Red flag as Covid-19 deaths continue to rise

Kenya’s Covid-19 deaths have risen exponentially in the past two weeks, a trend that has health officials worried.

Deaths from the disease rose by over 20 per cent in the past week, according to the latest African situation report, and the steady rise has continued this week.

In the past three days, 32 deaths have been reported, bringing the total to 902. Six fatalities were recorded yesterday. “The majority of the deaths have continued to occur at facility level,” Dr Patrick Amoth, the acting Health Director-General said last week.

But why are the deaths so high?

“There is a wide community transmission of the virus and we are having a severe form of the disease,” said Dr Amoth, sentiments echoed by Dr Ahmed Kalebi, the CEO of Lancet Kenya.

Dr Kalebi said: “The number of people getting infected with Covid-19 is higher, we are also seeing more case fatalities than before.”

According to him, there could be community deaths, a statement reiterated by Dr Bernard Muia, a public health expert.

Death patterns

“The data being presented by MoH has a selection bias — it is health facility-based and there could be many Covid-19 community deaths from the disease. Actually, 20 per cent of all community deaths could be from Covid-19,” said Dr Muia.

He explained the assertion, saying it is premised on death patterns during pandemics and his clinical experience having worked in rural settings.

“The upsurge could also be associated with the rate of hospitalisation, which is going up,” he said.

Dr Muia said the cases could also be going up because of poor management of the disease considering that there have been strikes by some health workers in various parts of the country.

“Industrial action should be addressed. Lack of equipment, supplies and human resource could impact negatively on patients and should also be addressed,” he said.

Yesterday, the Health ministry reported 931 positive cases from a sample of 6,691, with Nairobi leading (333) followed by Mombasa and Nakuru with 95 and 85 cases respectively.

Dr Githinji Gitahi, the Amref Health Africa Group CEO, said there is need of improving capacity in hospitals and ensuring that oxygen, which is very critical, is available. “Encourage people to seek healthcare early, they should stop being afraid of going to hospital,” he said, adding that there is need to look into ways of reducing stigma. “Increased deaths are as a result of a multiplicity of factors, the vulnerable (aged and those with existing conditions) are coming down with the increasing infections. They have become more exposed to Covid-19,” said Dr Marybeth Maritim, an infectious disease specialist at the University of Nairobi.

According to her, hospitals are not overwhelmed and cannot be blamed for the increased deaths, but they could in the next several weeks if the trend continues.

Hospital admission

She added that there could be transmissions in hospitals, stressing the need to wear masks everywhere. During a recent media briefing, Dr Amoth said the rate of hospital admission had doubled in the past two months.

“Two months ago, our admission rates were around 450 in all institutional facilities. Today, the figure is 991. This means we have a widespread community transmission of the disease, more and more people are also going to health facilities,” he said last week.

As of yesterday, a total of 1,198 Covid-19 patients were admitted to various facilities in the country while 3,437 are under the home-based isolation and care.

Read: Kenya reports 14 new Covid-19 deaths, 631 more cases

According to Dr Amoth, the number of people who need critical care is also increasing, from below 10 cases a few weeks ago to 18 patients in ICU currently, 49 on supplementary oxygen and 16 in the High Dependency Unit.“This tells you that we are getting a more severe form of the disease,” he said. According to Dr Amoth, the majority of the deaths are among those above 58 years, who account for four per cent of the total caseload, but for more than 50 per cent of all the deaths.

“We are losing significant number of people given that infection and transmission is significant as well,” said Dr Gitahi.

By yesterday, there were 902 deaths, out of which more than 360 were of patients aged 60 years and above— more than 30 per cent of all deaths. Those who were aged between 50 to 60 were more than190.

Pre-existing conditions

“This means that 66 per cent of all deaths are of patients above 50 years. Besides the age, they had pre-existing conditions” he said, adding that there is need to reduce the number of people getting infected by adhering to the public health measures.

Cumulatively, those aged 20-39 account for 54 per cent of all Covid-19 cases.

Unfortunately, they are also dying from the disease, even without coexisting medical conditions, said Dr Amoth.

According to Dr Muia, “any death emanating from Covid-19 is not a good indication of control measures — one death is a bad indicator of the disease management.

“We should not have deaths coming from it as a case fatality rate (CFR) of zero is the gold standard. If we prevent the disease, we will not get deaths,” he said.

Dr Maritim reiterated: “Deaths mean that we have failed in our public health measures,” she said.

But Kenya’s CFR has remained 1.8 to 1.9 per cent compared to the global average of 3.2 per cent, according to Dr Amoth.