The Status of the Covid-19 Pandemic in Africa
The World Health Organization (WHO) classified COVID-19 outbreak a global pandemic on March 11, 2020. The outlook for Africa at that time was gloomy. According to a recent publication by the British Medical Journal, it took 3 months from the declaration of the pandemic for all the 54 countries in Africa to record 100,000 confirmed cases and 19 days to reach 200,000 cases. The total number of cases reached 300,000 in the next 12 days and, by the end of the first week of July, Africa had recorded 500,000 total confirmed cases and 12,000 deaths. In the first 4 months since the declaration of the pandemic, the growth in the number of confirmed cases was exponential. Between April and July, 2020, total confirmed cases more than doubled in most African countries.
With these gloomy statistics, it is difficult to visualize why the rate of transmission of Covid-19 will not be exponential in Africa. According to a report by the United Nations Economic Commission for Africa (ECA, April 2020), between 300,000 and 3.3 million Africans are expected to die from Covid-19 depending on the interventions implemented to control the transmission.
Resources and capacity:
ECA data show that 56 percent of the urban African population live in overcrowded slums and just over one-third of households have access to hand washing facilities. Approximately seventy percent of the workforce are employed in the informal sector; most cannot work from home. In addition to these deprivations, Africa has the highest burden of diseases such as malaria, tuberculosis, and HIV/AIDS. The sub-Saharan region has 0.2 doctors per 1,000 people, compared to the global average of 1.6 per 1,000. Many African countries do not have adequate diagnostic kits. They also lack the capacity to test, isolate, trace contacts, and treat the severe illnesses identified. These factors all work against Africa’s chances of avoiding a catastrophe.
Paradox?
Instead of the predicted exponential growth in the number of cases and deaths, there have been a drastic decrease in the daily confirmed cases and deaths compared to all regions of the world with the exception of Western Pacific. WHO Coronavirus Disease (COVID-19) Dashboard shows that, Africa, with a population of 1.216 billion recorded total confirmed cases 1,206,767 since the onset of the pandemic. During the same period, the Americas (North and South America) recorded 17, 176, 705 confirmed cases; South-East Asia recorded 7,488, 605 confirmed cases; Europe recorded 6,337,772 confirmed cases, and Eastern Mediterranean recorded 2,503,734 confirmed cases.
Africa’s confirmed cases peaked on July 25th at 20,614 and has declined continuously to October 5, with total confirmed cases of 4,423. United States recorded 49,036 confirmed cases on October 5, 2020 while Europe recorded 72,082 confirmed cases on October 5, 2020. Africa recorded 70 deaths on October 5 2020, compared to 2,388 in the Americas; 440 in Europe; 1,070 in South-East Asia, and 468 in Eastern Mediterranean. The patterns of continuous declines in total number of confirmed cases, deaths, and increases in recoveries were repeated in all African countries.
African governments took tough and very costly decisions to control the transmission as soon as the pandemic was declared. According to the WHO Regional Director for Africa, Dr. Matshidiso Moeti, African governments suspended all international flights and closed their borders to neighboring countries based on the knowledge that the disease was imported from abroad. Entire nations or communities were quarantined as soon as the pandemic was declared by WHO. Dr. The population structure has served as a barrier to the transmission of the disease. World Bank data show that around 40 percent of the population is under 14 years old and only 3 percent is over 65 years. Data from other countries show that the share of older populations drives the death rates. Africa does not have nursing homes, which tend to serve as Covid-19 hotspots in Europe and North America.
Mobility has also served as a barrier to transmission of the disease. The large size of the continent ( 11.3 million square miles, approx. equal to Europe, USA, and Canada combined), poor conditions of inter-continental and domestic road networks, and the high cost of inter-continental flights have limited the mobility of the population, serving to further constrain the transmission of the disease.
