The spread of the COVID 19 pandemic has disrupted our normal daily activities including the delivery of healthcare services. However, our healthcare needs have not changed. Pregnant women still require their ante-natal care, children need to be on schedule for their vaccinations, emergencies need to be attended to, people living with chronic illnesses like diabetes, hypertension, cancer and others still require access to physicians, for continuity of care.

While one appreciates that the delivery of care may be disrupted by the movement restrictions and the need for social distancing, it is important that we in the healthcare sector ensure continuity of services so that all patients receive the care they need, promptly. If we fail to do so we risk an even bigger healthcare crisis in the near future.

With the fear of going into hospitals now rife amongst us, Aga Khan University Hospital, Nairobi has heeded the government’s call to ensure continuity of care for all, by enhancing safety measures for patients and staff and communicating these to the public.

Safety in hospitals

As a standard, safety at the hospital is a top priority for any healthcare provider. Now with the reality of COVID-19, we are even more vigilant. We have, for example, formed a disinfection team consisting of members who are specially trained by Infectious Disease experts to clean and disinfect the Hospital and Outreach clinics 24 hours 7 days a week, for the safety of all persons utilizing our services. In line with the government’s directive, everyone visiting our facilities (the Hospital and clinics) is screened on entry and their temperature is measured. All persons must wear a mask and sanitize their hands before entry into the facility. We are also enforcing social distancing rules and have arranged for additional waiting areas for patients.

Safety of healthcare workers

One of the biggest challenges for countries who were hit by the pandemic earlier than us was the high infection rates amongst healthcare workers. This is thought to have accelerated community infections in some of the countries. The safety of healthcare workers has, therefore, been a top priority for us. We prioritized training for all our staff on COVID-19 even before the first case was reported in Kenya. Besides ensuring that we have appropriate Personal Protective Equipment (PPE) for our caregivers. We spent a substantial amount of financial resources to ensure that we have 6 months’ worth of PPE supplies for our care providers and staff. We have also issued all our staff with masks, digital thermometers and individualized hand sanitizers to ensure their safety at all times.

Free COVID-19 testing

To enhance the safety of patients and caregivers, we have introduced free COVID-19 testing for all our in-patients, surgical and day surgery patients as part of our safety measures to provide a safe environment for all patients and staff. This will also enable us to determine the best approach to care for our patients including the appropriate use of PPEs during their stay in the Hospital. We continue caring for all patients and have made arrangements for separate facilities and isolation wards for patients who might need them. Strict safety protocols are observed.

Telemedicine

We understand that some patients such as the elderly might not be able to come to hospital even when they need care. Therefore, we have introduced Telemedicine services especially for patients who might benefit from this initiative and just need a follow-up. Through this, patients continue receiving the quality care they need from their trusted doctor, via phone or zoom. The service is augmented by mobile laboratory and pharmacy delivery services, both of which are offered free of charge to ensure you continue to receive care, as your health matters to us.

The World Health Organiza​tion has indicated that coronavirus may be with us for a while. We must, therefore, find a way to adapt to the new normal and continue with our lives. Thus, delivery of healthcare in a safe environment is our priority.

• All patients, staff and visitors are screened at entry to the hospital and their temperature is taken.
  
• Hand sanitizer is provided for their mandatory use before entrance into the facility.
  
• We are conducting free Covid-19 testing for all our In-patients, Surgical and Day Surgery patients as part of the safety measures to provide a safe environment for all patients and staff. This will enable us determine the best approach to care for our patients including the use of Personal Protective Equipment (PPE) during their stay in the Hospital hence enhance the safety of patients and caregivers. 
  
• All our staff are trained on appropriate infection control measures.
  
• Patients coming to hospital are required to limit those accompanying them to one person.
  
• Our visiting hours limited to only the registered next of kin, for 30 minutes only. Should
  
• All patients and attendants coming to our facilities should wear masks for their own protection, as well as observe social distancing.
  
• The hospital has set aside designated areas where suspected or infected COVID-19 patients are cared.
  
• Similarly, dedicated staff, are assigned duties to provide care to either COVID-19 or Non COVID patients separately, and are never mixed up.
  
• All staff at the front-line are provided with appropriate Personal Protective Equipment (PPE).
  

