 Good afternoon. Good afternoon. Thank you so much for joining us. And for yet another time with the Lord in fellowship. We are so glad that you took the time to join us this afternoon. We are coming from Nairobi Central Estee Church. And on this beautiful Saturday, we are excited to even start off with our song session. But before then, I want to start with a prayer. And George, George is going to lead us in the opening prayer. So, George, you can go ahead and say a prayer with us. Happy Sabbath. Happy day. Let us bow down for our Dove prayer. Dear Heavenly Father, we come before you this afternoon. We thank you, Lord, for the blessed Sabbath. And we want to thank you for the time of fellowship that we've had that we are starting now. We want to ask your presence to be with us throughout the process of my prayer in Jesus' name. Amen. Amen, amen. Thank you. We are going to the river. We are going to the river 432. You know, S.D. Himmels, shall we gather at the river? And we will sing all the stanzas. Four, three, two, shall we gather at the river? Crystal tide forever, the beautiful The beautiful, the beautiful, rich, the shining, Retidual soaring from sea, speak of this city, Desire, temptation and social law. It is to be but can see, but to remember, I'll take here His path, a stepping stone, That's winding on His in the world today. I see His hand of mercy, I hear His voice of cheer, And just the time I need Him, He's always near. He lives Christ Jesus' peace today, Talks with me, Christ Jesus' peace today, He walks with me and talks with me, Voice of rejoice for Christian, Lift up your voice and sing, It's Christ Christ Jesus' peace today, With me and talks with me, We see His cry and soar, His love that makes us happy, His love that makes us kind, His world is full of sorrow, His love is smooth, It helps us mind, it makes us kind, Our song shall be, It helps us mind, it makes us kind too. Stands up to the ladies who sing Stands Regation, Join us together in song 440. Jesus himself. Happy Sabbath, Thanks for joining us this afternoon as we continue with the Sabbath of today. Have a small health talk based mainly on the COVID-19 and before we start, I would just like us to have a short prayer. So let's bow down for a prayer first. Almighty and everlasting Father, we thank you very much for this day that you have given us today. We thank you very much for our lives, Almighty Father. And we ask you that as we discuss the health talk today, Almighty Father, you may guide us in whatever we are doing for the short duration that we have, Almighty Father and let your people listen to whatever we are going to talk about and at least understand Almighty Father. For these are us believing and trusting in your Son Jesus Christ. Amen. Yes, we are going to continue. So today in the afternoon, we are going to have a small talk on the COVID-19 and I would just like to introduce the people who are with me on this forum now. So our main speaker will be Dr. Lois Onbajo who is seated on my right side. Dr. Onbajo is working at Kenyatta National Hospital and she's a consultant physician. She's in charge of the infectious disease unit at Kenyatta National Hospital and she's been in a lot of contact and in the provision for the work of the COVID in the country Kenya. So we welcome Dr. Onbajo, Lois. Thank you very much. Yes. On my left, we have Diana. Diana Ocholla is one of our members here. She's also in our health team. So Diana will take all the concerns and the questions which will be related to this talk. As we continue, I thank Diana very much for being available and thank you very much. Thank you. Just a disclaimer, I'm not a doctor. I do say you're a doctor. Thank you. But she's in the health team. Yeah, she's not a doctor but she's in the health team. Yes, she's one of the members that we are in the health team together. So she knows something in medicine. Yes, it might not be the real one that we talk about in the hospitals but she's still in the health team. So we welcome, I welcome both of you. Other is I'm called Dr. Grace Akecho-Cheng. I'm also a member of this church together with Diana. Dr. Lois is not a member of this church. So we welcome you very much, Doctorie and be blessed. So most of the talk we are going to have today on the COVID-19. We will be done by Dr. Lois but we will ask questions as she continues on the COVID-19 with more emphasis mainly on the presentations of the COVID-19 and how we go about it in the medical field. So Dr. Lois, you are kindly welcome. Thank you. You can give us a slight talk on the COVID-19. Thank you. Good afternoon, everyone. And you say happy server. It's a happy server today. I am a member of the All Saints Cathedral but I'm very honored that you invited me and I'm very glad to have joined you this afternoon. And it's also refreshing to see how well you're adhering to all the COVID protocols in the church. Thank you for the very kind introduction as well. So I was asked to just talk a little about one of our experiences with COVID where we may be heading to and I'm very happy to take as many questions as possible. So those particular areas of concern, please feel free to post them or send them forward so that we try and answer as many of those questions as possible. So when COVID first started, I'll tell you what I was doing. So it was a Friday, mid-morning and I was at my son's prize-giving day in school. So we're sitting and I stood up to take some photos and when I sat back down, the parent next to me said, Dr. Teri, why haven't you told us? And he was watching breaking news and the breaking news was a Cabinet Minister for Health announcing that there was a first case of COVID at Kenya International Hospital. Unfortunately, it was top secret. So we had about in the news for the first time as well. But from that time, I think our lives totally changed. First, there was a lot of panic and a lot of fear largely because of what we had seen other countries go through. By the time we got the first case of COVID, we'd seen what was happening in China and the very strict lockdowns. We had seen what was happening in a lot of Europe, especially Italy, France and Spain around that time. We had seen a lot of people ill requiring ICU care and dying. And it was just after there was a large outbreak in the US specifically around New York. So clearly all of us were very concerned. And at that time when we thought we had planned and we'd given press conferences about how ready we were, we suddenly realized nothing prepares you for an outbreak that you had never gone through. So it's been a long learning process. We are still learning a lot. It's hard to say whether anyone is truly an expert in this. But in that period since last year, we've had the opportunity to treat a lot of patients. And maybe just as I talk about some of the things I'll just give a little bit around the health issues. So one, the patients that we have seen in the initial phase, a lot of them didn't have symptoms, but we're doing what we called screenings and surveillance. So a lot of people were screened and because we were very afraid and no one knew what to do, a lot of people were taken into what was called quarantine. And quarantine is where someone who doesn't have the disease but has had contact or exposure is kept away from other people so that in case they develop the disease, they do not spread it to other people. So people who are coming into the country initially were screened and those who are coming from countries where there are already a lot of cases of COVID were kept in quarantine. Those who were found to have disease were put in isolation. So this is where someone already has infection, is put separately so that you reduce the risk of it spreading to other people. And fortunately, many of the people who had disease did not have any symptoms. So they were found to be positive because they traveled in from the US, for