Prof. Hamadi Iddi Boga, the Principal Secretary of the State Department for Agricultural Research in the Ministry of Agriculture, Livestock, and Fisheries, contracted coronavirus last month and shared his experience on Facebook on August, 13.
THE MUSINGS OF A COVID TESTED SCIENTIST (long post)
Prof. Hamadi Boga, Principal Secretary, State Department of Crops Development and Agricultural Research also a Senior Microbiologist/Microbial Ecologist.
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. Here are my lessons and observations out of this COVID-19 experience.
Pre Test
1. It began with serious chills that go all the way to the bone marrow. I know it was July but that is not what I am talking about. These chills were abnormal, way way deeper than the usual July experience.
2. Then I had the aches…all over….especially muscles (calves, thigh and arms).
3. 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. I had no flu. Just this cough that irritated and persisted.
4. Nausea and intense urge to puke every time I coughed. This was scary.
5. The headaches and fever I was primed to expect were no show. Actually in all temperature checks at entrances to key buildings, I was recorded to have a temperature of 35 to 36.5oC. Only once did I have a low-grade fever (37.5 oC) when tested at the hospital.
6. I could not smell anything. Nothing. Not food. Not perfume. Nothing.
7. The taste buds went out of the window. I was basically eating grass.
8. The area around the kidneys or abdomen pained. It went on and off.
9. I was not dizzy but I would say…I was not sure I was really seeing properly. So I would take off my glasses just to be sure that the mist was not interfering with my vision.
10. I was also very tired and would sleep and sleep…of course interrupted by this irritating cough and the fear of the unknown that lay ahead.
11. My voice was hoarse. Most of my friends who called were concerned my voice was strange.
12. I got breathless just from talking in a zoom meeting.
The Test
On day four I started thinking, should I be tested just 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 5 minutes but administrative processes to pay the KES.10,000.00 fee took 2 hours. Something between my Insurance Company and the billing at the Nairobi hospital just does not work.
As a scientist, my mind wanders and I am asking myself…and why should the simple PCR test cost KES10,000.00? You see, 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 PCR. 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.
When I told my wife that I had gone for the test, she was terrified that the men and women in PPEs would come and cart the family away. How could I do that? I replied that it would be good as we would know the reality and get early treatment if we had all been exposed. I sense there is a lot of fear out there for 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 the symptoms just avoid 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.
After the Test
I waited for the results for 48h…and they came by a phone call. You are COVID 19 positive. Self-isolate for 14 days. Separate yourself from your family. Let the family come for testing tomorrow. They thought I was being weird. If there are any issues please call us. Any questions? Confusion.
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. We remained in regular touch throughout the isolation to clarify situation and review scenarios.
Luckily my family members were all negative. Immediately I had started feeling sick, I had instructed them to avoid getting too close to me and I started wearing a mask in 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.
Decision to Check into an Isolation Centre
So I began the self-isolation; day 1, 2, 3, 4 and 5. I am largely struggling with a cough and a desire to vomit. I also feel giddy especially when prostrating in prayers. I asked my physician to check me in. I was worried about oxygen levels.
It was also not clear to me if, in the event that things really got serious how I would get myself anywhere at night with the curfew. 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 me to the isolation centre. I am not sure how the average families get themselves into these isolations centres when the going gets tough. I checked into an isolation centre.
My blood pressure was high (maybe due to anxiety), the blood oxygen levels were manageable (94%) and the cough was pressing on. I had a low-grade fever. I learnt with trepidation that my insurance or any insurance for that matter does not cover COVID 19 isolation so I had to pay a deposit of KES.100,000.00 for admission which I did hurriedly via Mpesa. When push comes to shove, you do not think twice about such earthly things. Survival becomes the primary goal.
After 48 hours of monitoring and….
1. Regular sips of Dawa (ginger, lemon, honey)
2. Paracetamol every 8 h
3. Cough syrup (Bro Zedex) every 8 h
4. Glemont L (antihistamine) daily tablet
5. vitamin C tablet 100 mg per day
This is all I was given at the Isolation Centre. It was not for treatment of COVID 19, more for management of 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 realize that the testing and the ceremonies around isolation, PPES and quarantine is what will hamper our ability to manage this beast. I was checked out after 2 days to continue with home quarantine. I carried my medicines with me. It was looking good. My voice had improved. I was looking more energetic. I greeted people with vigor. There is light after darkness.
Lessons learnt and the opportunities to win the war
I have learnt some lessons along the way and done some reflections.
1. This beast is now in our communities. The 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 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 socialize casually. We need to activate our caring genes so that 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 that we should anchor any behavior change communication? Food for thought
2. I believe 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 should self-isolate and self-monitor with proper guidance and regular reports submitted to a health worker or central database so that their situation can be tracked centrally and data analyzed by epidemiologists and infectious disease experts. Not collecting information limits us from mining data from positive cases that would be helpful in managing the pandemic as it evolves. Testing everyone is expensive and the staff and facilities are overstretched and the more information we mine from 1 positive case the better for designing our management system. The PCR kits are expensive here in Kenya. We will go broke testing 47 million Kenyans.
3. Efforts should go into educating families on how to self-isolate and how to support those in self-isolation. This 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.
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. To what end? 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 the 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.
Now thinking as a scientist, there is to accelerate investment in scientific capabilities at three levels
a) People who understand viruses in KEMRI and in the Universities (scientists and technicians). Each region should have a serious Laboratory of CDC level. No need for new buildings. Just upgrading those which are there, and ensuring that they have the right people, equipment and reagents;
b) Let us incentivize synthetic biology startups to set up small biotech companies to manufacture the primers and reagents required for diagnostics and research. The COVID-19 Africa challenge is just about to unravel. The logistics of shipping reagents from abroad will just work against us. We should use the crisis to also emerge as a Biotech manufacturing hub.
Most University laboratories are now closed. MSc and PhD students have suspended their work….WHY? This is the time to unleash all the science we have in this great nation to this war. This is the time to get scientists back into the laboratories to help in surveillance, diagnosis, modeling and scenario building that will get the country ahead of this beast. How else do we grow if not through our pain? As we test, trace, isolate and report, let there also emerge some serious scientific work and discourse in the background to contribute to the body of knowledge required to manage this beast. No one will do our science for us but ourselves.
Today is day 32. Yesterday I had some courage to venture back into the office. Some symptoms still linger, but they are manageable. Sometimes my throat dries up and the 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”. I tested negative on 26th of July. As I venture out, I know I have to continue being…more cautious to avoid re-infection, have less physical meetings, hand sanitize properly, avoid touching may face and eyes less (very hard) and making sure that I wear my mask properly and people around me wear masks. Please do the same so that you can protect yourself, your family and your communities. The cheese has moved. Let us adapt. Let us all pray for God to protect all of us.
