Model scenarios, public perspectives, and implications for reopening in Kenya

Pondering pathways for coping with a pandemic which is determined to be endemic is ultimately a marathon exercise in managing complexity. Short-termism has no chance. Routine tools of tactical combat must give way to strategic plans supported by collective long-term commitments by governments and citizens alike.

Covid-19 Trends: Global

Since April 18, the global mathematical simulation equation for cumulative Covid-19 cases has been:

Brazil and Russia have overtaken Spain and the UK in cumulative Covid-19 cases to rank second and third after the USA, respectively. The projection based on this equation was to hit 6 million cases by May 31. Assuming the growth trend maintains, the cases will comfortably reach 7 million by June 10 and 8 million by June 21, 2020.

In Africa, significantly increasing Covid-19 testing rates are becoming a common trend. If there occurs a substantial spike in country cases, these projections can be exceeded by far. The most probable reasons are, first, an increase in testing rates unearthing rising cases from community clusters, as has been the case in Kenya lately. The second reason is a relaxation of containment measures despite serious risks of community transmission among socially active populations who either keep interacting without heeding social distancing or lack the luxury of adequate physical space in their areas of daily operations.

Covid-19 Trends: Africa and the Challenge of Testing Capacity

By June 3, 2020, the global cases had reached 6.5 million with a case fatality rate of 6% and a recovery rate of 48%. Africa had registered about 160,000 cases by this date with a case fatality rate of 3% and a recovery rate of 43%. South Africa was still leading in Africa with about 35,000 cases followed by Egypt (about 28,000), Nigeria (about 11,000), then Algeria and Ghana with about 9,000 cases each.

In East Africa, Kenya had confirmed 2,340 cases as at June 4 with a case fatality rate of 3% and a recovery rate of 25%. By June 3, only Uganda had not registered any Covid-19 fatality in the region. Uganda’s recovery rate by then was 16%. Rwanda, which had no Covid-19 case fatality for long, had already registered two case fatalities (0.5%) while still sustaining a high recovery rate of 70%. Madagascar, which had dominated headlines for Covid-Organics as a Covid-19 curing drink extracted from Artemisia, had by June 3 registered a relatively low recovery rate of 22% with 0.6% case fatality rate. High recovery rates were notable in some countries namely Mauritius (96%), Rwanda (70%), and South Africa and Senegal, which had posted recovery rates of over 50% by June 4, 2020. In the table below is shown a representative analysis of Covid-19 trends across selected African countries over a forty-day period between April and May 2020.

For a rational comparison, the efficiency of testing is presented in this review using normalised population and rate metrics that take care of differences in country populations and the time passed since their index cases were confirmed: number of tests per million people per day. As at May 26, the battered European countries had registered high testing indices based on this measure: Russia 701.4, Spain 644.7, Italy 491.9, UK 459.8, USA 366.9, Germany 351.8, and France 169.7. Brazil’s score on this measure was 35.1 by then. In Africa, Mauritius was leading on this metric at 1175.6, far ahead of South Africa (123.3), Ghana (86.3), Rwanda (63.2), and Kenya (16.0). Dismal testing performance in the group of African countries shown in the table below could be seen in Madagascar (5.2) and Nigeria (2.4). The large country populations in Nigeria and Egypt, a hundred million and more, evidently raise the bar for equivalent scores on the normalised metrics of testing their populations.

Insight 1: Higher normalised measures of country Covid-19 tests tend to associate with better overall performance for the countries. Though the mean case fatality rate in Africa is below the global rate, the recovery rates remain low in general. Madagascar’s low recovery rate of about 20% invokes curiosity for the main reason that the “Covid-Organics cure” is expected to have achieved a recovery performance far above the common country experiences across Africa.

Reopening: A Balancing Act and Litmus Test to Capitalism

Stakeholder capitalism

Analysts have surmised that the economic downturn of the Covid-19 crisis could cause the worst depression since the 1930s. The disruptive effects of the crisis have a promising outlook in the way they have prompted homegrown innovations out of sheer compulsion, even breaching common barriers of established practices and attitudes such as procurement bureaucracies and resistance to the digital transformation of work cultures. Klaus Schwab, the Founder of the World Economic Forum, has introduced a flip side to the crisis thus: The pandemic represents a rare but narrow window of opportunity to reflect, reimagine, and reset our world to create a healthier, more equitable, and more prosperous future. In his characteristic persuasion for “stakeholder capitalism”, he urges the world to act “jointly and swiftly” to revamp societies and economies, from education to social contracts and working conditions.

