The fight to contain Covid-19 in Africa
As the coronavirus begins its spread across Africa, some countries have announced travel restrictions and school closures. Now they need to curb community transmission
On February 17, the first person to test positive for the Covid-19 virus in Africa arrived in Algeria from Italy. By last weekend, the total number of cases on the continent had passed the 1,000 mark — most of them international travellers.
Africa has so far managed to dodge health experts’ expectations of how the virus would spread — though it’s early days yet.
"We have no explanation for why the spread is so slow in Africa," Dr Matshidiso Moeti, World Health Organisation (WHO) regional director for Africa, told journalists on Thursday.
She said the focus now should be on delaying the spread and preventing local outbreaks.
Higher temperatures and a youth bulge (the median age in Africa is 18, compared with 47 in Italy) could work in the continent’s favour. At the same time, there is a lack of intensive care units coupled with a large number of immune-compromised people on the continent.
Early on, a number of African countries announced preventive measures such as travel restrictions and school closures. With only 17 reported cases, Rwanda was the first country to go into total shutdown.
Prevention of community transmission is important as most African countries are ill-prepared to deal with large numbers of critical patients, should there be an outbreak like that in Italy. Nigeria, for instance, has fewer than 400 ventilators for a population of 190-million, says Ifeanyi Nsofor, CEO of health consultancy EpiAfric and Aspen New Voices senior fellow.
"The UK and Italy have tens of hundreds and they are still struggling."
It’s not all bad news. A month ago there were only two dedicated Covid-19 testing laboratories on the continent; now more than 40 countries have these, Moeti says.
Recent epidemics also mean the continent has response mechanisms in place and a strong focus on community health care.
At the continental level there’s the AU Africa Centres for Disease Control & Prevention, which opened its doors in 2017 but has been dogged by insufficient funds. Chinese entrepreneur and philanthropist Jack Ma’s Alibaba Group has donated 1.1-million coronavirus test kits, 6-million masks and 60,000 protective suits to the centre.
You prepare for epidemics in peacetime — you don't wait for them to happenIfeanyi Nsofor
At country level, the institutions are stronger. The Nigeria Centre for Disease Control (NCDC), for example, has five testing laboratories. It helped pick up and contain the first known Covid-19 case in the country — an Italian traveller who arrived last month.
"Because of the 2014 Ebola outbreak and intermittent Lassa fever outbreaks, countries like Nigeria have pre-emptively invested in epidemic preparedness," says Junaid Nabi, a public health researcher at Harvard Medical School. On the whole, though, "most countries are not well prepared".
However, recent epidemics affecting Singapore, Taiwan and Hong Kong meant they limited travel and could manufacture test kits as soon as the genetic sequence of the coronavirus became available, Nabi says.
"Singapore had a lot of deaths after the SARS [severe acute respiratory syndrome] outbreak and swine flu. They knew such epidemics were a question of if, and not when."
A wide and rapid dissemination of information globally has also been crucial. A number of academic articles have been published by scientists in countries where Covid-19 has broken out, and leading academic journals have made them available for free, Nabi says. "This has greatly improved our understanding of the disease and development of treatment protocols."
Aspen New Voices senior fellow Dr Serufusa Sekidde says WHO director-general Tedros Adhanom Ghebreyesus’s recommendation of "testing, testing and testing" is important.
Sekidde, who studied in China, says community health worker programmes based on the Chinese "barefoot doctor" approach are important in countries where funds are limited. "Politicians, when they think of building up our health-care system, focus a lot on the hospital system," he explains.
In contrast, China’s "barefoot doctors" were high school-educated rural dwellers with basic medical training. They promoted hygiene and preventive health care and treated common diseases. Countries such as Rwanda, Sierra Leone, Uganda, Malawi and Kenya have implemented this model, and used it to fight infectious diseases such as Ebola and polio.