example, or from Europe and when they were tested, they were positive. So they were kept in isolation to reduce the spread to other people. So many of them didn't have symptoms and that is what we continue to see today. Many people who test positive because they had contact with someone who had disease but they never develop symptoms. A few people develop symptoms and most of the symptoms that we've seen, at least from patients that we've managed, the most common has been cough. Then we've had patients who lose their sense of taste and smell. It's very distressing. We take some of these small things for granted until we don't have them. But a lot of people have lost their sense of taste and smell. Then you have a few people who may have fever then other symptoms like sore throat and a running nose. Some people may have muscle or joint pains and those are sort of the most common symptoms we've seen. Unfortunately, there's a proportion of people who get very severely ill which means they have trouble breathing because they develop inflammation of their lungs and end up with what we call pneumonia. So those ones may require to be in hospital for the purposes of giving them more oxygen. So for us to have enough oxygen in our blood, we need to have air spaces, those air sacs that are free to take in the air that we breathe and that is then exchange for carbon dioxide that is produced by our body. So if those air sacs are full of all these junk so to speak, inflammation, all these dead cells and other things fill up those air sacs, the sun is not able to get oxygen appropriately. So in that case, you may need to give them a higher amount of oxygen so that the few air sacs that are still there are able to get it enough oxygen. So many people, some of the people are severely ill, end up requiring oxygen and you have to keep them in hospital until they're able to get sufficient oxygen in the blood on their own. A smaller percentage of patients get very ill and we have to help them breathe. So some of those may end up on what we call a ventilator which is really just a machine to take over the function of the lung until the lung has improved sufficiently. So it drives higher concentrations of oxygen into the lung so that it allows you to get enough oxygen in as hopefully the lung repairs and heals so that someone can breathe on their own. As I said, majority of the people don't have symptoms and maybe we've had COVID. When we first started managing patients with COVID everybody was sort of scared of me they'd see me in the corridor and move to the other side because they thought you're the one who's managing this patient you must have COVID. The fear has since reduced but that same fear has also determined what we call stigma where again people who are scared of getting the disease and they thought if someone has it they'll definitely spread it to me and that issue of stigma marked a lot of our early experiences. We saw people in hazmat suits as if we're going to space we still do that in the hospital when we're managing patients with COVID but we saw people with hazmat suits going out you know to get people from the community so people were naturally afraid and there was a lot of stigma and many people who were taken into the isolation units and recovered and went home had trouble integrating with the community because the neighbors would be peeping out to see the ambulance and no one wanted to interact with them but I think as time has gone on we have become less fearful. Have you become less fearful? Yes. Or you're still afraid as afraid as you were in March last year so we have become less fearful even for us as healthcare workers when they started we're very afraid because we'd seen what was happening also they're saying oh doctors are dying so we're very scared even as we manage patients but I think God has been faithful He's kept us largely safe and we can now talk about experience almost a year down the line so I think there are a few issues that we then need to think about we know how people present we talked about most people being asymptomatic a few having severe symptoms and a few even smaller number having very severe disease that requires to be in hospital one of the things that we have to learn is that if 10 people got sick for example if 10 people got COVID about maybe two of them may require oxygen and maybe one of them may require to be on a ventilator if you have a thousand people who get COVID at the same time it means you'll end up with about 200 requiring oxygen so that's a big number and when there are very many people who are sick even in the hospitals we have trouble taking care of everyone so that's why it's so important that at any one time we don't have too many people who get sick so that we're able to take care of those who need to be in hospital for whatever care who require oxygen or who require ventilation and that is the essence of a lot of the health protocols that have been put in place so that we limit transmission we always reduce the number of people who are sick so that we are able to take care of them and that way more people get better so that really underlies them you know all the protocols that we put in place for us as individuals what really should we do so I think just based on what the Minister of Health has released over time so one is around reducing public gathering so we are not in a public gathering at this point because we have spaced ourselves around the issue of wearing masks so that I have to issue a disclaimer I was told to remove my mask I have it right here but you know wear mask so that we reduce the risk of infecting other people or of getting infected ourselves and these are really basic things things like washing our hands or maintaining hand hygiene they are very basic but they probably have protected a lot of us from getting infection so these are things that we still have to keep doing the question is how much longer do we have to keep doing this when will we go back to normal and maybe just tell you a little about what the epidemiology or spread of disease has been in our country as I told you from the 13th of March when it started we had very few cases at the time and probably because we didn't have too many people traveling into the country who were infected after a while the number of cases started to go up remember in the beginning there were a lot of stringent measures you couldn't all public gatherings were banned we were encouraged to stay home work at home there was a curfew travel into the country was reduced and that really kept the number of cases very low of course we got a bit tired and a little rebellious and we started moving around a bit so without the number of cases started to go up so around June to July we had a lot of cases our hospitals were full then you know that reduced because around that time travel out of Nairobi was stopped and a lot of other measures were put in place and with that the cases went down then came end of around October when we had all the political rallies and a lot of activity happening and come November we had a much larger spike than we had seen in July at a time when we thought now we are doing well we have flattened this curve and up to about mid December we still had a lot of cases but from December we've seen a decline in the number of cases even in the hospitals previously we'd have you know a hospital with 80 beds would be full but right now we probably just have about 20 patients who require to be in hospital that is for Kenyatta National Hospital over the last few weeks it's gone up by maybe just a few but we are nowhere near where we were in November or July so clearly trying to follow some of these measures has helped us we were a little concerned that once schools opened and because over Christmas everybody was gathering with everybody else we'd see a bigger spike so far we haven't seen that and a lot of people have