In this unprecedented global pandemic, countries around the globe are struggling to find both preventative social and medical solutions to curb the rampant respiratory disease. For now, the most proactive government response has been to quarantine. China was the first country to impose a nationwide lockdown following the initial outbreak of the virus in Wuhan in late December, and measures remained strict for the following two months. A number of other countries followed: Greece, Cuba and New Zealand announced full lockdown on March 22nd, 23rd, and 24th respectively, while the United States and United Kingdom also took action at the end of March. By March 25, nearly one third of the world’s population was in some form of lockdown. Today, the countries mentioned have begun to ease measures as case evolution has slowed– an observation that many public health officials deem positive as it relates to the effectiveness of lockdown in minimizing the virus’ impact. However, as we look across the globe it becomes clear that every country’s situation is unique. Outbreak timing, population size, population age and economic status all play important roles in determining how well countries will take drastic lockdown procedures. Are there alternative solutions countries can adopt in the fight against coronavirus?
One country for which quarantine is nearly impossible is Kenya. In a desperate push to contain the outbreak in its initial stages, the government followed what a majority of affected nations were doing and quickly progressed to impose strict lockdown rules following its first case on March 13. On the 15th, it closed all schools and ordered that both the private and public sectors work from home. On the 25th it suspended all international flights and announced that any citizen found to be violating quarantine measures would be forcefully reprimanded through violence. Initially these preventative actions appeared to be successful, as the country had only tallied 225 cases and 10 fatalities by April 15 (compared to the United States, for example, where the virus was killing 2000 Americans per day in April). It is widely believed such positive control likely resulted from strict police enforcement, but this did not come without a cost. On March 27th during curfew hours, officers swept through Nairobi firing tear gas and shot guns into the air, and even beat people with canes and rubber hoses. According to Emily Nyambura, a coffee business owner in Mathare, one of Nairobi’s densely populated settlements, that failure to comply stemmed primarily from a lack of sufficient technological communication. “Most slum people don’t have a TV; they get information from one another and don’t always get the right information,” she said in an interview with Aljazeera. Settlements like Mathare have also taken a severe economic plunge as homes are small, poorly built, and house large families who depend on streetside businesses to make ends meet. Enforcing early curfews depletes the number of possible working hours and exacerbates the economic hardships they already face. On a similar note, Sobecki wrote, “Kibera’s alleys still are bustling not for lack of knowledge of COVID-19, but for lack of options as to how to defend against it.” And now, as we near mid-June, Kenya has begun to see a concerning upward trend. As of June 16, it has confirmed 3860 cases and 105 deaths.
In order to better understand how the situation is impacting Kenyans, I conducted an informal interview with Ronnie Kihonge who is a student at Princeton from Nairobi. Kihonge’s parents work in finance, meaning they belong to a small minority of Kenyans who are able to continue their work comfortably from home. A typical week for his father involves going into his local office for a few hours in the mornings, and then returning home by lunchtime to finish the day’s tasks. Though he and his family remain in good health, Ronnie shared his biggest concerns about Kenya’s near future.
He doubts that most Kenyans will have the means to stay home, “I knew that Kenyans would not follow… telling them to stay home is not going to work”. “They won’t choose for their children to starve over government directives. A huge percentage of the population depends on leaving the house every day,” he adds. Citizens’ inability to comply therefore leaves me considering tensions that could be brewing in the midst of these difficulties.
Nichole Sobecki, an American photographer who has lived in Nairobi for eight years, shares similar concerns. “A lockdown would be extremely challenging for the 8 out of 10 Kenyans who work in the informal economy, and rely on their daily labor to provide for themselves and their families,” she explained in an email to me. Expanding further, she wrote, “they don’t have the financial stability to save, or stock up, and were they to try and quarantine it would still not necessarily work to slow the spread of the virus because many live in very crowded communities, with many people to a single-room home, and often without running water or private toilets. However, wealth in Kenya is distributed very unevenly, so those with greater wealth have the means to self quarantine in contrast with those living on just a few dollars a day. In a piece she wrote for National Geographic, she observed: “Driving through Kenya’s capital city during the time of coronavirus is like moving between two disconnected realities.” There are lush compounds in neighbourhoods such as Muthaiga and Karen — “their streets deserted, their occupants invisible […], their houses well stocked with food and other necessities.” In stark opposition to this, “a few miles southwest of downtown is Kibera, home to a quarter of a million people surviving together beneath tin roofs. Kibera is the largest of the more than a hundred informal settlements in Nairobi, where the vast majority of people scrape by on no more than a few dollars a day.”
