Advisory Opinion:

Contact tracing and testing; restriction of movement in potential

hotspots
Recommendations to Mitigate the Spread of COVID-19 in Kenya
Prepared 27th March 2020
By the Kenya COVID-19 Technical Task Force

Background
The coronavirus disease 2019 (COVID -19) is a serious respiratory viral infec-
tion caused by a novel coronavirus recently named SARS-COV2. The out-
break started in Wuhan City, Hubei Province in mainland China and has since
spread globally, infecting more than 467,710 people resulting in over
20,000 deaths and occurring in most countries. There is currently no treat-
ment or vaccine. On 11th March 2020, WHO declared COVID-19 a global pan-
demic.

H.E President of Kenya issued an executive order on COVID-19 on 28th Feb-

ruary 2020 that established the framework for up-scaling and coordinating
the preparedness and response initiatives through the National Emergency
Response Committee on Coronavirus.

The first COVID-19 case in Kenya was announced by the Cabinet Secretary
Health on 12th March 2020 and the CS outlined several public health preven-
tive strategies to prevent the spread of the disease that included social dis-
tancing.

On the 15th of March, H.E President further announced further directions

aimed at increasing social distancing, including the closure of schools and
limiting large gatherings.

To date (26th of March 2020) Kenya has 31 confirmed cases of COVID-19.

Whereas the initial cases were reported in returning travelers and their
close contacts, the country is currently noting some cases of community
transmission

Looking at the trajectory of cases in multiple countries, it is clear that the

countries implementing the most strict quarantine and rigorous contact
tracing and testing in addition to social distancing rules are the ones that
have managed to limit the number of cases of COVID-19 and prevent a wide
spread outbreak that would overwhelm the healthcare sytem. Many coun-
tries have now implemented lockdowns in various settings.

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This chart shows the trajectory of cases in various countries

It is clear that as more cases are detected among recent travellers, we will
continue to have clusters of outbreaks that eventually lead to more wide
spread community transmission and may culminate in a large outbreak. The
lack of adherence to self quarantine measures had led to exposure multiple
contacts.

County Number of cases

Nairobi 22

Kilifi 6

Mombasa 1

Kwale 1

Kajiado 1

Total 31

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Based on our preliminary modelling data (worst case scenario), we estimate
that in the absence of any drastic intervention, we will get to 1000 cases by
9th April, 5 000 by mid April and 10 000 by end of April. However in view of
the recent directives on social distancing, travel restrictions and mandatory
quarantine as well as other public health measures there may be a delay in
reaching the 1st 1000 cases.

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Further to the guidance issued on the 22nd March, 2020, the Kenya
COVID-19 Technical Task Force now recommends the following additional
measures:

1. For Kilifi,Mombasa and Kwale where confirmed cases have had multiple
contacts:
• Immediately roll out mass testing for all contacts including those
without symptoms. Positive cases should be isolated and negative
cases should ensure quarantine for at least 14 days from time of ex-
posure
• Trace all contacts as much as possible for testing
• Immediately restrict movement to only that which essential
• Track all who have travelled in to the country in the last 21 days for
screening and testing
• Immediately restrict all movement to other counties from Kilifi,
Mombasa and Kwale
• ?Consideration for cargo movement to be discussed

2. For Nairobi where there is evidence of community transmission:

• Trace all contacts and roll out mass testing for all contacts.
• Immediately restrict movement to only that which is essential
• Mandatory quarantine of all recent travellers for 14 days
• Immediately stop all travel out of Nairobi (this should be immediate
to avoid mass movement to the rural areas)
• ?Consideration for movement of cargo and essential services

3. For Quarantine:
• Establish dedicated RRT teams to screen and test all who develop
symptoms
• Establish dedicated medical teams to attend to emerging medical
issues for those in quaranting
• Testing should be conducted at day 8. Those that are positive should
be isolated and managed as per the case management guidelines.
Those that are negative should continue quarantine until 14 days
• All airline crew and accompanying flight engineers who have operat-
ed local and international flights in the last 21 days should be tested.
Those who arrived in the country in the last 21 days should be quar-
antined for at least 21 days from time of entry in to the country or
contact with positive cases. Crew on self quarantine should not op-
erate any flights, including dementing flights.

4. For cargo:
• Disinfection of incoming cargo at points of entry
• Regular disinfection of all internal flights

5. For research:
• Immediately mobilise funds for support research that will adequate-
ly inform the country’s response to the COVID-19 outbreak (National
research Fund under NACOSTI in the Ministry of Education)

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6. Given the restrictions in movement that are recommended above, from a
health perspective, measures need to be put in place to ensure that there is
provision for management of routine and emergency health needs unrelated
to COVID.

Prepared by:

Prof Omu Anzala Dr. Loice Achieng Ombajo Dr. Marybeth Maritim

______________ _____________________ __________________

Dr. Daniel Langat Dr. Patrick Amoth Dr. Kadondi Kasera

________________ ________________ ___________________

Dr. Thumbi Ndungu

________________

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