asked me since we are not seeing a spike does that mean COVID is over and we still have a few cases so COVID is not over and I also like to say and I was telling my colleagues earlier that if you see your neighbor's house burning don't sit pretty in a corner and right now we have a lot of other countries in the world where the situation is very dire there are a lot of cases and as long with infectious diseases as long as there's a lot in another country you are never truly totally safe so we really have to keep adhering to a lot of these measures I think public gatherings will continue to be something that we want to avoid for a long time we may need to wear our masks for a while before such a time comes when you know that the cases are sufficiently low in all parts of the world it's just a few sporadic cases here and there so as individuals we have to take responsibility for protecting ourselves and protecting the ones we love even the ones we don't love so much hopefully we love everyone but it will continue to be our responsibility to take care of ourselves and the people around us so that's very very important let's not put our guard down just because we see that the cases are low one of the other questions we've been asked there's been a lot of concern around schools and what will happen to our children well we're happy to say that we haven't seen a large flare up since schools were opened many of the schools at least around Nairobi I go to my son's school and I see they're really trying to make sure that our children wear masks half the time they're in the pocket but they're trying to keep their masks on they're trying to make sure there's hand hygiene and that the children are following basic measures and teachers are also following basic measures so I think it's just our hope and prayer that we do not have any major issues in school one of the things to mention is that children don't transmit the virus that much they don't transmit to each other that much so that's a good thing for schools children also don't get too sick they're the ones who are most likely to have no symptoms if they get sick so if you look at the context of a school the people who are more likely to be sick is the teachers rather than the children because these are adults adults are more likely to have symptoms than children so generally schools tend to be a safer a safe environment having said that we must make sure we also protect the children when they come home so if you go out without your mask and get contact and you come infect your children if they go to school we increase the chance that it may spread to other children so we have to as we watch schools and hope that our children are safe we have to protect children when they're at home I think there probably be other questions on the vaccine and other things and we'll take them as we go along so that I don't talk too much and send everyone to sleep we can take a few questions and go on from there Thank you, thank you for that introduction I have a question here from Nidia she's saying thank you Dr. Noyes is it possible for someone to get COVID a second time after having antibodies? We have heard of an existence of vaccine does it mean even the recovery cases need this vaccine? Thanks for that question that's a really good question so we know that with many infections once someone gets infected the body sort of puts up a fight what we call an immune response and that immune response can protect the body from getting the same infection at least for a little while and it is thought that for COVID-19 we have some antibodies and antibodies are things that fight fight any foreign organism that comes into your body in this case COVID-19 we know that people who've had the infection may have these antibodies I saw that these antibodies may last about three to six months and the level of the antibodies also goes down with time which means if someone has had the infection they still are risk that they could get infected again and indeed we've seen a few people who've had the infection once and they got infected again so it doesn't mean that if you've been infected now you throw your mask and walk around thinking you're immune there's still the risk that you could get infected again there's also the risk that you may get the COVID and not get symptoms but still be able to spread it to other people so you keep wearing the mask both to protect yourself from a reinfection as well as to protect other people in case you got an asymptomatic infection so you don't spread it to them if someone has had the infection and the vaccine comes yes they still need to get the vaccine because the immune response that is triggered by the vaccine is a little different from the immune natural immune response so it's still important that they get the vaccine even if they've had infection previously but just to add on to that the vaccine issue they say it takes two years for us to sort of know how a vaccine will work before it is given to people for testing and right now there are some countries which are testing vaccines so from a doctor's perspective isn't it dangerous to test out a vaccine that hasn't been tested over a long period of time? Are we exposing ourselves to more issues? To danger? That's a good question I think it's a question that a lot of people are also asking so if we look at the the usual vaccine development process in the past you have to find we call them candidate molecules and you find that thing that can trigger an immune response in the body and once you discover it you refine it and purify it and then you test it in animals you know they use lab mice and really to make sure is there an immune response elicited in these mice? Does this thing you've created kill mice for example because then you cannot test it in animal in human beings so once that stage passes that's what we call a preclinical trial then now it's taken to human trials and the human trials first they start with very few people just to see is there truly an immune response? Is it safe? All right then from there again they take it to a larger proportion of people where they see okay what dose is appropriate of this vaccine and is it still safe? Then they take it to a large number of people so thousands and thousands to see whether it is safe in the past these trials have taken a very long time one because already the basic molecule that candidate molecule was not yet discovered and also because the diseases that are being vaccinated again so fairly rare so by the time you had enough people who would get this infection it took several years so now comes COVID-19 COVID-19 is caused by a class of viruses that have been in existence for a very long time we call them the coronaviruses so there's already been a lot of work going on with coronaviruses remember several years back there was an outbreak of SARS a few years later there was an outbreak of Mars what we call the Middle East respiratory syndrome that came from camels and really started around the Middle East area so there's already a lot of work going on with this coronaviruses and they'd already identified the basic principles around what type of vaccines may work so we're not starting from ground zero so this was quickly taken through the human trials and then remember COVID was a widely spread disease so to get people who'd had disease or who were at risk was not a long process that's why they were able to recruit tens of thousands within a few months because there were so many people who were at risk it was not a rare disease so for example if you think of vaccines that we have like polio you see polio is not common you wouldn't walk around and see this on a polio this on this on this on it was rare so it took longer to get a sufficient number of people for you to show effect that they were actually protected against the disease so for that reason the process has taken a shorter