Another severe detriment to public health is the Kenyan healthcare system itself. It is not equipped to take on the burden of a nationwide pandemic, should it escalate to that point. “We definitely don’t have enough hospital space, and hospitals usually aren’t the cleanest places,” remarks Kihonge. According to one source, approximately 29% of healthcare funding in Kenya comes from the government. However, public healthcare faces several challenges. For one, it is overburdened and under-resourced. In recent years there have been two strikes in which doctors and nurses demanded better work conditions and pay. On average, there are only about 1.5 doctors per 10,000 people. As a result, the healthcare system is reactive rather than preemptive. Much of the federal funding is spent on hospitals, clinics and pharmacies that aim to heal common health issues, but relatively little is dedicated toward primary health care and efforts to address social patterns that promote disease spread. Furthermore, there is widespread corruption and frequent misappropriation of funds on the part of the government, and this has surely contributed to roadblocks in improving such challenges. Relative to many countries of the developed world, COVID-19 therefore poses a disproportionately greater threat.
“The health care system here sits relatively close to collapse normally, so this type of strain will put it over the edge far quicker than US or European health care systems,” says Sobecki. Difficult access to clean water, unsafe urbanization, and unsanitary habits have repeatedly hurt the health of Kenyan people.
Kihonge worries that the use of extrajudicial force in efforts to enforce public health recommendations will only serve to aggravate the already tense relationship between officers and civilians. After just ten days of curfew, six people had died as a result of police brutality.
Unfortunately, “many Kenyans do not respect the government because we’re constantly failed by it,” continues Kihonge. This only serves to add to the general sense of unease that characterizes a pandemic.
Lastly, Kihonge is worried about the long term consequences this pandemic could have on an underdeveloped country like Kenya, “There’s the possibility of debt, and it’s not like the economy was in a good place to begin with… it doesn’t look good for most third world countries.” While many high schools and universities in developed countries such as the United States have moved to virtual classes, in Kenya schooling has been cancelled altogether. This is also likely to have negative long term repercussions on the nation’s education and workforce productivity.
The struggles the nation currently faces are not necessarily a reason for despair. Rather, they might provide reason to turn to alternative strategies. In a Bloomberg article, Ari Altstedter explains how “herd immunity”, which allows the virus to pass through a majority of the population as it builds antibodies, could result in “less economic devastation and human suffering than the harsh lockdowns designed to mitigate its spread, according to a growing group of experts.” In fact, this has already been tested in some countries: Shamani Joshi, a writer for Vice India, reports “this controversial practice of letting a large percentage of the population get infected by coronavirus so that they can recover, develop antibodies and become resistant to it was floated around in countries like Sweden and the UK.” In fact, according to a Swedish epidemiologist reported in a News18 article from late April, Sweden’s refrain from lockdown appears to be working. The country kept public life open during the initial stages of the outbreak, with only restrictions on gatherings of more than 50 people. Within weeks, it began to observe a plateau and 20% of the population in Stockholm was already immune. The logic here was that the elderly remain in social isolation until the virus has passed through the young. Perhaps by looking at other less developed countries, like India for example– who face similar difficulties with a high density population and dependence on economic prosperity– Kenya can learn from its governmental decisions. Is herd immunity a more viable approach in countries where the average population age is low (India’s average age is 26.8 years, and Kenya’s is roughly 20 years) and the coronavirus potentially poses less risk?
I corresponded with Kenyan virologist Marion Kiguoya to find out more about their approach to the idea of herd immunity. No definitive responses were provided – however, all possibilities are being considered in this desperate fight to slow the coronavirus and protect the country’s population and wellbeing. As nations across the globe are pressed to make life changing decisions while they tackle this ever changing situation, Kenya is not alone in its fight. It may need to carve a unique path to recovery from COVID-19 due to the severe instability of its public health system and the citizens’ levels of distrust of the government and police officers.
Christiane Konstantopoulos is a student at The Woodrow Wilson School at Princeton University. Her research interests include global issues in gender and sexuality, health, and inequality.
Banner image by Ashkan Forouzani, courtesy of Unsplash.