Covid-19 taskforces and Germany’s progressive example

The general global trend in reopening and preparing economies for a post-Covid-19 era has assumed a phased approach beginning with the sectors perceived to be posing less exposure risks. Behaviour change is critical to the long-term coping strategy every country needs to face the challenges and sustain the positive paradigm shifts Covid-19 has caused, especially the much-anticipated “future of work” in the Fourth Industrial Revolution. Normalcy bias, a cognitive bias which leads people to disbelieve or minimise threat warnings, is a behavioural challenge. As nations form Covid-19 taskforces on reopening economies that are mainly composed of scientists and health experts, Germany has presented a model that appreciates the importance of behaviour-change agents in reimagining and recreating a whole new post-Covid-19 resilience. The German taskforce has displayed a heavy composition of experts in history and humanities, notably historians of science.

Balancing lives and livelihoods in Covid-19 decisions

Ultimately, reopening the economy after the lockdowns is a decision that challenges every government to exercise a balancing act between political, socioeconomic and health imperatives. Economic imperatives must be cognisant of market redistribution dynamics, which currently favour the strong global players. This perspective challenges countries to rethink their economic models towards diversification and reduction in global supply chain dependency. Economic stimulus packages, where applicable, must be responsive to domestic priorities and the key requirements for sustainability.

Insight 2: The Covid-19 crisis is also an opportunity for a whole new reset and laying foundations for a systems approach to the deeply interconnected and interdependent societal problems. The pandemic reignites the fire of the moral and political philosophy of social contracts. Incremental and reactionary fixes with a heavy dominance of fragmented and narrow disciplinary perspectives must give way to systemic, multistakeholder and proactive approaches with multidisciplinary perspectives.

Kenya: Covid-19 Trends and the Reopening Dilemma

By June 4, 2020, Kenya’s Ministry of Health had established that 85% of the confirmed Covid-19 cases were asymptomatic. On the normalised metric, Kenya’s testing rate was 5 in late March; 6 in early April; 7 in late April; 10 at the start of May; 14 in mid-May; 16 by May 26; and 17 on May 28, 2020. With a total of 90,875 Covid-19 tests on June 5, Kenya’s normalised testing index had improved slightly to 20 tests/million/day, still far below Uganda’s 29.

The daily confirmed Covid-19 figures in Kenya have been highly responsive to the number of tests conducted. The graph below shows a breakdown of different growth phases of Kenya’s Covid-19 curve.

Insight 3: Kenya is an exemplar of the already firm grip and grim footprint of Covid-19 on local communities in Africa. To ensure prudent reopening schedules and effective coping strategies, a country’s testing capacity must be enhanced and targeted to reveal an accurate big picture of the prevalence and ramifications of the infections.

Model scenarios for easing restrictions in Kenya

Three growth scenarios can be extracted from the number of confirmed Covid-19 cases: optimistic, business as usual (BAU), and pessimistic. Using the observed trends in the normalised testing index can give a hint on the possible scenarios. For Kenya, the changes in normalised testing indices since March usher in observed and assumed growth rates ranging from a low rate of 4.5% for the lower range of the testing index observed in March and April (5–7), 7.1 % for the testing index within the range observed from May to early June (10–14), and 10% assuming an increased testing rate (above 15) with increasing community transmission of the novel coronavirus. Unlike natural population increase which has a delay/gestation period of months, the novel coronavirus has a very short period between transmissions in congested areas such as informal settlements, amplified by its high reproduction number. Informal settlements host the majority of urban dwellers in Africa.

Scenario simulations in Kenya

For policy simulations in Kenya, starting from May 24, running the three assumed growth scenarios based on exponential growth and plotting the actual confirmed cumulative Covid-19 cases (white line) yields the figures in the graph below. June 6 is a strategic date because it is the day on which the restrictions on selected counties and dusk-dawn curfew expires. The white line of the actual figures confirmed by Kenya’s Ministry of Health has since June 1 been deviating from the projected business as usual (BAU). A possible interpretation is that the number of tests has been dwindling, hence not able to expose the full extent of growing cases in the targeted clusters. The deficiency of reagents for testing has been common experience in Kenya, resulting in fluctuations in the daily number of tests by up to 50%. The actual figure of 2216 cases on June 3 had exceeded the projected optimistic scenario of 2179 by June 6. Without containment measures or sustained behaviour change, the pessimistic scenario simulated in the graph below is also a possibility.

