Corona virus (2019nCoV): why Kenyan nurses might be a worried lot

There is reason enough to worry as Kenyan nurses about Corona virus (2019nCoV).

As Nurses

  • Know the basics first: COVID-19 = ‘CO’ stands for ‘corona,’ ‘VI’ for ‘virus,’ and ‘D’ for disease
  • 2019nCoV=2019 novel corona virus
  • Spherical enveloped particles containing single-stranded RNA. The envelope bears club-shaped glycoprotein projections.
  • Transmission is usually via airborne droplets to the nasal mucosa.

Novel

  • Its novel, new, an enigma-modes of transmission remain unclear
  • Many medics have been casualties
  • Virus replicates locally in cells of the ciliated epithelium, causing cell damage and inflammation.
  • Coronaviruses are found in avian and mammalian species.
  • Are extremely fastidious and grow only in differentiated respiratory epithelial cells
  • Genetically error-prone RNA viruses, with high mutation rates have, for millions of years, provided opportunities to switch to new hosts in new ecosystems.

 

Why there could be more than just fear

  • In the fight against Covid-19 health care provider’s health should be made a priority
  • Most are ill-prepared, scared and perhaps it will be asking for too much more than we are ready to risk!  Or Volunteer
  • We as nurses still have our usual tasks to perform, we may not be getting any extras allocated for our new riskier roles. Nurses have so many other demands on our time, they have to try to fit it all in.
  • Protocols to keep nurses and their patients safe should be practicable, usable, and available
  • Everyone is at equal risk of the virus but we as medics Are frontline https://youtu.be/fylWPZA6sJg
  • The one who identified it a pediatrician died from it so did the director of the hospital
  • by 29th February 3000 health workers were infected in China 8 dead according to  China’s National Health Commission announced on 2nd March 2020. Reported in Business insider.
  • in one site, a third of the patients involved were healthcare workers.
  • China has better access to PPE (including the highly-sophisticated hazmat masks) than most yet in China, hospitals have reported running out of beds, testing kits, and protective gear.
  • Prices of PPEs have skyrocketed, and even then the supply chain is completely strained
  • Sick people report to nurses and are treated before their condition is known
  • Nurses who have been in close contact with Covid-19 patients, in the US, were told to continue working, or recalled from self-quarantine.  If this could happen there it is not difficult to imagine what might happen in Kenya.
  • Nurses may unknowingly transmit the virus especially if they were not tested for the virus quickly enough after possible exposure, lots of bureaucracy has been reported elsewhere.
  • “If nurses aren’t safe, then really our community isn’t safe,” said J.M, a clinical nurse at the University of California, Davis, Medical Center.  Nurses need to stand together to make sure they can protect their patients -by being protected ourselves
  • National Nurses Association of Kenya (NNAK) chair recently stated categorically that self-quarantine without professional supervision was inadequate

Epidemic or Pandemic

  • An epidemic: is the rapid spread of infectious disease to a large number of people in a given population within a short period of time.
  • pandemic is the worldwide spread of a new disease.

Havoc 

  • The virus causes Acute Respiratory Distress syndrome (ARDS)
  • The condition may require some form of life support incl. mechanical ventilation
  • Few ICU beds KNH 21 beds per > 2,500 patients, the rest of the country <150 beds
  • Dilemma – whose interest to put corona pts on life support?
  • Infectious diseases hospital (IDH) not easy to put up, equip and run (11 beds set aside)
  • A presidential executive order on 28th February, 2020 to finish one in a week’s time and a steering committee
  • Apart from too many variants and being error-prone, a coronavirus vaccine may take years to develop

Signs & Symptoms

  • fever, cough, shortness of breath and breathing difficulties.
  • severe cases, it can lead to pneumonia, severe acute respiratory syndrome, kidney failure and even death

Typical Presentation

A bit of Pathophysiology

  • The entire lung becomes inflamed due to the immunological response elicited by the host.

Problems begin after inflammation.

  • The thin barrier becomes thickened due to fluid accumulation which automatically impairs gaseous exchange.
  • Low oxygen concentration in the blood leads to tissue hypoxia which may cause organ shutdown.
  • if several organs shutdown then the body shutdowns too, leading to death.

Asymptomatic

  • coronavirus may be asymptomatic for as long as 27 days (mode 14)
  • But yet infected and contagious

Stage of severity

 

  • the table above shows stages of severity.  Take note of the stage from severe disease downwards as drawn from the best of centers where the disease has occurred.  In resource-constrained settings, this is almost 19 5% of cases who might succumb.