But Denis Chopera, medical virologist and programme executive manager at the Sub-Saharan African Network for TB/HIV Research Excellence, says that according to modelling done by experts at Wits University, once it reaches 100 local transmissions, infection becomes exponential. At that point, more serious measures have to be implemented to slow the infection rate — particularly as a vaccine is still several months away.
"Over six months the impact will be less than if people are infected over a month, which will overwhelm the health-care system," he explains.
Should the virus spread to urban informal settlements, where it’s more difficult for individuals to self-isolate, he says health-care officials could isolate entire communities as a means of controlling the spread.
Chopera believes climate change will give rise to the spread of similar viruses in future, as the encroachment by people into animal habitats will mean a lot more interaction between the species. "Investing in biomedical research in future is important so that we can be prepared to see these things when they are coming," he says.
Local and innovative ways of dealing with the coronavirus are in the offing. A Senegalese innovation lab is already helping to develop cheap and rapid testing kits which could speed up diagnosis.
And Nsofor says a consortium of German and Nigerian public health, research institutions and a global software company, co-ordinated by the Helmholtz Centre for Infection Research, developed an outbreak response management system during the West African Ebola outbreak of 2014/2015.
"When data is entered, the states will see it and the NCDC will see it. It takes away a lot of the paperwork, which takes time." And delays could mean deaths.
Several tech hubs are also sending out calls for ideas on how to address the coronavirus. "This would help change the narrative that in everything, Africa has to wait for the West," says Nsofor.
While funding remains a big issue, he hopes one positive outcome from the virus will be that businesses contribute more to health care once they realise how epidemics affect their profits.
"You prepare for epidemics in peacetime — you don’t wait for them to happen," says Nsofor. "When they happen, there is so much tension people don’t think critically, and people make mistakes."
By the time Wamkele Mene was sworn in as the first secretary-general of the African Continental Free Trade Area (AfCFTA) last week, the speech he had written was old, with countries rapidly restricting travel.
Mene, a former department of trade & industry official, tells the FM that the Covid-19 pandemic “has caused untold disruption in global supply chains, global trade and global markets”. It has, however, also provided an opportunity for the continent to rethink trade.
“As Africans we now have to relook at our pattern of dependence on others, and we have to reflect in a very serious way on how we can increase our self-reliance,” he says.
Africa has a responsibility to “make sure that we have our own value chains and supply chains. If there is to be an opportunity from this crisis, this is [it].”
Jakkie Cilliers, author of Africa First! Igniting a Growth Revolution, says the AfCFTA could prove to be very important for trade integration. “You need larger markets,” he explains.
“The implementation of the AfCFTA agreement is critical for Africa to stop its deindustrialisation and to change the value-added component of manufacturing.”
It will, however, be a slow process, because the agreement will only be fully in place in 2034.
So, for now, the disruption of the supply chain from China — one of Africa’s biggest trading partners — will have a huge effect on the continent. But, says Cilliers, “the fourth industrial revolution and digitisation mean supply and demand are becoming localised”.
Democracy could suffer more lasting damage. This weekend Guinean President Alpha Condé ignored public health risks and deadly protests to push on with a referendum that could add 12 years to his 10-year rule.
Jeggan Grey Johnson, programme officer at the Open Society Foundations, says: “There have been no preparations to my knowledge on the coronavirus in Guinea-Conakry. We are beginning to see a defiance against dealing with the pandemic where dictators will not stop at anything to get what they want.”
In Malawi the rerun of a botched February election has been pushed from May to July, and President Peter Mutharika has strengthened his position by quietly dissolving his cabinet. Civil society organisations have expressed alarm, saying the country “is on the edge of civil strife”.
In Ethiopia, the postponement of elections planned for August could frustrate Prime Minister Abiy Ahmed’s reforms. And in Zimbabwe and Lesotho, the possible deployment of the military to enforce a Covid-19-related shutdown could escalate tensions.
There’s an upside, says Grey Johnson. “Political elites, when they get ill, will experience the same things the people of their countries experience when the health system is broken.”
That, at least, may drive some future reforms.