time I think a lot of it is also because to do with the fact there's a lot of funding to support vaccine development and that happens where a disease affects everyone around the world where it's confined to one region of the world people take a shorter time because it's not everybody's problem right so that's one the other thing is that while you're looking at vaccine side effects you know we are in danger most vaccine side effects are likely to occur within just a few days or weeks to months following the vaccine usually by about three to four months if there was going to be some catastrophic thing it should have been discovered you know it's not like ten years down the road I say oh yeah I had a measles vaccine ten years ago maybe it's what is causing this most vaccine side effects occur within a short while after vaccination and by the time the vaccine was given the first emergency we call it use authorization to use it in the context of an emergency already more than 40 close to 50,000 people had received the vaccine so if something was going to happen we would have seen it early so I think from at least from a medical's perspective we are fairly confident that this is going to be a safe vaccine and we are I don't know whether to say lucky but we've had the benefit of seeing people in other regions of the world millions of people having received this vaccine and we haven't seen reports of any severe outcomes or severe side effects so we've had the benefit of watching other people get it on our behalf before it reached us so I think it's a good thing to get the vaccine I know one of the questions people have had that now there's no corona why should we get the vaccine if you think look at many other countries I'll give you an example of Brazil last year Brazil had a lot of cases and at some point they told us that about 75% of the country had probably got an infection so they said oh we have what they called herd immunity we are all immune because we've gotten it but if you go to some regions of Brazil now people are dying in homes and on the streets because they cannot get oxygen because the hospitals are full so it means we can't say oh well as we are safer than other people there's nothing really that makes us special we're just as much at risk as anybody else okay allow me to throw a spanner in the works I speak as a layman here before I go to a question from Lucy you know I'll speak about you know people have this idea that Bill Gates is out to finish Africans and he's had a TED talk which has been watched by millions of people about dehumanizing and he's behind the backing of so many people so how do you approach such people who are very this vaccine is being funded by the Bill and Melinda Gates they want to finish Africans how do you talk to such people? that's always a tough one there's been so many conspiracy theories going around and the people very strongly believe in that I think for me as coming from a medical perspective I've taken care of a lot of sick people COVID I've also watched a lot of people die because there wasn't much we'd offer them everything we could humanly offer and there's nothing else we had to offer and it's a very sad place to be in as a doctor I teach at the University of Nairobi we've lost colleagues to this we've lost friends and family so clearly there's something there there's nothing that makes me special that I wouldn't be the next one to go it's something that can affect everybody and now I think most people know someone who has been sick or know someone who knows someone who's lost a relative so I think we have to be realistic and just look around if someone sneaked into the middle of the night in 2019 and told us he must get vaccinated and we'd never seen anybody get sick that would be different the other thing I usually wonder is I don't know how old Bail and Melinda Gates are but even if they wanted to finish Africa they'd probably be dead before we have finished so that may not be a goal in life at this point so I think we just need to be realistic and look around us and see what's happening and say if I had the opportunity to protect myself and my family would I take that or would I start looking for someone to blame I would take the road of protecting myself and my family Lucy is asking up to this day I don't understand how this infection works I have seen married people whereby a husband gets COVID two times but the wife never got sick and never got positive I have seen two couples the other couple the wife got sick but the husband didn't my question now is how does that happen considering they're sharing the same bed? Okay so we don't know how much they're sharing but let's assume they're sharing the same bed and the same house and all that so there are two things here if I got sick first and I went home and my husband got exposed to me it means I probably got exposed to someone else a few days earlier it took a while before I started to shed the virus and so my husband gets exposed to me so it will take him a few days before he sheds the virus I'm end up getting sick before him when we go to hospital we are both tested I may test positive and because of the timing of the testing he may test negative we know that if I'm exposed today it may take anywhere between 2 to 14 days before I begin to shed any virus so show any symptoms so many times when you have a negative test in someone who's been exposed one it's not 100% that if I'm exposed I develop disease people's immune systems are different some may fight it off a little better two it may have to do with the timing of the testing so they were tested maybe too early after they got exposed to me and before they develop disease and we've seen situations where two people are tested one positive, one negative and then later the one who are tested negative is the one who starts to show symptoms and when you test them at that time point you find that they are positive so sometimes it's got to do with the timing of the testing and as I said remember not everybody gets sick 70 to 80% of the people remain as symptomatic in this country about 90% of all those who tested positive didn't have symptoms so we know there are certain people are more likely to get sick because they have certain risk factors and there are some people who just will never have symptoms so you see there's no guarantee that if my husband and I will get the same symptoms on the same day and test positive on the same day the likelihood is high but it's not absolute okay thank you maybe I can also add something from the testing because the testing that we do is not 100% yes so when we do the throat swabs and the nasal it's not 100% that you will get so you may still have the coronavirus and you do the test and you turn out to be negative yeah so it's I think it's around 80 yeah so about even if I have COVID now we say sensitivity the chance that I will pick the disease when it is there is just about 70 to 80% because of the characteristics of the test it's not 100% in certain occasions you may miss it so if we have patients who come and they are sick they have the symptoms and you test the first time it's negative and you still really think this is COVID we may test another one or two times before we pick it so that's a really good point Catherine is asking what are some of the post-COVID effects you observe here in Kenya some studies elsewhere have shown that some lose part of their memory how true is this okay so I'm actually having a bit of trouble hearing you I don't know no I had the question is this like echo a bit of echoing so in terms of some of the post-COVID syndromes or what now is being called long COVID that we've seen here at the Kenyatta National Hospital we are running a post-COVID clinic so people who've been discharged are coming back to clinic and the most common is fatigue for patients who've been sick there's a certain level of fatigue that they can't explain they feel tired just dressing and that tends to linger for a bit of time in some people some of the people who've lost their taste and smell take a while before they get it back a few people have kept complaining about joint pains and muscle pains those are the most common that we have noted we probably haven't done very formal tests of memory but I haven't specifically had a patient to come back and complained of memory loss but now it's increasingly recognized that COVID can affect some parts of the brain and yes some people may have issues of memory loss one of the other things is almost like a post a stress, post-stressful disorder you know people have gone through a lot of stigma a lot of fear and even after they come out it takes them a long time to get back to normal because they're still, you know that stress is sort of still lingering they may not have had a lot of family support they may have lost relatives while they were in care so there may be a lot of other issues that require psychological support beyond their cute illness someone is asking should I keep my distance from somebody who's recovered from COVID-19 and I guess this was answering the question for stigma can we still be in the same house if they've recovered? so yes you don't need to keep distance from someone who's recovered so the data that we have from a lot of studies around the world is that up to about 10 days after someone has been found to be positive for COVID they may no longer be infectious which means the ability to spread goes down to almost zero which means after day 10 and someone has been in isolation they can come out of isolation and they're not likely to spread even those ones continue to test positive it's probably dead virus or just pieces of virus and they don't spread this infection to other people so if someone has had COVID this is something that has been particularly troublesome in offices where you're told no stay home until the day you test negative and even when you come back people are not quite sure you're not going to get COVID from someone who's recovered from it thank you for that is there a new strain that Kenya has? I think sometimes you know the disease is still morphing I mean I think it's something that we don't know about and if yes how is it being handled and is the vaccine safe or put with pre-existing conditions if you have diabetes if you have high blood pressure is it safe? so there are different strains that have been discovered around the world and remember viruses change all the time they're constantly changing what they look like most of the time the change is not of any significance you know it may weaken the virus a little occasionally it makes it a little stronger and by stronger it means it can either make it spread faster which the virus likes because it propagates itself or it can make it cause more severe infection most viruses avoid changes that make them cause more severe infection because if you kill everyone you infect then you can't spread and just like humans they like to spread and grab so they don't want to kill people so there are what we call variants of concern are the ones that seem to be transmitting a lot faster and that's what is being seen with a variant that was discovered in the UK a variant that was found in South Africa and another one that was found in Brazil so those ones are of concern because they seem to spread a lot more they're infecting a lot of people so in Kenya we've had other variants that are not of concern because they're not of much clinical significance for us recently there were two travelers from South Africa who are found to have that variant of concern their contacts were tested to make sure that it wasn't spreading and so far we haven't seen any of their contacts get that variant of concern but that doesn't mean that it would be safer forever because you know people are traveling in and out and even the virus that we have here is also changing so we really just have to keep following the protocols because we don't know when things may change somebody is concerned about you they're asking how frustrating is it for you as a frontline health worker seeing people disobeying masks, social distancing measures particularly in rallies and you know we are already in a pre-electionary mood and it seems like we're going to have like what like how does that make you feel? So in the beginning we'd get really angry I had a few very heated discussions with people in certain offices as we tried to convince them that we need to do certain things right and I think at some point we realized we'll kill ourselves with stress so we educate where we can, we correct where we can and we hope everyone takes responsibility for themselves and I think we realized that around the time the messaging chain to its individual responsibility because otherwise you walk around with a whip beating up everybody so we've had to realize that we need to encourage people to understand because many times it could disobey I don't think it's really because of defiance sometimes just a lack of appreciation of how important something is so more education probably helps but it is indeed very frustrating when people don't when people blatantly disregard some of these measures We apologize on the behalf Zabelie is asking if somebody gets the vaccine How long is the duration like are they protected from COVID? For example if I take it now am I immune for COVID for five years, ten years? Do I need a booster? You know like leave the pool you sometimes they have boosters there Truth is we don't know we don't know because we've only vaccinated for even with the trials the person who's gotten the longest duration is probably just about eight or so months so it means we still cannot tell how long they will remain protected from the studies again most of the studies were concluded in about eight months we know that at least by eight months they're still protected and likely much longer so one it depends on how much the virus changes because if the virus changes then you may need to keep giving boosters that take into account the changing virus but at this point we really still do not cannot tell how long it will be that will have to be informed over time Do we need a booster? At this point no, we need two doses of the vaccine to achieve the level of immunity required there is some suggestion that in the countries where they're seeing certain variants they may need a booster to have an even higher level of protection but that's just a suggestion as now there's still a lot of studies going on in that area and the question on is it safe for pre-existing conditions, diabetes, blood pressure if it's safe it is particularly necessary for those pre-existing conditions so there are certain conditions that put one at higher risk for getting very ill and even for dying and those are one older age pre-existing conditions like diabetes especially diabetes has been one of the most obvious risk factors so for people who are older, people who are pre-existing conditions it's particularly important that they get vaccinated and actually the strategy in many countries and in Kenya as well is that when the vaccine gets here it will start with frontline workers frontline workers will be healthcare workers, teachers and the next category will be those at risk so above the age of 50 with pre-existing conditions because those are the ones who are most likely to get very sick I think the power of social media we tend to read a lot of stories there's so many stories and we had this happen in Australia I mean I think there was a story I read where somebody said they got the vaccine then they turned to HIV positive you know so in the era of social media there's a lot happening and Tabitha is asking, I read a case in a European country where a patient got corona eight months ago and up to now she has not recovered from the virus