Healthcare workers are particularly vulnerable

  •  First, the coronavirus is highly contagious, and medical staff members are exposed to more viral particles than the general public.
  • Second, they’re facing shortages of supplies as the tide of patients rises.
  • Third, a combination of stress and long hours could make their immune systems more vulnerable than normal.
  • Fourth: a lack of data and information about the new coronavirus e.g it was recently discovered that an asymptomatic patient admitted with gastrointestinal symptoms had infected 10 HCW and 4 other patients by the time this was recognized as COVID-19.  GIT symptoms were hardly red-flagged as CoVid-19 before.
  • Fifth, one sick patient (case) is cared for by a multidisciplinary group, some up to 100 persons. The majority being nurses who work in shifts. One sick HCW alias ‘colleague’ would be attracting an even higher Nurse: Patient ratio.

Ambient environment

We are told but nobody knows for sure

    • disease tends to spread best in cold weather and low humidity
    • warm, humid weather slows coronavirus
    • Are we in control of the above? NO!

Broken down systems vis-a-vis economic interests

  • Kenya sixth-highest risk in Africa, highest in East Africa but this could change
  • extensive testing not yet started
  • has only tested 13 for Covid-19 (all of whom tested negative).
  • It may be a matter of time before coronavirus cases explode in Kenya
  • Heavily donor-dependent -disaster mnt and epidemics funding (Bill & Melinda Gates Foundation Sh1 billion ($10 million for to Africa to fight COVID 19)
  • World Bank has released $12Bn to be used to strengthen the health system of developing countries through the ‘fast track’ their fight against COVID 19.
  • only 11 beds were ready before yesterday’s  executive order 28th Feb 2020 on 120-bed IDH Mbagathi
  • Thermal tests non-touch in Airports (said to be only in JKIA)
  • Resumption of flights from China regions which were said to be epicentres of COVID 19
  • Southern Airlines with >239 jetload recently, who was it bringing in? (our >100 students locked down marooned in Wuhan? NO!)
  • What if any of the 239 passengers who we have asked to self-quarantine turns positive?
  • We don’t want to offend such an important trade partner
  • Weak and corrupt – sneaking in people from hotspots
  • ?Political willpower
  • culture of corruption may infect Kenya’s entire society,

Are we transparent enough to admit the figures and level of preparedness?

NO!!

 

  • Kenya has a large Chinese diaspora working on capital projects,
  • Whereas we have over 3000 Kenyans in China
  • Many Chinese businesses,
  • Kenya is an importer/consumer of Chinese goods (incl. raw edibles)
  • Opportunity real of sneaking in an (as) symptomatic and untested (case of Motomo-Kitui)
  • Obstructing police and medics access to the patient to test coronavirus.
  • We seem incapable of controlling the behavior of Chinese nationals
  • Asking people to self-quarantine ?27days is it possible
  • Equalizer: at least no-one will travel abroad for treatment

Hygiene- are we that sophisticated?

  • Recognizing the relationship between hand hygiene and sanitation: But why do Kenyans fail to see it?
  • WASH -water and sanitation hygiene
  • Handwashing with soap (HWWS)
  • Three out of five people had basic handwashing facilities in 2017 (UNICEF, 2019)
  • Even in health facilities challenge availability of a handwashing facility – on-premises with soap and water (SDG target 6.2)
  • On campuses and workplaces, one or both of the two water/soap may be lacking?
  • Only 5% of caregivers report HWWS at all critical times (KDHS 2009)

Has this improved?

 

Nairobi, Bondo study (MCIP (2014).

  • “… When you ask men to wash their hands they say most dirt is in the stomach … ” ~ Mother, Nairobi
  • “Men in this community only wash their hands before and after eating … as for children, we mothers have to remind them.” ~ Mother, Nairobi
  • “Like my husband, I have to stand there like ‘serikali’ and order him to wash his hands after visiting the toilet.” ~ Mother, Bondo
  • “Children do not wash their hands …. They only wash after eating and even then only at home. If they are out there they do not wash their hands.” ~ Mother, Bondo
  • “We advise women to wash their hands before handling the baby but majority do not follow.” ~ Service Provider, Nairobi

Do patients think we observe handwashing with soap and water?

  • Q: Do service providers wash their hands before putting on gloves and after removing them? From one patient to another?

“The service providers wear gloves so they do not wash their hands.” ~ Mother, Nairobi

Masks

  • Any mask is better than none at all but effectiveness unknown in as far as 2019nCov
  • Who will wear them in the local settings, availability affordability, acceptability?

Etiquettes – Are we that sophisticated?