The Role of Africa CDC
Individual African countries lack the capacity to control the pandemic. Fortunately, Africa CDC, a specialized office set up by the US Centers for Disease Control and Prevention in collaboration with the United Nations Economic Commission for Africa (ECA) in response to the Ebola outbreak, has created a taskforce to address the Covid-19 pandemic. In a recent interview Dr. John Nkengesong, the Director of Africa CDC stated that the taskforce has launched a partnership with African nations to accelerate Covid-19 testing on the continent. The taskforce aims to increase testing to 10 million from May to August, 2020; establish a pooling mechanism with African countries for access to diagnostics; and deploy one million health workers, under an initiative titled The Tracking, Testing, and Tracing Initiative to assist in testing and contact tracing. The aim of these strategies is to assist African countries with supplies and experts. The activities of Africa CDC have contributed to reversing the projected exponential growth of confirmed Covid-19 cases, death rates, and increases in recoveries.
In addition to the work of the Africa CDC, individual African countries also took bold steps. The Governments of Ghana and Senegal have recently been praised by WHO for their leadership in slowing the spread of the disease.
In a recent interview published in this blog, Dr. Kofi Osei, the leader of the Covid-19 management team in Ghana, stated that international flights were canceled early and the land borders were closed. Traditional contact tracing was implemented and enforced by the security forces. Digital contact tracing was later introduced to complement the traditional method. Drones were used to distribute supplies to the remote areas of the country. Coverage for treatment was free and the costs of utilities were subsidized to alleviate the financial burden on the population. Dr. Kofi Osei further stated that… “The government has been very truthful and transparent, and citizens have complied with the protocols”. This is demonstrated by the reduced number of confirmed and new cases, deaths, and increased recoveries. The cumulative number of cases as of October 2nd was 46, 829; 46,060 recovered cases, 303 recorded deaths with only 26 new cases.
The Covid-19 Global Response Index created by the Foreign Policy Magazine (August 5, 2020) ranked Senegal second among 36 wealthy, middle income and developing countries in the preparedness and management of the Covid-19 pandemic. The country’s strong mark was “based on its high degree of preparedness and reliance on facts and science”. Quick action, clear communication and experience gained from managing the Ebola outbreak in 2014 contributed to Senegal’s success in managing the current pandemic. According to Dr. Abdoulaye Bousso, the Director of Senegal’s Health Emergency Operation Center, the government initiated the development of a contingency plan as soon as the WHO declared Covid-19 as an international public health emergency on January 30, 2020. Curfew and travel restrictions were imposed throughout the country when the first six positive cases were recorded on March 6, 2020. Testing was ramped up promptly; mobile labs that can return results in 24 hours were created. The government guaranteed any person testing positive, with symptoms or asymptomatic, a hospital bed, avoiding the transmission of the virus to family members. The result was a dramatic reduction in confirmed cases, deaths and increases in recoveries. The cumulative number of cases as of October 2 was 15,094; 12,936 recovered cases, 312 deaths with only 37 new cases.
WHO Coronavirus Disease (COVID-19) Dashboard shows that large African countries like Nigeria, Egypt, and South Africa also demonstrated similar dramatic reductions in confirmed cases, deaths and increases in recoveries. In Nigeria (population: 200 million) the total number of cases was 59,583 on October 2, 2020; 51,308 recovered cases, 1,113 deaths with 126 new cases.
Conclusion
The data show that Africa may have avoided the catastrophic predictions due to a variety of social and environmental factors. Youth, immediate actions, preparedness, constraints to domestic and international mobility, and good leadership that delivers clear, decisive, transparent information may have bought the continent time to prepare for future surge. Infectious disease experts regard COVID-19 as unique based on the range of symptoms from none, mild and deadly. Asymptomatic people can have high levels of transmission. It is clear that no nation has the virus under control yet. According to Dr. Matshidiso Moeti, WHO Regional Director for Africa…”we must not become complacent. Other regions of the world have experienced similar trends, as social and political measures are relaxed, cases start ramping up again.”
Sources:
COVID-19 in Africa: Protecting Lives and Economies, by the Economic Commission for Africa, April 2020.
https://foreignpolicy.com/ August 5, 2020
WHO Coronavirus Disease (COVID-19) Dashboard
Bibi-Aisha-Waidvall, How Africa has Tackled Covid-19, BMJ 2020;370:m2830 http://dx.doi.org/10.1136/bmj.m2830 Published: 16 July 2020