kindly explain what's happening is it possible to have the virus for that long? for eight months is a long time locally we've had patients who are still testing positive 60 days, 80 days after their first test and many times we really struggle with that because it's frustrating for the patient they want a negative test so it's very frustrating for them to keep getting a positive test because sometimes some people will test negative then later test positive again is it the same virus that they had or is it that they've gotten a new infection? it may be that they've gotten a new infection not necessarily the old virus that they had the other thing is that the virus does a lot of damage to the lungs so especially those who are very severely ill who require a lot of oxygen or who require to be on a ventilator as some of that damage to the lung doesn't disappear the minute you turn negative it may take a very long time and they may continue to struggle a bit with breathing for maybe several months after the infection we're yet to see whether there are permanent effects to the lung because we'll probably only see that after we've had a longer experience with the disease I struggle with wearing masks every time I go to the supermarket I feel like my head is paining and somebody here is asking because I feel her frustration what are the effects of long-term use of masks and like for example for those of us who have a head pain like five minutes in the supermarket you're done, your ears are paining, your head is paining because this is not something we're used to so are there any long-term effects to wearing masks? because as a doctor I'm sure you wear them when you do yeah, I wear masks all day, every day yeah, so I mean this series you read about I'm breathing in my CO2 how is that affecting me? just demystify some of this so masks are probably as safe as it can get most of these masks that we wear allow free flow of oxygen, carbon dioxide, of air what they block are they filter out anything that's added to the air so if there's a droplet, you know those would be filtered out if there's some bacteria in the air those would be filtered out but air flows in freely and I remember some of my colleagues who do anesthesia you know anesthetists sit in theater to make sure you sleep and wake up okay and they wear masks in theater all the time and one of them took their blood test for the oxygen level after being on a mask for a long time and it was as good as ever so we shouldn't be worried that you're not getting enough oxygen what are the long lasting side effects? sometimes the fate is just to try the strap is short so it hurts your ear or if you sit in the sun you'll be a little lighter around the mask area in a little darker elsewhere but other than that we don't really have any lasting effects it's a bit uncomfortable yes so but if you're in public with many people you need to have it if you're on your own or out in the open where people are far apart then maybe there you can do without it but so far we don't have lasting effects we've worn masks a lot but we are still okay I think one of the things which people are suffering most women is they're calling it Maxime like Acne yes so it irritates the skin so definitely doing facial routines during this time may be something that people get into because it's not something we're used to doing yeah um elder Charles Abebe is asking or is sharing worrying concerns in no way they're reporting 33 deaths out of 42 vaccinated and Germany are reporting 8 out of 800,000 immediately after the short of the vaccine and this is in January should we be worried? so there's a time though some reported deaths and it was in an old people's home so remember some of these European countries are the older people's home where they put many of the patients are very old they have a lot of other what we call comorbidities and there was some noted death after the vaccine and there was a thorough investigation as to what may have caused the death and none of the deaths was linked to the vaccine there was an alternative cause that was identified so so far we do not have a death that's been caused by the vaccine that was directly linked to the vaccine so they could possibly have been other related issues yes in the investigations they all had other issues that caused the death none of the death was linked to the vaccine okay um Nico is asking people fly for eight hours in planes five hours on the SGR without social distancing but but with masks but we can't worship in church together and um so he's asking aren't these guidelines contradictory because when the plane for eight hours then immediately you get on the plane social distance but I've been with you for eight years so I feel like you know he's asking are some of these rules contradictory so not necessarily if you think about many planes at least what we know is that they've put in certain measures around filtering of the air that's within the plane so they've talked about putting HEPA filters and other things that filters the air within the plane so that reduces the risk that within the plane uh with public transport many times they've been told about social distancing and keeping your mask on and that reduces the risk uh why are churches and that's always been the question and I guess that's the other underlying thing why is it that we can't mingle in a church so one of the things is again from the earlier phases of the outbreak a lot of cases were linked to church gatherings uh people have measured how far you spread a droplet or even virus itself if you're talking if you're singing if you're shouting and with singing and shouting it's thrown a lot further so if you're all here and you don't have masks and we're singing then the risk of spread for someone who has COVID is higher uh the other thing is that for planes you see you get into a plane because you had to take that journey you know um so the things that you must do you do with certain precautions the things that you can find alternative ways of doing then we do not have to put ourselves in a place of risk so for many churches we found ways of attending church online of doing it on TV of you know meeting online with people where we have where we can get alternatives then let's get alternatives let's not constantly trying to put ourselves at risk flight is because you didn't have an alternative so if you're there we're saying there are certain filters that have been put in place and most planes will ask you to keep your mask on for the duration of the journey in the early phases they'd make you wear a shield and a mask and it will be uncomfortable to fly so where we do not have an alternative keep safe where we can find alternatives let's find alternatives Joffrey is asking is there something unique about Africans given that the infection mortality numbers compared to Europe and the Americas and here's a second question what is the timeline for vaccinating all Kenyans and I'd like to add that maybe I'm sure you have data for maybe Tanzania you have data for Mozambique I don't know if you do but it seems like the mortality you know compared to other and I know it's God who's keeping us well but is there a reason why our numbers don't look the same? So why are we protected there? The first statement is to say we don't fully know it having said that as I said the risk factors for mortality are things like advanced age the mean age of Kenyans is about 19-20 years if you go to the US the mean age is probably in the early 40s in Europe it's even older some European countries it's 48-50 so they have a larger population of much older people and a lot of the deaths have occurred in older people so probably even here many of the deaths have occurred in those above the age of 60 but there are not that many compared to the overall population so the age factor is important there may be other factors that we don't