  • Avoid contact with infected individuals, avoid touching the eyes, nose, and mouth with your hand,
  • Thoroughly wash your hands,
  • Covering the mouth coughing and sneezing
  • Use a tissue and dispose of immediately (WHO, 2020)

Measures we need to take

  • Passenger movements out-bound and in-bound (WHO guidelines)
  • Pooling trained medical personnel from across the country
  • Construction of 2 new IDH hospitals on record time 1,000-bed hospital completed in 10 days!!
  • Extending holidays for schools and businesses
  • Cancellation/postponement of events
  • seek medical care early
  • Ban on sale of fever and cough medications to encourage health-seeking.
  • Register all customers who purchase fever and cough medicine
  • Faster diagnosis efforts
  • Ensuring supplies to the most vulnerable and affected areas
  • US Centers for Disease Control (CDC)  recommends that hospital staff put potentially infected patients in an airborne infection isolation room, wear eye protection, and immediately notify the CDC about any person under investigation.
  • Ministry of Health Kenya hotlines 0800721316; 0800721316;0732353535;0729471414
  • USSD code*265# for free tips
  • thoroughly wash your hands with soap and water for at least 30 seconds.
  • if you don’t have access to soap and water, then you can use a hand sanitizer that’s alcohol-based.
  • do not put your hands around your mouth, eyes, and nose if your hands are dirty.
  • avoid at all costs physical contact with people that are displaying signs of infection.
  • stay inside if you’re sick.
  • clean and disinfect all the objects you constantly use, as well as sanitizing all surfaces that you’re getting in contact with.
  • cover your mouth when sneezing or coughing- use a tissue and then dispose of it yourself by throwing it in the trash.
  • any raw meat, milk and animal organs you handle should be done with care, to avoid any type of cross-contamination with uncooked foods.
  • wash your hands after sneezing or coughing using soap and water, or alcohol-based hand sanitizer.
  • wash your hands when caring for those that are sick around you.
  • wash your hands before, during and after you prepare food.
  • wash your hands after using the toilet.
  • wash your hands after handling animals and animal waste.
  • thoroughly cook any meat and eggs you buy/ procure from farms and supermarkets.
  • avoid any unprotected contact with animals.
  • when preparing meat make sure to use different cutting boards and knives especially if you prepare different types of meat.
  • wash your hands in between handling raw meat/ food.
  • do not eat any type of animal that has died due to any type of disease.
  • thoroughly cook your meat and properly handle it during its preparation.
  • do not directly touch any spoiled meat.
  • do not touch any stray animals, waste and fluids when you’re at the market.
  • disinfect all objects you are getting in contact with at your workplace.
  • avoid traveling to countries that have been affected by the 2019 Wuhan Coronavirus illness.
  • avoid touching any person that is displaying flu-like symptoms.
  • discard single-use masks after you use them, then make sure to wash your hands.
  • if you are sick during your travels, then you should inform the crew and seek medical care as soon as possible.
  • if you are sick and you need medical care, then you should share all your travel history to the smallest of details

Social-Cultural bottlenecks

  • Handshake: Avoid handshake, hugs. \This is the handshake season politically in Kenya
  • Social distance at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing
  • Bodies disposal In some countries use of incineration, or is it cremation, gassing?
  • Conspiracy, satire, myths, stigma, stereotyping
  • Faith  Phil 4:6 Do not be anxious for anything… We better be prepared, than sorry. Pray – Godspeed

Lack of seriousness

  • Court orders not necessary obeyed Law Society of Kenya case 28th Feb 2020 to have flights canceled and self quarantined case tracked down for formal quarantine
  • No less than the Vice president of the US is overseeing the Corona situation in the US
  • Economy slump China from 10% to 6% since Dec 2019 (has been 10% plus in the last 40 years).
  • Can Kenya, avoid becoming a hotspot from it’s hotpots? China, Italy, Iran etc.?
  • Now at Patient Zero, then what?  It is NOT a matter of IF…. BUT WHEN…
  • Could Kenya become the next hotspot?
  • While individual action is important, it will not stop an epidemic, only collective action will

The nursing situation still dire yet the nurse is the fulcrum of the health system

Compleat Nurse* 2020

 

Have you been personally affected by the coronavirus? 
As a healthcare worker on the front lines of this disease what are your apprehensions? 
Have you or someone you know been tested or diagnosed? 
We want to hear your story in the reply section.
 

Disclaimer

This is a moving target with new developments to keep pace with, therefore readers are advised to find out more from other authentic sources e.g https://corona.help/,  WHO , and among other links provided in the bibliography section below.

Bibliography and links

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