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Crisis warning as ICU beds run out in county hospitals

By People Team
Monday, October 26th, 2020
An elderly man undergoes a COVID-19 nasal swab test. Photo/Courtesy
In summary

PD Team

Several counties across the country are staring at a potential crisis over  shortage of Intensive Care Unit (ICU) beds and other critical health facilities as the number of new coronavirus cases keeps surging.

Already, the Ministry of Health has issued a red alert in five counties - Nairobi, Mombasa, Kericho, Nakuru and Turkana as virus hotspots and warned of a possibility of a lockdown unless the situation changes.

Several public hospitals, among them the Moi Teaching and Referral Hospital (MTRH), Nakuru County Referral Hospital and the Coast General Teaching and Referral Hospital have reported shortage of beds in ICU and the High Dependency Unit (HDU) as a result of the rising  new cases.

Kenya’s infections curve has taken a sharp turn, recording more than 4,500 new cases in the past one month, with the daily average of the past seven days risingcompared to the week to September 30 when President Uhuru Kenyatta announced easing of containment measures across the country.

Rate tripled 

The country’s positivity rate has tripled in the past month, coupled with a steady rise in hospital admissions.

Last Sunday, Health CS Mutahi Kagwe warned Kenyans to brace themselves for fresh containment measures, warning of a “potential crisis”.

Ironically, new cases of infections are on the rise in the rural areas after several counties closed down most of their isolation centres in the hope that Kenya was already out of the woods.

And as the situation threatens to get out of hand, a Senate committee investigating the use of Covid-19 funds has directed Auditor-General Nancy Gathungu to undertake a special audit on the utilisation of funds allocated to the 47 counties.

The Ad hoc committee on the Covid-19 chaired by nominated Senator Sylivia Kasanga in a report tabled before the Senate last week said county health facilities had a total functional capacity of 7,723 beds including 7, 411 isolation and 312 ICU beds against a projected need of 14,100 beds.

Only seven counties, Nairobi, Mombasa, Machakos, Makueni, Garissa, Mandera and Kakamega, met the 300-bed minimum capacity threshold while counties with at least 250 isolation beds include Kilifi and Kisii.

According to the report the 10 worst performing counties are Kwale, Nyamira, Kitui, Bomet, Uasin Gishu, Narok, Siaya, Marsabit, West Pokot, Wajir, Tana River, Samburu, Bungoma, Lamu and Kirinyaga.

“The Ministry of Health, Council of Governors and County Governments should act expeditiously to ensure expanding ICU infrastructure across the counties is matched with the availability of requisite specialised personnel including ICU nurses, medical anesthesiologists, anesthetists,” reads the report.

As of August, counties had a total of 312 ICU beds against a projected need of 370, leaving a demand gap of at least 58 ICU beds.

Though reports from the counties  indicated the situation could be running out of control particularly in the five hotspot counties, the chairman of the Council of Governors (CoG) Wycliffe Oparanya downplayed the fear and assured that the devolved units had put in place mechanisms to deal with the situation.

“These are measures that we have been working on since the outbreak of the pandemic.

There is no cause for panic as the counties are working closely with the national government to contain the situation,” Oparanya told People Daily.

Oparanya disclosed governors had planned a retreat in Mombasa to discuss challenges the devolved units are facing in tackling the current wave of infections and draft recommendations on the way forward. 

Patients seeking to be admitted to the ICU in Mombasa are being forced to seek alternatives after all the beds ran out.

The County Covid-19 Response Committee has now warned the county is staring at “a serious health crisis” in the wake of the second wave of infections.

Mombasa County Commissioner Gilbert Kitiyo, who co-chairs the committee alongside Governor Hassan Joho, strongly warned residents against violating the Covid-19 health protocols, to avert further spread.

The Coast General Teaching and Referral Hospital (CGTRH) in Mombasa County has 12 ICU beds.

“All emergency beds in major hospitals in Mombasa are now full and the situation is worsening in Mombasa.

We are warning people to adhere to Covid-19 guidelines to avert further spread, because it is evident the second wave is here with us,” Kitiyo warned.

Governor Joho, while addressing the Mashujaa Day celebrations, warned residents to brace themselves for more stringent measures should the second wave of Covid-19 situation deteriorate.

“If you don’t want tougher restrictions, then ensure you follow the Covid-19 guidelines, we have a responsibility as a people,” Joho said 

In Nakuru, patients seeking emergency medical attention at the Nakuru Level Five Hospital are being forced to scramble for space at the facility’s lone Intensive Care Unit (ICU) which has a capacity of six beds.

The public hospital, which serves Nakuru and a better part of Baringo and Narok counties, can only manage six patients at the general ward ICU at each given time notwithstanding the ever-increasing demand for the crucial care.  

Health protocols  

With the county having a population of more than two million people, the hospital has a bed capacity of 500 and six ICU beds whereas the international standards require that for every eight hospital beds there should be an ICU bed.

With these statistics, Nakuru Level Five in the Hospital should have at least 63 ICU beds.

According to the hospital’s Medical Superintendent Dr Joseph Mburu, there are plans to increase the hospital’s ICU capacity to meet the increasing number of patients at the hospital.

Currently, amid the pandemic, Dr Mburu notes that in the general ward, the hospital has six ICU beds, three High Dependency Unit beds whereas, in the Covid-19 isolation wing, the county boasts of 10 critical care beds.

“The ICU beds are classified into two groups, one is the general wards and the other is in the isolation unit since we cannot allow patients to mix as we try to contain the pandemic,” said Mburu.

Last week, Governor Lee Kinyanjui warned residents to either change their lifestyle and adhere to the health protocols or risk facing stricter restrictions.

In Eldoret, MTRH chief executive Dr Wilon Aruasa said the facility had been overwhelmed with new cases of the virus, with ICU beds full.

“We are trying our best to handle the situation and ensure that it does not get out of hand, but the number of new infections and admissions are on the rise.”

But the Kiambu County government says its confident it is fully prepared to handle the situation. 

Governor James Nyoro says the county has in the last nine months invested heavily in health care infrastructure as well as human resources.

Nyoro added that his government is well prepared for a surge in new coronavirus infections. - Reporting by Mercy Mwai, Harrison Kivisu, Oliver Musembi and Roy Lumbe