How, and Where, Covid-19 Is Spreading in Africa

Lessons from Ebola are being applied continent-wide, and could work inU.S., says WHO doctor

By Noah Smith

Africa currently has the second-fewest number of confirmed Covid-19cases in the world, except for the World Health Organization’s Western Pacific region, according to the most recent WHO figures. In total WHO Africa member states have 623,851 confirmed cases,including 12,666 in the past 24 hours. More than half of these cases are in South Africa. Across the continent, at least 10,116 have died from Covid-19.

However, African nations also have some of the lowest rates of testingin the world, with Nigeria offering one test daily per 100,000 people (18.44%positive), Ghana at 10 tests daily per 100,000 (10% positive) and South Africaat 26 tests daily per 100,000 (7.25% positive). For comparison, the U.S. offers168 tests daily per 100,000, with 6.51% coming up positive, according to datasourced by Johns Hopkins University.

Assessing the full scope of the situation among its member states, Dr.Miriam Nanyunja, regional advisor for emergency risk management for WHO Africa,said the pandemic has not spread to all countries within Africa in the sameway. In Mauritius, six recent were all imported in Seychelles, localtransmission ended in April.

She pointed out that 88% of confirmed cases are in 10 countries, led bySouth Africa, and also including Nigeria, Ghana, Algeria, