COVID-19 Pandemic – A Spotlight on Africa

April 8, 2020

By IGHN Key Correspondent, Quwam Kelani

A new year is usually a cause for optimism and hope. While the year 2020 is no different, it is considerably noteworthy. When a cluster of pneumonia cases in a Chinese city was identified1 in 2019, the world did not necessarily foresee a pandemic brewing. The cases were determined to have been caused by a novel coronavirus SARS-COV-22, presently known as COVID-19, named by the World Health Organization (WHO)3. The first case unrelated to the cluster cases was identified in Thailand on the 13th of January 2020. This indicated the beginning of a worldwide spread4. In the week that followed, the first case of the virus in the United States of America was recorded. Barely a month later, early death from the illness was recorded in France5. As of the 27th of February, Africa had recorded cases in Algeria and Nigeria6.

The virus had begun to spread over continents due to its direct and indirect mode of transmission; in the main, through contact with respiratory droplets while in close contact with an infected person, or from residual fomites within the recent environment7 of an infected person. Infection rates were exacerbated considerably due to many infected people being asymptomatic or showing very mild symptoms.

By the 8th of March, COVID-19 cases were estimated to be reported in over 100 countries encompassing 100,000 cases4. On the 11th of March, The World Health Organization declared the outbreak a pandemic8.

How Africa is the Most Vulnerable:

As of the 19th of March, the WHO had confirmed 633 COVID-19 cases and 17 deaths in Africa9. Over the course of just the past two weeks, the spread has meant that only 4 African countries are currently free of COVID-199. Some African countries had begun early surveillance, tightening their air border controls to mitigate the risk of importing the virus through air travel10. However, the reaction taken to the possibility of community transmission and movement across borders has been less immediate; far less strict security, potentially attributable to difficulties in implementation due to the continent’s geographical structure.

The demographic structure of Africa is unlike other regions in the world. Africa has a dense population of 1.3 billion, with the median age of 19.7 years11, compared to 43.1 years and 32 years in Europe and Asia respectively12,13. Findings from Europe and Asia indicate people above 60 and persons with underlying health problems are most susceptible to severe COVID-1914.  However, there have been outliers of severity in the younger population, and the chance remains for the virus to mutate, therefore the potential future effect of the virus remains uncertain.

Africa has a 68% prevalence rate of people living with HIV/AIDS and tuberculosis in the world15. Africa has an estimate of 90% malaria mortality rate, not to mention the 38.1% of women within reproductive age suffering from anaemia16. These endemic conditions are associated with a weakened immune system, potentially leaving much of the population vulnerable to COVID-19 infection. Therefore, as far as Africa is concerned, severe cases of COVID-19 have the potential to occur irrespective of age on the continent.

Social Isolation is therefore a crucial determinant to flatten the curve in the race to reduce the burden of this pandemic. However, the economic structure of Africa is dependent on its informal sector. The informal sector accounts for 30% to 90% of non-agricultural jobs and more than 40% of most countries’ Gross Domestic Product (GDP)17. Nigeria’s and Tanzania’s informal sector contributes to over 60% and 50% of their GDP17. Most Africans cannot survive without their daily trade. Many also lack access to the comfort of savings and online commerce. If social isolation becomes the only successful long-term solution to COVID-19 in Africa, the quest to survive and prevent starvation will soon undermine the precision required. The economic requirements for the population’s survival will put Africans at higher risk of being infected and spreading COVID-19.

Africa’s Healthcare system has the lowest capacity to provide critical care in the world. In one WHO media briefing on COVID-19, the Regional Director for Africa addressed the challenge of availability of testing kits18. This challenge could also be responsible in part for the low number of cases identified in Africa so far, which is deviant from reality. Just like viruses such as HIV, people are at more risk when they don’t know their COVID-19 status, leading to sparse data with which to tackle the pandemic. A recent study reported that, out of the countries in the world with the highest number of intensive care units (ICU) beds per capita19, no African countries makes the list. Zambia has 0.6 ICU beds per 100,00 people, while Gambia and Uganda have just 0.4 and 0.1 beds respectively. In contrast, the United States have 20 beds per 100,000 people in the population20.

Severe COVID-19 cases lead to respiratory failure that demands ventilation support in the ICU. Liberia has no ICU with ventilators, not to mention the deficit of 2.4 million healthcare workers on the continent as a whole. Africa has 2.3 healthcare workers per 1000 population compared to America, which has 24.8 per 1000 population21. If the spread of COVID-19 in Africa reaches the levels seen in other parts of the word, the surge of cases will overwhelm the already weakened healthcare system.

 How Prepared is Africa?

The COVID-19 pandemic resembles a familiar scenario that transpired in 2014; the Ebola outbreak in West Africa, with the Democratic Republic of Congo one of the most severely effected. The resilience that emerged in response to the Ebola epidemic; rigid health protocols; and social togetherness; this showcases an inherent ability and drive to manage this novel coronavirus meticulously.

The blueprint for identification, contact-tracing, monitoring and isolating where necessary was essential in getting the Ebola outbreak under control. This framework can be viewed as a head-start in establishing and implementing similar measures in response to COVID-19 in Africa.

