MINISTRY OF HEALTH DATA AS REPORTED BY 1700 HOURS 23 July COVID-19 OUTBREAK IN KENYA 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 Nairobi (539), Kiambu (63), Machakos (57), Kajiado (37), Migori (26), Kericho (15), Narok (11), Uasin Gishu (11), Laikipia (9), Nakuru (7), Busia (6), Mombasa (4), Kisii (3), Murang'a (2), Siaya (2), Embu (1), Kisumu (1), Nyeri (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), Kilifi (96), Makueni (72), Kwale (56), Narok (55), Nyeri (55), Kisumu (44), Taita Taveta (43), Kericho (42), Garissa (38), Laikipia (35), Siaya (33), Meru (31), Murang'a (31), Lamu (25), Kisii (22), Kitui (22), Turkana (22), Mandera (20), Wajir (19), Isiolo (14), Kakamega (14), Bungoma (12), Vihiga (10), Bomet (9), Marsabit (8), Nandi (8), Homa Bay (7), Trans Nzoia (7), Nyamira (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. MOH Kenya /24 July 2020 1 | P a g e 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 MOH Kenya /24 July 2020 2 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 1.2 Cumulative Cases and Deaths Figure 2: Cumulative case load MOH Kenya /24 July 2020 3 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 1.3 Laboratory Testing Figure 3: Laboratory Tests Conducted by Date Results were Shared MOH Kenya /24 July 2020 4 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 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 MOH Kenya /24 July 2020 5 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 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 MOH Kenya /24 July 2020 6 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 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% MOH Kenya /24 July 2020 7 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 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% MOH Kenya /24 July 2020 8 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 1.7 Distribution of Confirmed COVID-19 Cases by County and Transmission Classification Of the 15601 cases, 9157 (59 percent) are from Nairobi County followed by Mombasa County 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 MOH Kenya /24 July 2020 9 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 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 MOH Kenya /24 July 2020 10 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 1.8 Map of Kenya Showing Distribution of Confirmed COVID-19 Cases by County Figure 8: Distribution of confirmed COVID-19 cases by County MOH Kenya /24 July 2020 11 | P a g e COVID-19 SITUATION UPDATE: 24 July 2020 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).