​By Prof Rodney Adam, Infectious Disease Specialist and the Chair of Infection Control Taskforce at Aga Khan University Hospital, Nairobi

The name and origin of the virus

The name of the virus has rapidly evolved since the first cases in early December 2019 and the recognition that it was a new virus in late December. Viruses have been traditionally named after their location of discovery, so the initial designation was Wuhan coronavirus. However, no one wants it named after their place, so the agreed naming of the disease is COVID-19 (COronavirus VIrus Disease-2019) and the virus is coronavirus SARS-CoV-2. The sequence of the virus was released in January and made it clear that this virus is from a bat and related to SARS and MERS, but more closely to SARS; thus, SARS is part of the name. The other bat coronaviruses came to humans via another mammal (civet for SARS and camel for MERS) and that is also suspected for the new virus. The sequence also means that the conspiracy hypothesis about this being a lab-adapted virus are false.

About the COVID-19 Illness

What are the symptoms of COVID-19?

The two main symptoms of COVID-19 are fever and cough. The initial case definition also included shortness of breath, but that is true only for those who are more seriously ill. One of the more recently identified symptoms is loss of smell and/or taste. This may occur in up to half of symptomatic patients and when present, it is highly suggestive of COVID-19. Other common symptoms include fatigue, muscle pain and sore throat. Symptoms like runny nose or diarrhea are sometimes found, but may be found more often in other types of infections. Seek medical attention if you have these symptoms or have been in contact with someone who was diagnosed with or suspected to have COVID-19.  

How does SARS CoV-2 (COVID-19) spread?

SARS CoV-2 spreads through droplets which are released when people sneeze or cough. These droplets may be large and only travel up to one meter or may be small, allowing them to travel several meters and cause infection when they contact the mucous membranes of the mouth, nose or eyes. The ventilation makes a big difference, so transmission is reduced substantially when you are outside or inside with windows open and good air flow. The infection may also spread from contaminated surfaces.

How long is the incubation period for COVID-19?

Incubation period is the time between catching the virus and when the symptoms of the disease start appearing. The average is about five days and ranges from two to 12 days in most cases.

What temperature is normal? 

For most people, their temperature ranges between 36 to 37 degrees depending on the time of day and rarely someone's normal temperature may be up to 37.2 or 37.4 degrees. With COVID-19 infection, high temperatures, greater than 39 degrees are common but even temperatures of 37.8 degrees can be significant.

How do I know that I have shortness of breath?

First, shortness of breath does not mean that it's difficult to breathe because of a stuffy nose. It means that when you are breathing normally through your mouth, the activities that didn't bother you now make you feel like you don't have sufficient breath. For example, could you previously walk up a flight of steps and now you are short of breath after only a few steps?

How do I know if I have COVID-19 and not regular cold or flu?

The only way to know if you suffer from COVID-19 is through a special lab test called PCR. The PCR test is currently available through the Ministry of Health and at a number of other facilities, including AKUHN.

If I have symptoms should I walk into hospital or call first?

If you are sick enough that you might need to be hospitalized, you should come to the Accident and Emergency Department.

I've seen somewhere that 4 out of 5 spread COVID-19 when they don't have symptoms. Is this factual?

It is now clear that much transmission occurs from people who have no symptoms but it may be more common for transmission to occur from people with very mild symptoms. People are infectious beginning about 1 to 3 days before symptoms develop so transmission occurs commonly in this time period. There are others who transmit but never develop symptoms.

COVID-19 Testing

Who should be tested for coronavirus?​

The highest priority people for testing include patients with severe symptoms that may be severe COVID-19, especially for older people or those with heart, kidney and lung disease. The major symptoms include fever and deep cough. Other people include those with exposure to COVID-19 and health care workers.

There is a role for testing asymptomatic people, especially if there is recent contact with a known case within the last few days, especially in households with someone who is infected since the likelihood of transmission in households is very common.

I have a cough, should I be tested?

You should call and obtain medical advice. It will depend on your likelihood of being infected yourself or of transmitting to someone else.

Quarantine and Isolation

What is physical/Social distancing?

The concept of social distancing has come from observations that in preceding outbreaks, such as the 1918 influenza pandemic. Cities that limited large gatherings had fewer cases. Now there is substantial evidence during the COVID-19 pandemic that physical distancing is very helpful. It is because the virus is spread primarily by respiratory droplets that are produced when coughing. These droplets quickly drop to the ground.  A distance of 1.5 or 2 meters is recommended.

