August 2020 TheStar ; Agriculture Principal Secretary Hamadi Boga, who is also a senior microbiologist, has written an open letter to Kenyans about his successful battle against Covid-19.
“Dear Family, Friends, Neighbors, fellow Kenyans. Here I am. Still alive. I am doing okay, largely. I have finished self-isolating at home after 32 days since I first experienced Covid-19 symptoms.
“I did the retest for Covid-19 and thank God came out negative. The test procedure looks scarier than it really feels. Most people would cringe at the thought of taking that test. For me the nose swab was easier than the throat swab. The technician who took my swab said that the throat swab is the riskier one even for the one swabbing. One could easily puke,” he says.
Before he went for his test, he suffered chills that went all the marrow of his bones.
“I know it was July but that is not what I am talking about. These chills were abnormal, way deeper than the usual July experience. Then I had the aches all over, especially muscles (calves, thigh and arms). Then the cough that was not productive and that persists, and a tightness or numbness around the chest at the back and at the front,” Boga says.
He says he had no flu, just a cough that irritated and persisted, then nausea and an intense urge to throw up every time he coughed, which was scary.
There were no headaches and fever he was primed to expect. In all temperature checks at entrances to key buildings, his temperature was 35 degrees Celsius to 36.5 degrees.
“Only once did I have a high-grade fever of 37.5 when tested at the hospital. I could not smell anything, not food or perfume, nothing. The taste buds went out of the window and I was basically eating grass. The area around the kidneys and abdomen pained. It went on and off,” he explains.
Boga says he was not dizzy but he was not sure he was seeing properly. So he would take off his glasses to be sure the mist was not interfering with his vision.
He was also very tired and would sleep but it was interrupted by the irritating cough and the fear of the unknown that lay ahead.
His voice was hoarse and most friends who called were concerned that his voice was strange. He was breathless just before speaking in a Zoom meeting.
On day four, the PS started thinking he should get tested to rule Covid-19 out – or in.
“I called my physician and picked a referral letter to go to the tents at Nairobi Hospital, where sampling took five minutes but administrative processes to pay the Sh10,000 fee took two hours.
Something between my insurance company and the billing at Nairobi Hospital just does not work, and as a scientist, my mind wonders why a simple PCR test cost Sh10,000. The Polymerase Chain Reaction Test (PCR) is an old technology that has been here since 1982 when Harry Mullis won the Nobel Prize for chemistry for inventing it. I think the laboratories have found a cash cow, cashing in on our ignorance, fear and desperation. Because of these high costs, testing will be the limiting factor in our fight against Covid-19,” he says.
Boga says when he told his wife he had been tested, she was terrified that men and women in PPEs would come and cart the family away.
“When she asked why I did that, I replied that it would be good as we would know the reality and get early treatment if we had all been exposed. There is a lot of fear out there about testing and my wife was no exception.
If we do not address the fear component, most people will keep hiding and infecting others. Most people who have symptoms just avoid the hospital, hoping to wait things out. Others go into hiding. This disease can make you die in hiding if it causes an acute infection and you are not one of those lucky asymptomatic victims,” the PS says.
After the test, Boga waited for the results for 48 hours and they came by a phone call.
“You are Covid-19 positive, self-isolate for 14 days and separate yourself from your family. Let the family come for testing tomorrow. If if there are any issues please call us. Any questions?” he was asked.
Confusion hit him.
“I was sure the lady across the phone was doing her best, but she really was not sure what to tell me or what to do beyond announcing the positive results. I called my physician for further details and we remained in regular touch throughout the isolation to clarify situation and review scenarios. Luckily, my family members were all negative,” he says.
Boga said that as soon as he started feeling sick, he told his family not to get too close to him. He wore a mask around the house.
“They thought I was being weird until the verdict came. They were there to take care of me as I self-isolated, thank God Almighty for that,” he says.
Checking into an isolation centre
Boga began the self-isolation for five days and this time he was struggling with the cough and an urge to vomit. He was also feeling giddy, especially when prostrating in prayer.
Boga asked his physician to admit him because he was worried about his oxygen levels.
Because of the curfew, he also didn’t know if he would be able to get to the hospital in the event his condition deteriorated.
“I was sure if an ambulance showed up at my apartment, chaos would break loose. My neighbors would probably shout Boga must go. We feared. I decided to use private means to get to the isolation centre. I am not sure how the average families get themselves into these isolations centres when the going gets tough,” he says.
His blood pressure was high (maybe due to anxiety), blood oxygen levels were manageable at 94 per cent, he had a low-grade fever but the cough was persistent.
Boga learnt with trepidation that his insurance or any insurance for that matter does not cover Covid-19 isolation so he had to pay a deposit of Sh100,000 for admission which he hurriedly paid via M-Pesa.
“When push comes to shove, you do not think twice about such earthly things [money]. Survival becomes the primary goal,” he says.