fully understand people have wondered what we may have whether we may have some other immunity because the general group of viruses called the Corona viruses are very prevalent they cause Homa and you know the common cold very frequently so may we already have some level of immunity but we don't truly understand so we just thank God and pray that he stays the same What is the timeline for vaccinating all Kenyans? Is there a timeline? Will it be a must? Will it be optional? So it will not be a must you can't force people to get vaccinated you can only offer them the option of vaccination and hope that many people take it up because the more people take it up the more protected we are we want as many people to be vaccinated as possible so that the general level of virus in the society is low because if it's low everybody is safe but if only 10 of us are vaccinated and there are 100,000 then it doesn't really help you know so we hope that that individual responsibility will extend to thinking by getting vaccinated I protect myself but I also protect my loved ones and those around me so the hope is that as many people as possible are vaccinated the timeline I think the initial at least the initial messaging that you've had from the Ministry of Health was that they would expect the initial doses of the vaccine to arrive at the end of February so maybe by mid-March they would have started the initial vaccinations remember a lot of this is dependent on supply and we've already seen even European countries already beginning to fight because of the supplies of the vaccine so it's really dependent on how much the manufacturers can supply but I guess the hope would be that over the next 18 or so months most groups will have gotten vaccinated so it's utter by December will all be vaccinated it will depends on how well we can get and remember it's just about the vaccine landing here where will you store it how will you transport it where will this vaccine be given who will be the vaccinators there are a lot of other things that have to be put in place as well I think in line with that Catherine is asking a very good question what are the decisions making variables that inform the government in selecting vaccine providers why skip the biggest vaccine producers like India and go to UK does it affect efficacy so I think it's got to do with availability the initial vaccines that were available in sufficient quantities were probably the Pfizer and Moderna more from the US those were the initial ones that were available in sufficient quantities that could be availed to us so probably the initial one we get maybe what is called the Pfizer vaccine thereafter we'll have this one from the UK called the AstraZeneca the India I think there's an institute called the Serum Institute in India that's also producing the UK vaccine the AstraZeneca vaccine so it's really got to do with who was producing it first which volumes are available first if we had sufficient and they have to be registered so even for the government of Kenya they won't just go to say we hear certain countries producing we just rush and get it it has to be what we say pre-qualified certified as safe and effective by recognized bodies like the World Health Organization so if that is certified and they have sufficient quantities then the country is free to access it from any of those areas that have sufficient quantities of pre-qualified vaccines and does it affect our DNA? No, it doesn't affect our DNA I think most people are like those who are in childbearing or thinking about they're like me I don't have a vaccine that's going to you know stop me from having babies so there's a lot of fear around this thing it's changing just our system So the vaccine doesn't affect our DNA most of them have been noted to be safe even in pregnancy and we've had the disadvantage of watching a woman pregnant near term die of COVID so I think as many people as can get the vaccine they should get the vaccine What's your take on natural remedies? As the Adventists faith we talk about the health message we strive for eating well exercise water, air, sunlight trust in God we call it new start and many of us have been boosting vitamin C with barb or powder or steaming with eucalyptus just to ensure that what's your take on teaching people yeah and just educating them as much as we're educating about the vaccine just educating them on doing proper healthy things that you know normally just allow you to go to live well So you see think of the vaccine as the severity may be dependent on where it finds you in life if it finds you sick then you're probably likely to get worse if it finds you healthy with a robust immune system then you're likely to fight it off better So a healthy diet an exercise and sufficient sleep you know are all important aspects of getting healthy so we need to be found healthy by whatever comes even after this so those are things that we must do natural remedies like you know steaming, taking some ginger and garlic they're not harmful so if somebody is able to do them why not whether they actually treat the disease itself is not known the vitamin C there's no evidence that it works once someone has COVID so we'd encourage people not to take too much of it because remember too much of everything can also be harmful so don't take too much of it rather eat fruits that give you vitamin C naturally you know eat your oranges and you know other fruits that give you vitamin C but having people naturally healthy is the most important thing you can do not just for COVID but for every other disease whether it's a stroke whether it's a heart attack whether it's cancer whether it's you know living a healthy lifestyle is the one thing we can actually do to protect ourselves from a lot of these other things someone is asking are cloth masks effective? I think there are many different types of masks maybe you can cover that there's the N95 sorry N95 you can see I don't like masks N95 there's the blue one which you have today there's the cloth one how you know what's more effective you know what should I do is there one that is better than the other? the type of mask you use depends on the amount of risk you are exposed to so if I'm working in a COVID unit taking care of COVID patients it means I'm surrounded you know patients are coughing somehow you know there's COVID all over in that situation I need to have an N95 mask when I'm in the general world you know I can do with the blue mask where I'm not directly exposed knowingly exposed to COVID right if you are in a more congregate setting then you probably want to have the mask that's a little more protective for someone walking out there or on the street at home or wherever a cloth mask is sufficient so it's really got to do with the level of risk that someone is at for the older people who have comorbidities or this underlying conditions then the encouragement would be for them to have what you call a medical or a surgical mask as compared to a cloth mask for younger, healthier people a cloth mask would probably be sufficient okay I have another theory here from Lucy there's a theory that America, Canada and UK have their own vaccine and then there's another one they built for Africa yeah, since the fight is against the same virus why is it different? wow, I haven't had that theory all the other theories are usually forwarded to me as soon as they come out this particular one has missed me so not to our knowledge it's the same vaccine that is being shipped to Africa as well so we are not aware that the one we are getting is different from the American one the place of manufacture may differ so remember I said for example the AstraZeneca vaccine was from the UK but you have other plants around the world that may manufacture the same vaccine so for example, India will manufacture the same AstraZeneca vaccine so it's around getting institutes that have the