On May 14, 2020, the World Health Organization (WHO) Chief of Emergencies, Dr. Michael Ryan, warned that coronavirus may become another endemic virus in our communities.
This warning lays bare the question of how much longer we can maintain our phase one response, stopping the spread of the virus through restrictions and lockdowns.
That the economic costs of these measures have been tremendous is not a matter of debate.
The false dichotomy we presently have is that our choices are reopening the economy or face a mass loss of lives. The reality is that we can and must do both.
The current choices we have availed ourselves are, either holding off on reopening the economy until such a point when the pandemic recedes or that the economic consequences of an extended shut down become so intolerable for policymakers and citizens alike, that we end up relaxing restrictions anyway.
The former, as the WHO’s warning suggests, may never happen. The latter would be just as reactive as our initial response, a stagnation on our learning curve of the pandemic.
The inertia in the policy shift I suggest is understandable, after all, we have no record of a similar phenomenon in our living memory as a country.
Unfortunately, if we don’t purpose to overcome said inertia ourselves, circumstances will force us to do so painfully and at a great cost.
A situation where we have food riots, increased crime and despair deaths (deaths resulting from economic despair occasioned by the pandemic) is completely understandable.
This calls for a change in policy that takes into account the lessons we have learned so far, our strengths and weaknesses and use those as building blocks for a formula that allows us to live with the virus rather than merely stopping its spread.
The efficacy of such a formula should be pivoted on its ability to minimize deaths, protect our already fragile health system from collapse whilst averting a full on economic crisis.
This then leads to a question of how to reopen our economy.
Even as President Uhuru Kenyatta extended restrictions for three more weeks and announced the cessation of movement of persons across our Tanzania and Somalia border, we need to see tangible efforts in building the capacity of our hospitals across the country.
Such capacity would include functional isolation and treatment units in each county, provision of personal protective equipment and training of health workers on the treatment of the pandemic.
Assuming that this is already happening, I have identified three areas that require immediate attention if we are to have any hope of relaxing restrictions and jump-starting the economy.
Desecuritization of our response
Phase one of our pandemic response has been heavily securitized. One may argue that this is necessary to slow down the spread of the virus.
However, as we learn more about the pandemic, we begin to see some serious shortcomings of a securitized response.
First, this response came with the unintended consequence of criminalization and subsequently, stigmatization of the virus.
As a result, the public has shied away, at best, and resisted, at worst, any efforts to identify, isolate and treat coronavirus cases. This loss of public trust in the response makes it extremely difficult to wage a war against the virus.
Second, we have seen rising cases of human rights abuse as well as extra judicial killings by the police, as they enforce restrictions, particularly in informal settlements.
Finally, the nature of police enforcement operations counteract the wisdom of social distancing. This makes those very operations a potential vector for spreading the virus.
Bearing the above, it is necessary to change tact to a softer, community-driven approach that will onboard public trust and goodwill.
Fortunately, Kenya has a robust network of community health workers and volunteers- a legacy of our war against HIV/AIDS, Malaria, Cholera and other communicable diseases.
These health workers and volunteers command a lot of trust from the public. In most vulnerable communities, this level of trust is only comparable to that accorded to teachers and agricultural extension officers.
There is wisdom therefore in activating this network and building its capacity become the frontier of mitigation of the pandemic.
The war against coronavirus will not be won with guns and batons. Rather, it’s a war we need to wage by winning the hearts and minds of the community through effective communication and civic education.
We must treat this as an ideological war where we try and build trust and goodwill amongst Kenyans.
This is the only way we can expect to see a willingness, by the people, to not only follow guidelines and bear the inconveniences therein but also to identify those who don’t follow the rules and present them for sanction by the authorities.
Furthermore, this goodwill shall greatly enhance our ability to trace contacts of those who test positive for isolation.
Community driven contact tracing addresses the glaring gaps that are inherent in the use of technology such as GPS.
Last but not least, activating the health volunteers to work on mitigation, and paying them would be, in and of itself, an economic stimulus package as they will spend their earnings in the communities where they live, improving those microeconomies.
“Shifting from locking everybody down to locking down people who we know are infected will reduce both health and economic risks”
Paul Romer, Nobel Laureate Economist.
SARS-COV 2 is a virus optimized for rapid spread. It is estimated that up to half of the people infected are asymptomatic carriers who can spread the virus unwittingly, for weeks.
This, coupled with the fact that its symptoms vary from one person to the next makes it extremely difficult to identify. It is this peculiar nature of the viruses that informs drastic lockdown measures across the world.
Mass testing, done on a vast scale, can help relax or even replace lockdown restrictions. In a survey of health experts and economists by Chicago’s Booth School, 93 percent of the respondents agreed that a massive increase in testing is necessary for an economic restart in America. The circumstances are not any different for Kenya.
An ideal mass testing regime would need to, firstly, test any and every individual exhibiting symptoms and secondly, perform wide scale intermittent tests targeted at those whose work requires them to interact with many people eg transport, hospitality and health workers.
In such an ideal the tests must be free, easy to administer and available at point of care facilities. Finally, the regime would require capacity to test each targeted individual multiple times as this is not a one test per person scenario.
It is important to note that the required capacity of testing to safely relax restrictions is much more complex than acquiring kits. It would probably require a dedicated war time- like committee that pools expertise from the private sector, academia and government.
The committee would then direct processes such as procurement of kits and reagents, build capacity for local production of the same and train the people needed to take samples and run the testing apparatus, as well as track the spread of the virus.
Granted, building an ideal mass testing regime is an expensive undertaking. However, since it is a necessary ingredient for relaxing restrictions and getting our economy back on track, its ROI is more than promising.
The provision of water, sanitation and hygiene systems is essential in the war against coronavirus.
Frequent and proper hand hygiene remains one of the most important measures to contain the virus.
As such, for restrictions to be eased, WASH systems must be availed and/or enhanced across the country, to enable frequent and regular hand washing.
Bearing in mind that the country’s WASH infrastructure was already weak before the pandemic, and that it has further been weakened by the recent floods that have affected supply to urban areas, the government must establish emergency support to address these structural weaknesses.
Such a system should include, rapid and low cost WASH interventions, targeted at informal settlements, rural communities and all public areas.
These areas need to be equipped with widespread, just-in-time water access points that also have soap. A comprehensive mapping exercise needs to be carried out to identify the most strategic places to position these points. The idea is to reach as many people as possible.
Any disruptions, occasioned by the recent floods must be repaired to restore and enhance supply and ensure that water from the access points is not diverted for household use.
The physical infrastructure will need to be complemented by effective communication and mass education around the need for proper hand hygiene. This will ensure that there is the behavior change that is absolutely necessary as people resume their normal lives.
Finally, the government must put in place measures to ensure that there is regular deep cleaning and sanitization of all public surfaces to limit the spread of the virus that would otherwise be associated with increased interaction with surfaces once restrictions are relaxed.
An unintended benefit of enhanced WASH systems is that it will help reduce the spread of other communicable diseases such as Cholera and TB which kill thousands of Kenyans every year.
While the three areas I have addressed are far from exhaustive, they are indicative of some of the big picture and fine-point policy changes we must begin to explore as we prepare ourselves for the possibility of an endemic virus with no cure or vaccine possible at least for the next year.