Insight 4: Easing restrictions in Kenya on June 6 must confront the reality that the recently increased Covid-19 testing rate has revealed that the trend of community transmission is beyond the optimistic scenario. The situation can easily slip into the pessimistic scenario if reopening is executed hurriedly without robust measures and citizen behaviour change.

Is Kenya’s Covid-19 curve flattening soon?

Based on a study of the reported data on Kenya’s confirmed Covid-19 cases from May 24 to June 4, the simulated rates of change of the emerging Covid-19 curve can take on two possible mathematical equations as shown:

Equating both to zero gives a solution for days (x) in the range of 41–60 days from May 24, hence landing on the following range of dates: July 4–23 with a total of 3,600–4,600 confirmed cases. This scenario seems highly unlikely unless the trend reduces to a low range of 40–75 additional cases per day for another one month starting from June 4, 2020 — maintaining well-targeted mass testing all the same.

Insight 5: Signs are clear that the peak of Kenya’s Covid-19 curve can only be expected later than July 2020. Targeted mass testing must be enhanced to unearth the actual prevalence and accurately inform policy and strategic responses.

Citizen perspectives on reopening Kenya’s economy

Public participation is critical to arriving at decisions that can be collective owned and operationally sustained. In answering the question on when to reopen various sectors and activities in Kenya, the following results were received based on an online survey responded to by 61 Kenyans (graph below).

Easing the time of start and end of the curfew in Kenya and opening up the counties through which movements have hitherto been restricted have become popular public recommendations. There seemed to be public consensus on delaying the reopening of learning institutions in Kenya, rather giving priority to reopening places of worship and transit stations. None of the areas scored the most urgent priority level of 3 (open immediately).

Opinions were widely divided on the level of citizen confidence in the Covid-19 figures the government has been reporting. The very confident ones made up 12% of the total responses, the somewhat confident ones 35%, the not-so-confident ones 30%, and 23% were not confident at all.

Insight 6: The Kenyan public is aware of the dangers of reopening places of mass gathering as Covid-19 cases keep increasing, schools for younger learners being the most sensitive to the majority and perceived to be deserving a delay in reopening.

Citizen concerns on Covid-19 impact and challenges

The same survey revealed that citizens were worried about the impact of the novel coronavirus on them: extremely worried (27%), very worried (30%), somewhat worried (28%), not so worried (13%), and not worried at all (2%).The top-three biggest challenges to working remotely over the Covid-19 restriction period were presented as general anxiety about the impact of Covid-19 on one’s life (50%), social isolation (33%), and too many distractions at home (30%).

Communication tools for coping with Covid-19 disruptions

In a descending order, the applications the respondents have been using frequently for communication over the Covid-19 restriction period are WhatsApp, Facebook, Twitter, YouTube, Zoom, Instagram, Skype, Google, Microsoft Teams, Team Viewer, and WebEx. The opportunities the respondents have utilised over the stay-home period have mainly been in the areas of online work and learning new software skills, family bonding, and research. Student-teacher and mentor-mentee interactions over the period, from the responses, have mainly been via Zoom and e-mail. Zoom conferences have been cited as the main platform for interactive group meetings.

Citizen views on when to resume routine work schedule in Kenya

On when to resume routine work or school, the majority preferred June (31%) or September (31%), followed by July (13%) or some time in 2021 (13%). The rest of the months in between were the least preferred, especially August, which got only one vote. The remaining months got two VOTES each.

Insight 7: Besides the obvious economic disruptions, virtually everyone is psychologically affected by the Covid-19 pandemic. The situation in Kenya confirms the critical role of social media and e-conferencing technologies in bridging the social isolation the pandemic has caused. The most used applications so far are WhatsApp, Facebook, Twitter, YouTube, and Zoom.

Conclusion

Covid-19 has been the century’s frenemy par excellence. On the one hand, it has caused massive social and economic disruption, evident in personal worries, anxiety, social isolation, loss of earnings, among other stresses. On the other hand, it has disrupted established traditions and expedited leapfrog innovations in policies, work culture, and homegrown solutions. The post-Covid-19 era presents a clean slate on which progressive leaders should scribe entirely new policy pathways and map out inclusive framework changes, complete with long-term commitments to strategic development goals.