Africa has some hope to beat COVID-19, failure will be devastating

COVID-19 cases are increasing rapidly across the continent, sparking widespread fear about Africa’s ability to cope. Tom Collins looks at the situation as it unfolds. 

Up until recently, Africa watched as Europe and North America were plunged into disarray over the rapidly spreading COVID-19 (coronavirus) which originated in China last year.

Putting to bed the unconfirmed hypothesis that the virus cannot survive in moderate heat  – the recent spike in cases suggests that Africa’s poor global connectivity was responsible for the lag in transmission.

On Friday 20 March, Africa counted 768 cases across 34 countries with 19 deaths according to the World Health Organization (WHO).

Egypt, South Africa, Algeria, Morocco, Burkina Faso and Senegal had the most cases in that order.

Most of the individuals had travelled to countries with high infection rates, yet cases of local transmission are beginning to emerge.

In terms of the data gathered, health experts are concerned that reported cases account for a mere fraction of those actually infected.

“It really comes down to use not being able to detect cases,” says Dr. Ngozi Erondu, biosecurity expert at Chatham House’s global health programme.

“We have many more cases than we are actually reporting.”

One of the reasons behind the lack of detection is due to what Erondu calls “health seeking behaviour”.

Making a trip to the hospital for flu-like symptoms is not a cultural-norm in many parts of Africa.

Most of those testing positive for the virus are affluent individuals who had recently travelled, leading to concerns that less-globalised individuals will fail to seek healthcare advice when showing symptoms.

This adds to the worry that Africa faces a shortage of testing kits.

The high frequency of cases in South Africa and Senegal could be explained by little more than the fact these countries have better access to testing kits.

In the absence of the virus being identified, many are concerned that COVID-19 will spread rapidly throughout Africa’s densely packed cities which is where most of the continent’s population is found.

Yet while African countries scramble to import the kits from Europe and South Korea, institutions and individuals are working to plug the gap.

The Africa Centres for Disease Control and Prevention (Africa CDC) announced yesterday that it has built COVID-19 testing capacity in 43 countries and has provided 60,000 kits.

Operating as the African Union’s infectious diseases emergency response unit, it also received 2,000 kits from the Chinese government and expects to receive 10,000 more in the coming days.

The WHO’S Africa branch aims to supply 2,500 tests to each of the 47 countries where it has an office – leading to roughly 400,000 kits.

Senegal is working in partnership with the UK government to produce a 10-minute handheld test which should be ready by June.

In the meantime, only those who are showing symptoms will be tested – a strategy shared by other countries struggling to secure the equipment.

Compared to South Korea which appears to have brought the virus under control through its efforts to test 10,000 people each day and 250,000 in total, Africa’s supply is clearly lacking.

Some hope   

Regardless of the amount of infections recorded, a number of factors stand Africa in good stead to beat the virus.

First is that many African governments immediately introduced tough measures to halt the spread of the virus.

Countries like Sudan and Ghana have banned arrivals from any country with COVID-19 cases whereas South Africa and Tanzania have enacted partial bans.

Following state instruction, many African airlines also blocked routes to China during the outbreak of the virus and have since banned flights to areas of secondary impact.

Further measures have been taken by many countries to limit public gatherings and ban schools.

Within days of confirming three COVID-19 cases, Kenya shut down all schools across the country – a measure that is not yet adopted in some countries with more than one thousand cases.

Niger ordered school closures even before its first COVID-19 case was announced today.

Second is that Africa is much better prepared to combat infectious diseases due to its historical experience.

“Certainly the experience that we’ve had with some very severe widespread outbreaks in the African region is an advantage,” WHO regional director for Africa, Matshidiso Moeti, told a digital press conference yesterday.

“For example, some of the work that we are doing has been created on the platforms that have been established in response to the Ebola outbreak. The community platforms, the lessons learnt and the mechanisms that are in place are going to help us.”

Gearing up for the continent-wide spread of Ebola in 2014, most African countries established precautionary responses to infectious diseases and these have been implemented in response to the new threat. 

Many airports across the continent quickly enforced rigorous screening measures for arriving passengers, something which had not been matched in the global north.

Along with the Ebola outbreak, Africa’s wide variety of diseases has led to a great diversity of well-funded and well-resourced health institutions.

Africa CDC is one such institution and Erondu says its offshoot Nigeria CDC is “probably one of the best public health institutions in the world.”

Finally, Africa’s younger demographic should help it combat the virus.

COVID-19 is most dangerous for the elderly and those with pre-existing medical conditions like diabetes, heart disease and respiratory illnesses.

Around 70% of Africans are under the age of thirty and in some places like Nigeria half of the population is under the age of 19.  

The greatest COVID-19 fear in Africa is that the continent’s healthcare systems will be unable to cope and thousands will be denied treatment.

Only those who have fever, cough and difficulty breathing should seek medical care, according to WHO guidelines.

Yet there have been many cases of COVID-19 which show either minimal symptoms or none all.

This means that many who contract the virus will be able to recover at home, thereby reducing the burden on Africa’s healthcare systems.

Moreover, African’s young population should mean that far fewer cases exhibit serious symptoms and require healthcare.

That said, the prevalence of secondary diseases like malaria and HIV will mean that Africa’s younger population is slightly more at risk.

It must be noted, however, that a report issued on Wednesday by the US Centers for Disease Control and Prevention showed that nearly 40% of patients sick enough to be hospitalised in America were between 20 to 54 – casting doubt on this hypothesis.

For those who are seeking treatment, the lack of technology and decent healthcare relative to the rest of the world is a major problem.

“We don’t have enough oxygen masks or ventilators,” says Erondu.

“We lack the critical machinery and technical capacity to really save lives.”

Most African countries don’t have enough intense care units or healthcare workers, let alone the technology used by China and others to treat those infected.

If an African country witnessed an overnight spike in COVID-19 cases similar to events in Italy, most patients would have nowhere to go.

Africa currently has fewer cases than other parts of the world, but for the cases it does have there is an increased likelihood of fatality.

If the continent is unable to use its advantage to combat the virus, the consequences will be devastating.