Which activities should physical distancing apply to?

This typically refers to public settings, especially in closed spaces. The risk should be minimal when outside and walking. Within households, physical distancing is appropriate when one person is infected and trying to prevent transmission within the household. That is notably hard to do but should still be done when there are elderly people or those with pre-existing conditions such as heart disease, lung disease and kidney disease.

How far should I be from someone?

It is recommended that you are 1 to 2 meters apart.

What is self-quarantine? 

Normally that means separating yourself from others when you are having no symptoms, but have been exposed and are at risk. That is commonly done after high risk exposures and is typically for 14.

What practical steps should I take when on self-quarantine at home?

It is boring and you may get tired of television, so start a new book you have been waiting to read. Otherwise, watch for symptoms and if mild, continue away from others until at least 10 days after developing symptoms and 3 days after recovery. If possible, have a test done when you develop symptoms, especially if you are doing medical work. If you are more severely ill, come to the hospital but let the people in Accident and Emergency. Also wear a mask.

What is isolation?

Isolation refers to separating yourself from others when you have symptoms that may be due to COVID-19. This may be done at home when the symptoms are mild or at a health facility when the symptoms are severe.

Personal prevention and treatment

How can I reduce the risk of getting coronavirus from infected humans?

There is growing evidence on the importance of transmission through the air by respiratory droplets. These can be large droplets that drop quickly to the floor or may be smaller ones that spread farther. For this reason, there is growing evidence on the importance of the use of masks. Even cloth masks worn by both people who are in contact with each other are highly effective. The greater benefit is when the infected person is wearing the mask. In medical settings, the caregiver should wear an N95 mask if available and if not should use a surgical mask.

There has been much discussion about the potential role of transmission from a contaminated environment, but that is much less likely and has not yet been clearly documented. We do assume that directly touching the infected person or something that person coughed on is a risk factor. That means that the most important thing you can do is proper hand hygiene, either washing with soap and water or using an alcohol-based hand sanitizer when you have contact with someone who might have a respiratory illness.

Will a normal flu shot help me avoid the worst symptoms?

The flu shot is for preventing infection from influenza and will not prevent coronavirus infection. However, the illness caused by influenza is similar to the coronavirus infection, so if influenza is prevented, there is less chance of suspecting that you have the coronavirus when in fact, it is influenza. There is discussion about whether influenza vaccine prevents COVID-19, but that is not proven.

If I catch the virus what is the standard treatment?

Most of the important medications currently available work by inhibiting a portion of the immune response to the virus, such as dexamethasone or tocilizumab. Remdesivir is an antiviral drug that also has benefit. Remember that good supportive care is very important and nearly everyone can survive. That includes oxygen when needed and even a ventilator for those who are really sick.

I have a bad cough and would normally not see a doctor for it—but with this going on, should I go?

You should only be alarmed if you exhibit the two main symptoms of cough and fever and have been in contact with someone suspected to have COVID-19.

Given that the virus originated from animals should I stay away from meat and animal products? Should I worry how I handle animals?

The 2019-nCoV coronavirus is originally a bat virus but was likely initially transmitted to humans via another mammal. However, transmission now is human to human, so animal contact will not make any difference for this virus. However, do note that there are other infections that can be acquired from animals. For example, there is anthrax from dead cattle who are then butchered. There is brucellosis from goats, sheep and other animals, and Salmonella from chickens and eggs. And don't forget that if dogs haven't been immunized, they can transmit rabies when they bite. That means we must be careful with animals, but it will not be a factor to getting the coronavirus.

General Questions

Can COVID-19 be treated with antibiotics?

No. COVID-19 is caused by a virus and antibiotics only work on bacterial infections.

How serious is COVID-19?

COVID-19 is usually a mild to moderate respiratory (lung) infection. In the elderly or those who are immunocompromised or have other chronic diseases, it may lead to a severe pneumonia and can be fatal. Children and young adults rarely develop serious disease.

What is the risk for health care workers?

There is definitely a risk but the magnitude of the risk is lower than initially thought. In China, the majority of HCW cases were actually acquired within their own households. However, when proper personal protective equipment is used, the risk is low.

What is Aga Khan University hospital doing for people who might have COVID-19?

If patients come with a potentially contagious illness they will be screened on entry to the facility and when necessary, appropriate precautions will be used.