At the isolation centre, he was monitored and given regular sips of dawa (ginger, lemon, honey), paracetamol and cough syrup (Bro Zedex) every eight hours, a daily tablet of Glemont L (antihistamine) and 100mg of vitamin C per day.
All of this was not for treatment of Covid-19 but to manage the symptoms.
“I get amazed at this: the actual management is cheap when the symptoms are mild. I guess that is why, for most cases, management can be done at home. Most of the items can be obtained over the counter at minimal costs.
“I realise the testing and the ceremonies around isolation, PPEs and quarantine is what will hamper our ability to manage this beast,” he says.
Boga was checked out after two days to continue with home quarantine and he took his medication along.
“It was looking good, my voice had improved and I was looking more energetic. I greeted people with vigour. There is light after darkness,” he says.
Lessons learnt and opportunities to win the war
The PS says he has learnt some lessons along the way and done some reflecting.
One is that “this beast” is now in our communities. Social-physical distancing is the only tool available for the mass market.
“We can all afford this. The poor people cannot afford the testing or the quarantine and the ceremonies that go with that. Let us make social distancing a religion. It should come from the bottom up.
“It should be everyone’s responsibility to understand and manage the disease for ourselves and our communities, whatever we do and wherever we live. We have to change and tame our instincts to socialise casually.
“We need to activate our caring genes so we project care by preventing the spread of Covid-19 and we show our humanity that way. Should this be the single most important thing in which we should anchor any behaviour change communication? Food for thought,” Boga says.
Boga says testing should be for people really in distress and after key symptoms are confirmed positive.
Those who have come into contact with positive persons and are not showing any infection, he says, should self-isolate and self-monitor with proper guidance. They should make regular reports to a health worker.
This will help track their situation centrally and so data can be analysed by epidemiologists and infectious disease experts.
Not collecting information limits mining data from positive cases that would help managing the pandemic as it evolves.
“Testing everyone is expensive, staff and facilities are overstretched. The more information we mine from one positive case the better for designing our management system. The PCR kits are expensive in Kenya. We’ll go broke testing 47 million Kenyans,” Boga says.
He says families should be educated on how to self-isolate and how to support those in self-isolation at home.
This he says, requires education and discipline.
“Inahitaji ujirani mwema and reawakening the spirit of being each other’s keeper. This thing will be defeated bottom up. Formal systems will be overrun and everyone has to view themselves as part of the war against Covid-19.
“In the end, change in community behavior is what will help us manage this public health challenge. Our communication at all levels should aim to make that mother, father, youth and that community-/religious leader take ownership of the Covid-19 challenge. We cannot afford to have misleading messages laced with conspiracy theories,” the scientist emphasises.
He adds, “I have read many snide remarks from talented critics with a gift for writing who can better use their talents to understand and build community resilience. Instead they are spreading lies, misinformation, distortion and cynicism. There are many conspiracy theories being peddled out there. All of them do not matter at this moment.
“Let us use our hands, words, deeds and imagination to stop the spread of Covid-19 and create safe communities. The spread is within communities. The interventions must be at the community level.
The youth in the maskanis, blogs and WhatsApp groups are consumed by skepticism and conspiracy theories. We should scale and frame our communication at this phase of the pandemic and trickle it down to the community influencers so that we can address the negative narrative.”
As a scientist, Boga says it’s necessary to accelerate investment in scientific capabilities among people who understand viruses in Kemri and scientists and technicians in universities.
“Each region should have a serious laboratory at CDC level. No need for new buildings. Just upgrade those that are there and ensure they have the right people, equipment and reagents. Let us incentivise synthetic biology start-ups to set up small biotech companies to manufacture the primers and reagents required for diagnostics and research,” the CS advises.
He says the Covid-19 Africa challenge is just about to unravel and the logistics of shipping reagents from abroad will work against us.
“We should use the crisis to also emerge as a biotech manufacturing hub. Most university laboratories are closed. MSc and PhD students have suspended work. This is the time to unleash all the science we have in this great nation in this war. This is the time to get scientists back into laboratories to help in surveillance, diagnosis, modelling and scenario building that will get the country ahead of this beast,” Boga says.
He says as we test, trace, isolate and report, there should emerge serious scientific work and discourse to contribute to the body of knowledge required to manage this beast.
“No one will do our science for us but ourselves,” he says.
Thursday was Day 32 and the PS says he had courage to venture back into the office on Wednesday. Some symptoms linger but are manageable.
“Sometimes my throat dries up and my voice gets hoarse again, I break into a sweat thinking maybe the beast is still around. Or is it my imagination playing tricks on me? Wahenga walisema, ‘ukiumwa na nyoka, utakimbia hata kambaa’.
“As I venture out, I know I have to continue being more cautious to avoid re-infection, have fewer physical meetings, hand sanitise properly, avoid touching my face and eyes (very hard) and make sure I wear my mask properly and people around me wear masks.
“Please do the same so you can protect yourself, your family and your communities. Let us adapt. Let us all pray for God to protect all of us.