by Lorraine Anyango
Staff members from Jaramogi Oginga Odinga Teaching and referral hospital (JOOTRH) undertaking Continuous Medical Education (CME) on validation of the WHO COVID-19 verbal autopsy tool.
The staff members drawn from different departments were being trained by Washington State University on the tool that will be used for determining cause of death in Kenya during the COVID 19 Pandemic.
The validation of the tool will be done through a study that will be conducted at JOOTRH to know the actual causes of death during COVID-19 pandemic.
The study notes that death registration have declined in 2020 [~35.9%; was 39.1% in 2019] and they are speculative or undocumented in many cases, also people not seeking medical care out of fear or COVID-19 stigma.
There is abridged medical workup in suspected or confirmed COVID-19 cases, most respiratory syndromes designated COVID-19 and reliable data is crucial for health planning and prioritization and designing better interventions and programs hence better population health.
The objective of the study is to assess the sensitivity, specificity, and level of agreement of the WHO Verbal Autopsy COVID-19 tool in ascertaining COVID 19 mortality and comparison with a reference standard cause of death (COD) from medical records.
The tool has not been validated for widespread use in low- and middle-income countries where there is sub-optimal access to COVID-19 testing.
The six months study will be conducted at JOOTRH, Siaya County Referral, Busia County referral and all sub-counties where deaths of close relative living within 50km of the study facility are reported.
The importance of mortality data comprises monitoring the health of the population, knowing the leading causes of death, establishing mortality rates (geographic variations) and trends over time.
It informs decisions about health policy and strategy, prevent premature deaths, service provision, health budgets and evaluate health service outcomes.
During the training the staff learnt that Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) , a new strain that has not been previously identified in humans.
They were also informed that as coronaviruses are zoonotic, meaning they are transmitted between animals and people and that common signs of infection include: Respiratory symptoms, Fever, Shortness of breath and breathing difficulties.
As at January 2022, a total number of corona virus infections stood at 379.1 million with 5.692 million deaths worldwide. While Kenya has registered 321,381 cases with 5,583 deaths, new cases in the last 28 days in Kenya stands at 189/21649 which is 0.87% of infections.
Taking the participants through the training Dr. Dismas Oketch, Mortality Surveillance Technical Officer, Washington State University-GH Kenya, said that all viruses, including SARS-CoV-2, change over time.
He added that most changes have little to no impact on the virus’ properties. However, some changes may affect the virus’s properties, such as ease of spread, disease severity, performanceof vaccines, medicines & diagnostic tools, or other public health and social measures.
Dr Oketch stated that WHO, in collaboration with partners, have been monitoring and assessing the evolution of SARS-CoV-2 since January 2020.
Dr Oketch further told the participants that the variants if interest (voi) has genetic changes that are predicted or known to affect virus characteristics such as transmissibility, disease severity, immune escape, diagnostic or therapeutic escape and causing significant community transmission or multiple COVID-19 clusters.
The above has been witnessed in multiple countries with increasing relative prevalence alongside increasing number of cases over time.
The participants were informed that Omicron is the current dominant strain, it has a high infection rate, shorter incubation period of 3 days compared to delta variant which takes 4 days and 5 days compared to previous variants.
Omicron replicates well in upper airways, however it has poor replication in lower airway in lung cells, it’s a less severe disease and it seems able to get around immunity (infection & vaccine)
“The vaccine still prevents severe disease and booster shots reduce risk of infection by half.” Dr Oketch added.
The participants also were trained on Flurona and that it entails infection with flu and corona viruses at once and it’s seen mostly in the unvaccinated and children under five years with symptoms largely the same including headache, fatigue, fever, cough and it’s potentially any riskier than the individual diseases.
Currently there are two types of tests available, the viral test which includes rapid Ag test, rapid or lab (PCR) and the current infection. The antibody test include serology and past infection.
The treatment available for corona virus include dexamethasone administered when the disease is severe disease and one is hospitalized.
“Corona virus is also treated using Toclizumab which is administered to patients aged two and above with severe disease, receiving corticosteroids and it dampens immune response.” Dr Oketch said.
Other treatments include remdesivir administered to patients aged two years and above with the disease being severe the treatment increases recovery time.
Bactricinib is also available and it’s combined with Remdesivir, when one requires respiratory support
“Doctors also administer anti-coagulants to reduce the risk of clots.
There are orther newer drugs including two pills approved for treatment in US (FDA), which come into use on 22nd Dec 2021, Pfizer. For patients who are 12 years and above For persons with mild to moderate disease at risk of severe disease. The drugs are only prescribed to be used only, within five days of symptom onset. They reduced risk of hospitalization and death by 88% by day 28.
The Molnupiravir drugs started being used on 23 Dec 2021, Merck, used with those with mild to moderate disease at risk of severe disease, used within five days of symptom onset and it reduces risk of hospitalization and death by 30% by 29 day.