CORONA IS EVERYWHERE--PART TWO

THE CORONAVIRUS PANDEMIC IN AFRICA

Wednesday--Kwei Quartey

As of this posting, the continent of Africa has around 116,000 recorded cases of COVID-19, of which some 3500 have died. From South Africa's high of 24,000 cases and 429 deaths to Western Sahara's low of only ten cases, the profile of the pandemic in Africa is as varied and multi-layered as the continent itself.

Map of the COVID-19 outbreak in Africa. (Image: Canuckguy, Lokal_Profil + Xfigpower)    100,000+ Confirmed cases    10,000–99,999 Confirmed cases    1000–9999 Confirmed cases    100–999 Confirmed cases    10–99 Confirmed cases    1–9 Confirmed cases

Lockdowns/Stay-At-Home

Some African governments followed the lead of western nations in imposing stay-at-home orders, but as has been pointed out, in many cases, the efficacy of such a measure is questionable. Consider slums such as Nairobi's Kibera or Accra's Agbogbloshie, where six to ten people may live in a small wooden shack. The notion of "social distancing" in this situation is farcical. For many of these people who work in the informal economy, missing even a day's work can mean going hungry.

Agbogbloshie slum, Accra (Photo: Kwei Quartey)

In Ghana, President Nana Akuffo-Addo probably read the signs of rapidly growing malcontent among the citizenry and eased the restrictions after a strict lockdown of only three weeks. Like Trump, Akuffo-Addo faces a challenge to his reelection at the end of 2020, and media optics of out-of-control Ghanaian policemen assaulting people in the streets for not staying home reflected badly on Ghana's president, who is not wildly popular at the moment. 

Testing

Like other parts of the world, the numbers in Africa depend on several factors, including the fundamental ability to perform the COVID-19 test in the first place. Here, individual nations have widely differing capabilities. With vast testing experience for HIV, South Africa, with less than 5% of the continent’s population, has a testing rate of 6.5 per 1000 population, with Ghana following at 5.5/1000. But Nigeria, with more than three times South Africa’s population, has tested only about 0.2/1000. 

Therefore, do we have a true representation of the number of cases and the fatality rate in Africa? Almost certainly not, particularly as many young people may not be showing any symptoms (pre-symptomatic or asymptomatic). Remember that 19 of the top 20 youngest countries are in Africa.

Ghanaian lab tech with SARS-CoV-2 test kit (Image: Shutterstock)

Bearing in mind that even the US has had months-long problems with access to testing, Africa faces great difficulties in the areas of infrastructure, equipment, and trained human resources, but the most severe obstacle is the availability of reagents necessary for the testing. Warns Africa CDC head John Nkengasong, "The collapse of global cooperation and a failure of international solidarity have shoved Africa out of the diagnostics market. With its lack of hospitals and high prevalence of conditions such as HIV, tuberculosis, malaria and malnutrition, Africa could see COVID-19 mortality rates higher than elsewhere, even in children."

Under the Partnership to Accelerate COVID-19 Testing (PACT), established by the African Union and Africa CDC, the number of tests throughout the continent grew from a mere 415,000 in mid-April to approximately 1.2 million now. PACT aims to strengthen capacity to test at least 10 million Africans for COVID-19 across Africa in the next six months.  

Dodgy Predictions and an Incomplete Picture

There have been dire predictions of a devastating 300,000 to 3.3 million COVID-related deaths in Africa. During a CNN interview, Melinda Gates said, "Look at what’s going on in Ecuador. They’re putting bodies out on the street. You’re going to see that in countries in Africa.” While Gates was undoubtedly expressing a fear she had and not relishing the notion, it's no surprise that this declaration did not go down well with Africans, many of whom are already suspicious of the Bill and Melinda Gates Foundation's involvement with vaccine production. 

Melinda Gates's distasteful imagery ("putting bodies out on the street") painted the 54 different African countries with a broad, sweeping brush suggesting passivity and helplessness. But, it should be recalled that the African continent has had experience with HIV, malaria, tuberculosis, and Ebola. Whereas the concept of lockdown for COVID-19 was foreign to the US and many European countries, Sierra Leone and Liberia were already familiar with it from the Ebola epidemic, and both countries wrestled with Ebola until they beat it, much of it through local efforts. 

Just as the states in the US can hardly be said to have had homogenous responses to the novel Coronavirus outbreaks, neither has Africa, but many African countries imposed travel bans before or around the same time that the US government did. For example, Ugandan President Yoweri Museveni announced a ban on large public gatherings including weddings and church services on March 19, 2020 before Uganda had a single COVID-19 case. Uganda has around 212 recorded cases and an unknown number of deaths, according to the site ncov2019.live. 

Rwanda, with 327 recorded cases, was also quick to react. Shortly after the outbreak was confirmed in January, the government set up a committee to evaluate and bolster preparedness and response to the pandemic, training about 500 health workers, including laboratory technicians to cope with a potential national epidemic.



Hospitals and Health Care Systems

Some of Africa's best hospitals, both private and public, are found in South Africa, Tunisia, Kenya, Tanzania, Rwanda, Algeria, Egypt, Morocco, Zambia, Tanzania. Even so, South Africa has fewer than 1,000 intensive care unit (ICU) beds, of which 160 are in the private sector, for a population of almost 60 million.

Aga Khan University Hospital, Nairobi, is used as a benchmark by other hospitals in Africa.
(Photo: Aga Khan University Hospitals)

Estimates are that South Africa currently has 3,216 ventilators, with 2,105 in the private sector. South Africa's health authorities put the projected need for a peak COVID-19 epidemic at 7,000. Meanwhile, Kenya has 259 machines; Ghana, 200; Nigeria, 169; South Sudan, 4; and Somalia, zero. Fortunately or unfortunately, depending from which angle you look at it, the desperate ICU/ventilator scenarios in the West months ago could not even logistically exist in most of Africa, and the continent's response to COVID-19 will not be a picture of elite hospitals like the Aga Khan placing hundreds of people on ventilators.

Instead, it will be a story of how the illness affects communities with few resources. As in Ghana, the unfolding march of the disease might be more represented by mortuaries overflowing with bodies as families wait for a day in the future when full-scale funerals can be held again. They may have to wait a long time.