key: cord-345083-f2jzho3i authors: Gachohi, John; Aduda, Jane; Thuo, Reuben; Mung'atu, Joseph; Wamunyokoli, Fred; Ngigi, Thomas; Athiany, Henry; Kikuvi, Gideon; Mambo, Susan; Gichaiya, Wairimu; Matheri, Joseph; Mburugu, Patrick; Simba, Justus; Otiwa, Carol; Muriuki, Charles; Mwaura, Joshua; Yariwo, May; Kariuki, Beatrice; Machua, Joseph; Mwangi, Catherine; Amoth, Patrick; Aman, Rashid; Kamau, Onesmus; Muthoka, Kennedy; Otieno, Jacob; Mwele, Pascal; Nzioka, Rose; Karanja, Simon title: Public health challenges posed by delays in obtaining COVID-19 clearance for long-distance truckers across East Africa date: 2020-10-24 journal: Glob Epidemiol DOI: 10.1016/j.gloepi.2020.100039 sha: doc_id: 345083 cord_uid: f2jzho3i nan COVID-19 related death on March 26, 2020 1 , followed by Tanzania on March 31, 2020 4 , and Uganda on July 23, 2020 5 . In Kenya, the number of reported cases and deaths has increased modestly compared with countries from the West, with 38,529 confirmed cases and 711 deaths reported by September 30, 2020 1 . Following the initial reports of the cases in March 2020, the COVID-19 epidemic curve grew slowly in the lead phase lasting three months between mid-March and mid-June 2020 in response to intensive public health responses mounted to contain the disease spread in Kenya 1 . These responses included the ban on mass gatherings, working from home where possible, observing social distancing, handwashing with soap under running water, and wearing face masks 1 . While the country experienced exponential growth of cases in July 2020, the cases peaked in August 2020 1 . In early September 2020, the incidence curve started to drop, reflecting an inflection (tipping) point 1 . During the lead phase, the EAC identified long-distance truckers (LDTs) as one of the high-risk groups in the spread of COVID-19 on the premise of their extensive spatial mobility and interactions with diverse populations across the region. In response, the EAC formulated protocols, mainly focusing on testing and certifying all LDTs for COVID-19 and presenting evidence of negative status at cross-border points. Implementing the COVID-19 certification directive overwhelmed the capacities to detect cases due to slow testing; this led to unprecedented delays at cross-border points. For instance, at any given time, 1,500 truck drivers and their assistants (combined referred to as LDTs) waited for their COVID-19 test results for at least ten days at the Kenya-Uganda crossborder at Busia and Malaba points, translating to 30,000 person-days in one location of J o u r n a l P r e -p r o o f approximately 4 kilometers squared per the ten days of delay 6 Although the prevalence of risk factors for severe COVID-19 among LDTs could be high based on their lifestyles and the nature of work, majority of them fall in the 30-39 years old category 9 . This age range mainly comprises of COVID-19 asymptomatic spreaders if infected 10 . Among others, these include the disproportionate substance abuse through smoking, precisely compromising their respiratory health and immunity in general 11 . For being away from home for long, they live through suboptimal nutrition that may further affect their immunity 11 In the long term, the disease burden attributable to diarrhoea emanating from low levels of WASH affects child growth and increases the risk of developing irritable bowel syndrome 20, 21 . Epidemiological studies have demonstrated that a significant association exists between transactional sex and HIV 22 . Through transactional sex, the abovedescribed delays might sustain current gendered disparity in HIV incidence among young people. Young women aged 15-24 years have >2 fold risk of acquiring HIV relative to their male counterparts in sub-Saharan Africa 23 . The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. 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