What level of care will COVID-19 patients receive?

Patients with COVID-19 will receive the level of care that is required for their illness, including intensive care treatment and advanced medical treatment when needed, such as a breathing mechanical ventilation or kidney dialysis.

Where should a patient with suspected COVID-19 go?

All patients who have suspected Coronavirus symptoms and or have a travel history should call our hotline on +254 709 931700 before coming to hospital for guidance.

1. Travelling outside the country?
   
2. Resuming work?
   
3. Have COVID-19 like symptoms?
   
4. Suspect to have come into contact with a COVID-19 infected person?

Covid-19 vaccine - FAQs

Is it mandatory to get vaccinated against COVID-19?

The COVID-19 vaccine is not mandatory. However, considering the benefits of vaccination against severe disease and death, it is strongly recommended that all eligible persons be vaccinated. The need for vaccination is even greater for healthcare workers.

What is the efficacy of the Oxford / AstraZeneca vaccine?

In the different clinical trials conducted, this vaccine has been shown to protect against symptomatic infections with an efficacy ranging between 60% and 90%. According to an analysis published in The Lancet, this difference may be due to the interval between both doses: a longer interval (12 weeks) protects better (above 80%) than an interval below 6 weeks (under 60%).

To date, no hospitalizations or deaths have been registered among people who received both doses of the Oxford / AstraZeneca vaccine in clinical trials.

Does the Oxford / AstraZeneca vaccine protect against the new viral variants?

According to preliminary results obtained in the UK, this vaccine maintains a high efficacy against the “British" (B1.1.7) variant. In contrast, its capacity to protect against symptomatic infections caused by the variant first identified in South Africa (B1.351) seems to be much lower (around 25%) according to a small clinical trial in the African country. Still, it is hoped that it will protect against hospitalisation and death, since to date no cases of hospitalisation or death by COVID-19 have been reported in people who have received both doses of the vaccine in clinical trials. Even in South Africa, the vaccine prevented severe disease.

How long does it take to be protected by the Oxford / AstraZeneca vaccine?

Preliminary results from Scotland show that the Oxford / AstraZeneca vaccine drastically reduced COVID-19 hospitalizations (by 94%) one month after the first dose, even in persons above 80 years of age. However, this does not mean one dose is enough since it is not clear how long the protection would last after one single dose.

Why is the Oxford / AstraZeneca vaccine not given to older people in some countries?

The European Medicines Agency approved the Oxford/AstraZeneca vaccine for use in all ages from 18 years onwards. However, some European countries (including Spain) have decided not to use the vaccine in people above 55 years of age because the clinical trials did not include enough people in this age group in order to draw firm conclusions. Nevertheless, the United Kingdom is using this vaccine even in people above 80 years of age, and the first data from Scotland show that it works well in the elderly: four weeks after the first dose, a 90% decrease in hospitalizations is observed.

What are the contra-indications to the administration of the vaccine?

Hypersensitivity to the active substance or to any of the excipients. Note that none of the currently available vaccines include human or animal products. Thus, egg allergy is NOT a contraindication.

A positive IgG test (i.e., having been exposed to the disease) is not an exclusion criterion for vaccination; available data suggest that previously infected individuals can be at risk of COVID-19 reinfection and could benefit from vaccination.

The administration of COVID-19 vaccines should be postponed in individuals suffering from acute severe febrile illness.

Individuals with bleeding disorders may receive a COVID-19 vaccine if considered safe to do so by a physician familiar with the individual's bleeding risk.

What are the side effects of the vaccine?

Injection site tenderness (>60%); injection site pain, headache, fatigue (>50%); myalgia, malaise (>40%); pyrexia, chills (>30%); and arthralgia, nausea (>20%). The majority of adverse reactions were mild to moderate in severity and usually resolved within one to two days of vaccination. By day 7 the incidence of subjects with at least one local or systemic reaction was 4% and 13%, respectively. When compared with the first dose, adverse reactions reported after the second dose were milder and reported less frequently.

How do I obtain help if I got side effects?

Within 15 minutes of vaccination, there is a doctor to provide care at the vaccination center. Beyond 15 minutes (and after leaving the vaccination center) please obtain care at the Accident and Emergency department.

How does the vaccine work?

