Africa’s death ratio lower than the West but higher than Asia

What does the data reveal about COVID-19 in Africa compared to Europe, North America and Asia? Analysis from political economist Ian Inkster at the University of London’s School of Oriental and African Studies (SOAS). 

If Africa is to respond effectively to the coronavirus pandemic it must do so early and with a clear focus. Here a few statistics might help, based on comparable data analysis of 40 African nations. On 4 April the total cases of the virus in Africa amounted to 5823, total deaths to 258, with a death/cases ratio of 4.4%. This compares to ratios of 5.29% for the world, 3.7% for East Asia (29 March), 3.3% for South Asia, and 6.3% for the West represented by the largest cases of USA, Italy, Spain and Britain (29 March).

By this measure Africa was in a much better position than the West but was trailing the well-managed cases of six East Asian nations, who had intervened very early and secured extremely close cooperation in social spacing and in lockdown of epicentres and larger areas.

The death to cases ratio has many faults as a measure but is superior to most of the random, floating and insubstantial data that is presently flooding the media. Because death from the virus takes time and threatens mostly the older and immune-suppressed part of the population, its ratio to total cases is a rough but reasonable indicator of the extent to which any nation or region has managed the virus effectively enough to reduce mortality.

Urgent action is needed

It is clear that time is of the essence even at this relatively early stage of the African case. The death ratio for the seven nations with an early first case (from February to 5 March) averaged at 5.3%, the ratio for the next group of 15 nations (6-14 March) is 4.2%, the next group of 13 nations 3%, the last group of 6 nations (22 March-4 April), 3.4% with four nations yet registering no deaths. The longer the virus lasts the more the death to cases ratios will rise.

Second, even at an early stage there are links between the severity of the virus and socio-economic indicators. The first is obviously age – of nations in group 1 where the virus has been longest, the highest ratios are in nations of greatest median age and highest proportion of those over-65 years. Thus, Algeria’s total of deaths was the highest of all 40 nations, and its proportion of those over-65 is much higher than the norm for that group

If we measure the presence of the virus in terms of effective income per head (the purchasing power parity global measure) then Algeria and Tunisia score very highly in effective income compared to the rest of the early group, yet highest also in virus deaths. The six nations with highest total cases have an average per capita income level (PPP) of $8,162, compared to the average of all 40 nations of $5,193.

This is significant but counterintuitive and possibly relates to the degree of commercial activity, including cross-frontier in the richer of the 40 nations, leading to more movements and contacts, thus to greater likelihood of the virus passing between and within nations earlier and faster.

Finally, the virus is moving very fast as seen by comparing the above data from 4 April with the most reliable recent data, that of 8 April. In less than four days total cases rose from 5386 to 8,745, or by 62%, deaths from 258 to 443, or by 72%, representing an increase of the ratio of death to cases of 20%, which is a worry.

Policy implications

We might conclude with policy implications. Firstly, given acceleration in the rate of change then prompt actions must begin with border and entry controls, especially in large nations with multiple borders.

Second, keeping the virus from initial expansion clearly does not depend on high income expenditures. As Asia also shows, more important is the identification of contact networks (especially of returnees and visitors) and testing, followed by social isolation of specific groups.

Third, keeping the death to cases ratio down again may not depend on national wealth but on isolation of older members of the population, especially in South Africa where the death to cases ratio moved from less than 1% to over 13% in just 4 days. If effective, such measures can avoid lockdowns and business collapse. The former may be ineffectual in societies where the agricultural sector is of far greater importance, and where many people will be moving from cities back to their home villages.

This has the danger of spreading the virus but alleviating its effects in situations where infected people may rest and be isolated in local communities and where traditional values hold older and more vulnerable people in high esteem. Together with the age impacts noted above, this might lead to a larger number of cases but a lower proportion of deaths.

Finally, Chinese commercial self-interest could be used to request aid or special assistance in provision of masks, ventilators, personal protection for medics and even perhaps medical expertise. The figures show that time is of the essence and there is no panacea.

Professor Ian Inkster, SOAS, London is a global historian and political economist who has written 13 academic books and nearly 200 articles in peer reviewed journals and held professorships since 1973 in UK, Australia and Taiwan. Since 2000 he has been the editor of History of Technology (London). Twitter: inksterian