 17 3 60% 4 4 7 6 17 75 50% 4 1 3 1 2 1 2 6 1 3 2 1 1 2 2 5 7 40% 18 45 63 20 1393 30 9 30% 181 62 2 5 3 8 2 41 2 32 20% 5 4 1 4 112 4 1 14 10% 1 67 1 33 1 1 84 1 24 538 26 8 1 2 1

0% 1

Kisii

Kilifi

Kitui

Isiolo

Busia

Nyeri

Wajir

Lamu

Meru

Embu

kwale

Nandi

Narok

Vihiga

Migori

Bomet

Garissa

Nakuru

Nairobi

Kisumu

Kajiado

Laikipia

Kericho

Kiambu

Turkana

Nyamira

Makueni

Marsabit

Kirinyaga

Bungoma

Murang'a

Mombasa

Homa Bay Homa

Machakos

Kakamega

Tana River Tana

Nyandarua

Trans Nzoia Trans

Uasin Gishu Uasin TaitaTaveta Tharaka Nithi Tharaka

Figure 10: Number of days’ cases pending contact lasting

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2.0 KEY ACTIONS

2.1 Coordination ➢ The Cabinet Secretary addressed the nation today in which he noted that there is an increase in gender-based violence from March to June 2020 compared to a similar period last year. The country has also witnessed an increase in by 7 percent in all forms of violence. Wajir, Kisumu, Turkana, Kisii, Lamu, Homa Bay, Nandi counties have recorded a 30 percent increase in violence. In addition, close to 5,000 rape cases have received medical treatment in health facilities during the period of the pandemic with children below 18 years bearing the greatest burden, as they comprise 70 percent of these survivors with 5 percent of survivors being male. The Ministry of Health has provided guidelines to healthcare workers on how to deal with all forms of violence including gender-based violence during this period of COVID-19 pandemic. ➢ Ongoing coordination meetings at both national and sub – national level in affected counties.

2.2 Case Management and Infection Prevention & Control ➢ In the last 24 hours, 378 COVID-19 patients recovered and were discharged bringing the total number of recoveries and discharges for COVID-19 to 7135.

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, 6754 samples were tested across various laboratories of which 796 samples turned positive for COVID-19. A total of 256,060 cumulative tests have so far been conducted.

2.4 Utilization of the Integrated Data Management Platforms Utilization of electronic case investigation is summarized in Table 4 below which presents the combined data from CHT and KenyaEMR to give a picture of which counties are using either CHT or KenyaEMR for electronic data collection. It is noteworthy to indicate that there has been a drop in week three with regard to utilization of the electronic case investigation forms. Further, some counties, such as Machakos, Homa Bay, Isiolo, Mandera, Marsabit, Bungoma and Meru have never utilized the systems.

MOH Kenya /24 July 2020 14 | P a g e Table 4: Utilization of the Electronic Case Investigation Forms

Case Investigations Epi Week 27 Epi Week 28 Epi Week 29 # County CHT KENYAEMR CHT KENYAEMR CHT KENYAEMR 1 3 0 17 0 1 0 2 4 0 0 0 0 0 3 0 1 46 65 75 31 4 0 0 0 0 0 0 5 0 0 0 0 0 0 6 3 27 19 32 3 9 7 22 0 26 0 0 0 8 13 0 0 7 0 0 9 0 0 1 2 0 5 10 0 0 1 0 0 0 11 0 0 0 0 0 0 12 0 0 0 0 0 0 13 0 0 0 0 0 0 14 11 7 1 7 8 5 15 Mombasa County 3 0 0 0 0 0 16 Nairobi County 0 0 2 0 7 0 17 0 0 0 0 4 0 18 0 0 0 0 10 0 19 0 0 1 0 0 0 20 0 0 0 0 0 0 21 0 0 0 0 0 0 22 0 0 0 0 1 0 23 0 0 0 0 0 0 24 0 6 0 0 0 0 25 0 1 0 51 0 2 26 0 0 0 1 0 0 27 Taita Taveta County 0 3 0 9 1 1 28 0 0 0 2 0 2 Totals 59 45 114 176 110 55

3.0 KEY CHALLENGES ➢ Inadequate resources for operations at the sub – national level for COVID-19 surveillance activities, this is glaring at the sub – county level. ➢ The long turnaround time for relying laboratory results to clients in most counties is causing delay in public health action. ➢ Weak diagnostic quality assurance system.

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➢ Risk communication messages that may be out of step with the evolving epidemic and interventions. ➢ Reports of violence by communities directed and rapid response teams conducting COVID-19 contact tracing. ➢ Some communities are not reporting deaths, this is bringing a challenge in responding to alerts and sample collections ➢ 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. ➢ Low uptake of integrated data management systems especially for the electronic case investigation form in the CHT and KenyaEMR with counties such as Machakos, Homa Bay, Isiolo, Mandera, Marsabit, Bungoma and Meru never utilizing the systems (Table 4 above). ➢ Shortage of assessment tools used in the household for already confirmed cases, the tools are usually photocopied or printed, hence they are stockouts.

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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