capacity to manufacture in large volumes remember it's we are like 8 billion people on earth for you to get a place that can manufacture that number is very difficult so they may end up being manufactured in different parts of the world somebody is asking I think may I paraphrase the question what of COVID leads to death? like what is it that ends up killing an individual who has COVID? so many things one as I said the lung gets affected and we depend on our lungs to breathe if you have no lung you can't breathe and for many of the patients who die with very severe disease the lung is almost all gone you know it's full of all this inflammatory material and there's barely any lung left to allow someone to breathe for some people unfortunately they may get clots as well and if you get a large clot in the lung for example going to the lung that may cause death the patients may end up with kidney disease and other things so by the time someone is dying often you find that if they had very severe lung disease other organs that are dependent on a functioning lung dependent on oxygen may begin to fail so the kidney may begin to fail they may have multi system multiple systems and organs also failing at that point okay somebody's worried and once your opinion on Tanzania doc what is your opinion regarding Tanzania? did they embrace the pandemic and we have relatives there how do we relate to them? so the truth is I do not have intelligence about what's happening in Tanzania what we know is that for example they are not testing at least what our colleagues have told us is that they are not doing any testing we know of people who've lost relatives in Tanzania from what sounded like COVID so I think I always want to go with the known rather the unknown because the known helps you to prepare for any eventuality so I'd say you know what if someone does not share data move on and look at the people how many countries are there in the world? many so in Kenya learned about in Africa learned about 50 right? so why do you want to look at this one when there are 49 others sharing data? let's work with what we know I have no idea what's happening in Tanzania thank you Lily is asking about expectant mothers what happens to expectant mothers who contract the virus is it more severe? not necessarily we've had very many pregnant women who delivered healthy babies and had gotten the virus at some point along the way we may just want to keep a closer eye on how the organs are working so that if there's anything you can pick it early but we've had a lot of pregnant women who went ahead to deliver healthy babies who did not have corona who the babies didn't necessarily have corona yeah so it's usually a bit more difficult because after the mother delivers you want the mother to have a mask when she's breastfeeding you know so it's a little more difficult but many people have overcome that remember in 10 days the risk of transmitting is so low so do you think we'll be wearing masks for the next one year? like are we still going to be in this place? let's take a poll how many people think we'll still need masks for the next one year? the rest don't think that because they don't want it they're hoping we'll say remove your mask I think we'll still be wearing masks for the next year oh wow I hope we probably will let's just accept it Ali and I are not fighting okay I think I have covered most of the questions okay yeah thank you very much I think the questions have actually helped and most of the questions have been on the vaccines yeah people concentrating on the vaccines which is quite encouraging yeah so I think that Dr. Bidja has answered most of the questions that have been asked concerning the COVID and unless somebody has anything else that is burning even from the congregation we can now allow these ones who are allowing the people who are at home around maybe working or somewhere else who are on using the YouTube so we can allow the congregation anybody who has any question I think we will allow this one go out of time oh and we're sorry we have to stop by so maybe just one question that's what the doctor has requested thank you for the exposition and what you've enlightened us on the issues of COVID I think the concern that has also been the air and largely you have discussed it the issue of the efficacy of the vaccines that have been imported I think we cannot completely eliminate the theories that are there I know we've just had a discussion with the doctor outside but I think we wish we wish to be given assurance beyond reasonable doubt that what is coming into the country is safe for us we are aware that we have more than 1.2 million vaccines that have been imported to be administered in the next few weeks we're concerned what is the efficacy of these vaccines that have been brought into our country and are we sure that they will be safe for all of us thank you thank you very much for that question so to the best of my knowledge there is no vaccine that has come into the country for the general use a few embassies they probably brought some but that's only for use within the embassies not for the general public so to the best of my knowledge there's no vaccine there's 1.2 I'm not sure where the figure comes from but there's no vaccine that has been imported the first batch of vaccines is expected to arrive in the country at the end of February that will be the Pfizer vaccine and it is the same vaccine that's being administered in other parts of the world so all the vaccines that are brought here as I told you have to be pre-qualified by established agencies like the FDA which is the American organization for authorizing drugs the WHO or the European organizations for the same authorization so that is the basic principle behind every drug every vaccine that will be imported into the country yeah I think we have to bring to a stop they convert whatever we've had to do on the COVID-19 and the vaccines and we are very very grateful for Dr. Anvidya at least for giving us her time we are very very grateful doctor you just don't know how happy I am yes and Diana thank you very much for being with us yeah for this afternoon so any other questions that somebody may wish to ask we can answer at a later date yeah because Dr. Anvidya has to leave now she promised to be with us at least it's almost time and she's been with us for one hour so we have to release her and I think we've been very very grateful for whatever she has discussed in terms of COVID-19 so I'm very grateful and I think I will call it off and we will finish there yeah thank you very much thank you thank you so much we thank you so much for staying with us to this part of the program and for the very in-depth discussion you've had on COVID-19 experience I've learned so much and just before during the conversation I was asking my fellow choristers if they would have the vaccine so we were split I mean 50% were like yes we're going to have the vaccine and then the 50% were like hey we're not sure and I guess there's a lot of people not sure but one thing that we thank the Lord for that he's kept us safe and when the time comes he will help us to make the right decision we are going to close today's service with a response and thereafter we'll have a prayer at the very end and Keith will pray with us at the end after the response so we'll we'll have the response now may his peace be his peace thank you for being with us throughout this day thank you for being with us throughout this service dear Lord for ourselves but also to Father your gospel dear Lord as we close this service we want to pray that you be with those who are at home watching us be with those of us who are still here as we also make our exit to head home send your angels to watch over us as we go and when we arrive home all praise and honor will be given unto you all this I pray in the name of Jesus Christ our Lord and Savior Amen