Viral vector-based vaccines use the body's own cells to produce antigens. They do this by using a modified virus (the vector) to deliver the genetic code for the antigen, which then triggers an immune response. The vaccine mimics what happens during natural infection with certain pathogens — especially viruses. This has the advantage of triggering a strong cellular immune response by T cells as well as the production of antibodies by B cells.

How many doses should one take?

Two doses 4-12 weeks apart are administered. In Kenya, the doses shall be 8 weeks apart.

What is the duration of protection after vaccination?

The duration of protection has not yet been established. As with any vaccine, vaccination with COVID-19 Vaccine AstraZeneca may not protect all vaccine recipients.

Is the vaccine safe in pregnancy and breastfeeding?

Pregnancy:

There is a limited experience with the use of COVID-19 Vaccine AstraZeneca in pregnant women. Preliminary animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryofetal development, parturition or post-natal development; definitive animal studies have not been completed yet. The full relevance of animal studies to human risk with vaccines for COVID-19 remains to be established. Administration of COVID-19 Vaccine AstraZeneca in pregnancy should only be considered when the potential benefits outweigh any potential risks for the mother and fetus.

Breastfeeding:

There is evidence from some vaccines that the breast-feeding baby may acquire a level of protection. The vaccine is recommended for use during breast feeding.

Fertility:

Preliminary animal studies do not indicate direct or indirect harmful effects with respect to fertility.

How was the vaccine developed so quickly?

Medicines, including vaccines, are highly regulated - and that is no different for the approved COVID-19 vaccine.

There are a number of enablers that have made this groundbreaking medical advancement possible and made it possible to develop them relatively quickly compared to other medicines.

1. The different phases of the clinical trial were delivered to overlap instead of running sequentially which sped up the clinical process.
2. There was a rolling assessment of data packages as soon as they were available so experts at the MHRA could review as the trial was being delivered, ask questions along the way and request extra information as needed - as opposed to getting all information at the end of a trial.
3. Clinical trials managed to recruit people very quickly as a global effort meant thousands of people were willing to volunteer.

How can I find out if what I have been told about the vaccine is just a myth?

There is an excellent myth buster online. (https://www.britishima.org/operation-vaccination/hub/covidmyths/#ATM)

Are the vaccines effective against new strains of the SARS COV-2 virus?

It is possible that the vaccine has reduced efficacy against some of the new strains, but very likely even for those strains that the recipient will be protected from severe disease. While further work is ongoing in this field, the advice is to continue with the vaccination as planned

Do I need to continue to social distance and wear a face covering after receiving the vaccine?

It is important to note that even when you have received both doses of the vaccine, you must continue to follow current guidance on social distancing and wearing a face covering when you are in public places. You must also to continue to follow the current PPE use guidance when you are at work and out in the community.

If I've had a positive antibody test, should I still get vaccinated?

Yes, it is currently recommended that the vaccine can and should be given if you have had a positive antibody test.

I'm currently ill with COVID-19, can I get the vaccine?

People currently unwell and experiencing COVID-19 symptoms should not receive the COVID-19 vaccine until they have recovered.

Should I get vaccinated if I have already had COVID-19?

Yes, you should get vaccinated against COVID-19 even if you have already had the disease. However, if you are currently infected, you must wait for your symptoms to resolve, your isolation period to end and if you were prescribed steroids, these must also have ended. This applies to either of the doses of the COVID-19 vaccine.

What if I missed the second dose?

If the vaccine you received recommends two doses and you miss the second dose, it is best that you take it within seven (7) days of the missed date. However, if for some reason the second dose is delayed further, you shoud get the second dose as soon as possible.

How long should I wait to get any other vaccine, after getting the COVID-19 vaccine?

After getting vaccinated for COVID-19, you must wait 14 days, before getting any other type of vaccine, for any other disease or condition.

How do I access the vaccine?

The vaccine is on offer at the Aga khan University Hospital Nairobi, as well as other designated centers. Please liaise wish your supervisor to schedule you for vaccination. The AKUH, N vaccination center is at the Jamat Khan Pavillion (the usual venue for convocations) near the Mosque. The center is open from 7:30 a.m. to 4:30 p.m. on weekdays.

Do I require to continue taking infection prevention precautions after vaccination?

Yes, you require to continue with the usual precautions of wearing face masks, physical distancing, cough etiquette, use of PPEs and hand hygiene.​