In the aftermath of the Ebola crisis, the World Bank established the Regional Disease Surveillance System Enhancement Project (REDISSE) to bolster health systems and disease surveillance in 16 West and Central African countries22. Two years ago, the World Bank supported the Nigeria Centre for Disease Control (NCDC) in strengthening Nigeria’s capacity to detect, prepare for, respond to, and prevent disease outbreak23. Since then, a further 25 laboratories in Nigeria and 18 more in South Africa have been equipped and trained. These laboratories have the scope and capacity to research the epidemiology of, and test for, COVID-19.

The WHO is currently working with experts in Africa to coordinate regional surveillance efforts, modelling, diagnostics, clinical care and treatment. In addition, research is being conducted into methods of identifying and managing the disease, and of limiting widespread transmission. They have also issued guidelines to African countries that include quarantine, repatriation of citizens and measures for workplace preparedness24.

 The rise of confirmed cases of COVID-19 on the continent least prepared to handle a pandemic has begun to increase daily. Actions to slow down, break the chain of transmission, and flatten the curve are needed immediately. The Ebola crisis response trained African countries to invest in a reliable healthcare system and efficient surveillance mechanisms to manage epidemics. Together with the effort of the WHO, an effective response to COVID-19 pandemic will necessitate building on these lessons together.

References:

  1. Coronavirus Disease (COVID-19) – Statistics and Research – Our World in Data. https://ourworldindata.org/coronavirus. Accessed April 4, 2020.
  2. Ren L-L, Wang Y-M, Wu Z-Q, et al. Identification of a novel coronavirus causing severe pneumonia in human. Chin Med J (Engl). February 2020:1. doi:10.1097/cm9.0000000000000722
  3. Naming the coronavirus disease (COVID-19) and the virus that causes it. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it. Accessed April 4, 2020.
  4. COVID-19 — a timeline of the coronavirus outbreak | Devex. https://www.devex.com/news/covid-19-a-timeline-of-the-coronavirus-outbreak-96396. Accessed April 4, 2020.
  5. Coronavirus: A timeline of the pandemic from China’s first case to now – Business Insider. https://www.businessinsider.com/coronavirus-pandemic-timeline-history-major-events-2020-3?r=US&IR=T#march-13-a-us-national-emergency-was-declared-over-the-novel-coronavirus-outbreak-25. Accessed April 4, 2020.
  6. NCDC Coronavirus (COVID-19) Information Minisite. https://covid19.ncdc.gov.ng/. Accessed April 4, 2020.
  7. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations. Accessed April 4, 2020.
  8. WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020. Accessed April 4, 2020.
  9. COVID19_Cases. https://who.maps.arcgis.com/apps/opsdashboard/index.html#/0c9b3a8b68d0437a8cf28581e9c063a9. Accessed April 4, 2020.
  10. Gilbert M, Pullano G, Pinotti F, et al. Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet. 2020;395(10227):871-877. doi:10.1016/S0140-6736(20)30411-6
  11. Population of Africa (2020) – Worldometer. https://www.worldometers.info/world-population/africa-population/. Accessed April 4, 2020.
  12. Population of Asia (2020) – Worldometer. https://www.worldometers.info/world-population/asia-population/. Accessed April 4, 2020.
  13. Median age over 43 years in the EU – Product – Eurostat. https://ec.europa.eu/eurostat/web/products-eurostat-news/-/DDN-20191105-1. Accessed April 4, 2020.
  14. Older Adults | CDC. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html. Accessed April 4, 2020.
  15. Global HIV and AIDS statistics | Avert. https://www.avert.org/global-hiv-and-aids-statistics. Accessed April 4, 2020.
  16. Africa Nutrition Profile – Global Nutrition Report. https://globalnutritionreport.org/resources/nutrition-profiles/africa/. Accessed April 4, 2020.
  17. Economists struggle to figure out where Africa’s informal economy — Quartz Africa. https://qz.com/africa/1759070/economists-struggle-to-figure-out-where-africas-informal-economy-starts-or-where-it-ends/. Accessed April 5, 2020.
  18. COVID-19 in Africa: insights from our media briefing with WHO | World Economic Forum. https://www.weforum.org/agenda/2020/04/covid-19-in-africa-insights-from-our-media-briefing-with-who/. Accessed April 5, 2020.
  19. The Countries With The Most Critical Care Beds Per Capita [Infographic]. https://www.forbes.com/sites/niallmccarthy/2020/03/12/the-countries-with-the-most-critical-care-beds-per-capita-infographic/#77d65a97f864. Accessed April 5, 2020.
  20. Kwizera A, Dunser M, Nakibuuka J. National intensive care unit bed capacity and ICU patient characteristics in a low. BMC Res Notes. 2012.
  21. Plange-rhule J, Eastwood JB, Eastwood JB, et al. Shortage of Healthcare Workers in Developing Countries — Africa Loss of health professionals from sub-Saharan Africa : the pivotal role of the UK. Lancet. 2005;365(February):1893-1900.
  22. Regional Disease Surveillance Systems Enhancement (REDISSE). https://projects.worldbank.org/en/projects-operations/project-detail/P154807. Accessed April 5, 2020.
  23. Nigeria Centre for Disease Control. https://www.ncdc.gov.ng/news/169/redisse-project—tor-for-social-safeguard-officer. Accessed April 5, 2020.
  24. Coronavirus (COVID-19) | WHO | Regional Office for Africa. https://www.afro.who.int/health-topics/coronavirus-covid-19. Accessed April 5, 2020.
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