MATTHEW FEARGRIEVE explains why the World Health Organization says Africa should prepare for the worst. And why the continent is not prepared for what is coming.
AS AT 15 APRIL 2020 there are around 16,000 known cases of COVID19 in Africa, and 880 reported deaths (source: African Arguments). There is currently no model for projecting the extent of COVID19 mortality across the African continent: the continent is too vast, the African nations are too different, and so much is still unknown about the virus. Tragically, when you read this article, these numbers will be much higher.
So it is perhaps unsurprising that the director-general of the World Health Organization (WHO) should have erred on the side of caution, by advising the continent to “prepare for the worst”. Though the pandemic is in its early days on the continent, however, health experts have warned that even facilities in Africa’s richest nations could be overwhelmed by the spread of the virus.
Tedros Adhanom Ghebreyesus, the Ethiopian director-general of the WHO has said that the number of cases in the continent was likely higher and urged African countries to “wake up” to the increasing threat.
He uttered this warning as Nigeria, Africa’s most populated nation, barred entry to arrivals from 13 badly-hit countries. Other African countries have taken similar measures, and have enforced mandatory quarantine of passengers from affected regions. Others have closed their borders, but most countries in Africa remain, to varying degrees, open to the rest of the world.
Senegal, Rwanda, South Africa, Kenya, Ethiopia, Zambia and Tanzania have closed educational facilities, whilst Botswana, Ghana, Ethiopia and other countries have banned sporting events like football matches. Other nations such as the Democratic Republic of the Congo, Rwanda and Ghana have banned gatherings at places of worship.
The Kenyan government has urged employers to allow their staff to work at home, similar to what European governments have done. This, however, is unlikely to be replicated in poorer African countries, with unskilled workforces and frequent power cuts.
China and European countries have learned – the hard way – that the only known mitigatory measure that can be taken against the virus is to maintain separation between people. The virus is propagated by coughs and sneezes, and so many countries worldwide, including the United Kingdom and the US, are practising what has become known as “social distancing”, which is basically keeping your distance from other people. Those showing coronavirus symptoms or who have tested positive for the disease are required to self-isolate in their homes, if their symptoms are sufficiently mild not to require hospital treatment.
But how does a person maintain social distance from others in a slum, where he or she may share a toilet and a room with tens of other people? This is one of the big challenges that faces the African continent. Social-distancing is simply not possible for the majority of its population.
Although people are relatively dispersed in rural areas, communicating information about social distancing in order to change behaviour there will be challenging, if not practically impossible. And unlike the developed world, where ordering food deliveries to one’s home is easily achieved with an internet connection, the vast majority of people in Africa have to walk into a shop to buy food.
So the virus is likely, if it follows the same trajectory seen in China, Europe and the US- to spread quickly and easily in Africa. That brings us to the next problem.
Health-care systems on the continent remain weak and will not be able to handle a widespread outbreak. In addition, many people there have serious health issues—such as HIV, tuberculosis, or acute malnutrition—that make them vulnerable to other illnesses.
Many healthcare systems in the developed world – including those in the United Kingdom and the US- are overwhelmed with severe cases of COVID19. But African countries are even more vulnerable because they have significantly fewer hospital beds. For example, the most recent data available indicates that Ethiopia and Niger each have 0.3 beds per 1,000 people, and Tunisia has 2.3, compared to an average of 5.6 in Europe.
Africa has limited tertiary-care capacity, including critical care units, and limited medical supplies in many places. There are not nearly enough ventilators, or oxygen-giving equipment, which is absolutely crucial for the treatment of COVID19 patients. This lack of infrastructure is causing problems in Europe and the US. Its impact on Africa is not difficult to imagine.
HIV in Africa
Millions of adults and children in Africa have severely compromised immune systems, mostly because of HIV infection and related tuberculosis. Data on the fatality rate for immuno-compromised COVID19 patients is very limited, but early indications suggest that the death rate for individuals with chronic medical conditions is significantly higher than the overall case mortality rate.
There is widespread malnutrition in Africa the continent, particularly in infants. Given that the increased risk of mortality from diseases like pneumonia is up to 36 times higher for malnourished children, COVID19 puts this population at significant risk.
Data from countries that are further along in the pandemic, including China and Italy, consistently indicates a much higher fatality rate among older people (roughly, the over-60s). This could mean that Africa’s relatively young population could mitigate mortality rates. Over 80% percent of COVID19 deaths in China were in the over-60 group, which accounts for 16% of the population. In Africa, on the other hand, the same group represents 5% of the continent’s population.
This factor could therefore represent a glimmer of hope that the trajectory of the virus in Africa will not be as ravaging as some experts are predicting. But it is very much a case of wait-and-see. So what can African countries be doing to prepare, as best they can, for the coming onslaught of coronavirus?
Many, but not all, governments in Africa are moving quickly to implement a national response to the pandemic.
Governments in Africa, unlike those in the developed world, have a better understanding of pandemics, particularly after the 2014 Ebola outbreak, and have already implemented confinement measures, closure of borders and widespread handwashing stations.
Three critical steps to preparedness can be tabled as follows:
- African governments must work together, as well as implement national strategies. Regional unions and the African Union can be powerful drivers of that cooperation.
- Global groups working to support the pandemic response in Africa—including UN agencies, governments, donors, NGOs, and companies—must be yoked to the struggle by the governments of the richer African nations.
- Other stakeholders must bring community leaders into the process from the start to build trust and to ensure that people and communities understand and adopt potentially challenging constraints.
So what are the continent’s prospects as coronavirus continues to spread and COVID19 cases rise?
If the virus does not, as is hoped, find it harder to spread in Africa’s relatively young population, then social-distancing, which is practically impossible in vast swathes of Africa, will not mitigate its spread. The only bulwark against the disease that will be available to African countries, rich or poor, will be their healthcare systems.
If those systems become overwhelmed, the consequences will be broadly as follows. First, deaths among patients with other illnesses could spike. Secondly, public distrust of hospitals and general unease could increase, leading patients who need treatment to avoid seeking care, a social phenomenon seen during the 2014 Ebola crisis. Thirdly, the capacity of healthcare systems could erode further if large numbers of healthcare workers fall ill with the virus. This is something now beginning to manifest itself in Europe, in particular Italy, Spain and the United Kingdom, where protective clothing has not been readily available to medical staff in hospitals.
A central lesson of the 2014 Ebola outbreak is that people MUST be educated, enabled and – if necessary – forced to take the mitigating steps that the government recommends, such as regular hand washing and avoiding unnecessary social contact. Governments in Africa must work hard to ensure that their people do not lose trust in community and health organizations that are there to help and support them.
Now the Developed World Must Look Africa In the Face
For a very long time, widespread, unstoppable disease and pandemics were something unknown in the so-called developed world. The previous pandemic to which much comparison is being made in social commentary in Europe and North America is the “Spanish ‘flu”, that infected around 500 million people (or one-third of the world’s population) in the early part of the twentieth century. Not since that time has a pandemic had such an impact on the whole world as the coronavirus.
Now the developed world may at last truly empathise with the plight of African countries throughout time, as the world – hopefully – now comes together in the face of a disease that is no respecter of sex, race, religion or other accidents of birth.