While countries in Europe have reported 74,000 confirmed cases, countries in the World Health Organization’s African Region have reported fewer than than 250 confirmed cases. This could in part be attributable to low levels of testing or mislabeling of viral pneumonia. But given that roughly a third of cases require admission to intensive care units and 29 percent develop acute respiratory distress according to a Lancet study, if covid-19 has indeed been spreading rapidly across the continent, we would expect to hear of clusters of patients with these symptoms appearing in the hospital. So far, this does not appear to be the case.
Europe might have lost the window of opportunity to contain the virus, but African countries still have a chance. For real preparedness to occur, the continent will rapidly need more international support and potentially additional social-distancing measures. The next two weeks will decide the fate of the African continent in terms of covid-19. As Tedros Adhanom Ghebreyesus, director general of the WHO, has said, African countries need to wake up.
There are reasons for concern already. First, though case numbers are still low, confirmed cases in the area have increased rapidly to 233 on Wednesday, with 25 countries affected. In South Africa, cases have doubled within two days to reach 62 confirmed cases. Senegal has reported 27 cases and Burkina Faso 20. In some countries, a shift is occurring from “imported” cases to local transmission, suggesting that the virus might be starting to circulate within communities.
Second, testing is still inadequate. While epidemic surveillance networks built on past Ebola and flu outbreaks exist in the region, WHO only reports a few hundred tests in its African Region so far. Without more tests, we still run the risk of ignoring a larger outbreak taking place in the region that is going undetected. As the experience of South Korea, China the United States and other countries has shown, the more testing that is done, the more cases seem to be found. This testing is crucial to conduct contact tracing and ensure that chains of transmission are broken.
Third, the continent bears the brunt of fighting several infectious diseases, including tuberculosis, AIDS and malaria (93 percent of the global burden of malaria is in the region), while parts notoriously suffer from inadequate water and sanitation. Primary health care is often barebones, and many countries struggle to reach WHO-recommended health spending targets to provide essential health-care packages. Preventable illnesses such as childhood pneumonia and diarrhea are still a challenge to address. This makes it even harder for governments to be able to address the challenge of covid-19 and could make the situation much more dire if an outbreak emerges.
Finally, the region does not have the financial resources to fight yet another pandemic. While the World Bank and International Monetary Fund have pledged tens of billions of dollars to help developing countries in their fight against covid-19, these financial stimuli pale in comparison with the hundreds of billions that China, Europe and the United States are capable of mobilizing for themselves.
There is, however, a glimmer of hope. Africa’s currently low number of cases provides a window for containment. In addition, the newly established African Centres for Disease Control has started extensive preparatory measures for covid-19, and both governments and the public have heightened awareness about the virus and how devastating outbreaks can be.
Some countries are taking the crisis seriously. Senegal, the hardest-hit West African country, has moved particularly quickly to contain this virus. While it has only 27 cases, the country has actively sought to track known cases and, anticipating testing shortages, is working to develop a cheaper diagnostic test that could be available to distribute quickly throughout the region. Several countries, including Senegal, Nigeria and Mali, have restricted travel from affected countries and limited public gatherings and school attendance. Given that many in the region rely on self-employment and unsteady income, it remains to be seen how these instructions are followed, but these are early signs of strong action.
There are still many unknowns about this virus: how it will operate in a warmer climate, the genetic susceptibility of different populations and whether re-infection is possible. In the absence of more detailed information about the virus, we must use the window of opportunity that Africa’s low case number currently provides. Complacency kills in outbreaks — and, after Ebola, African governments know this all too well.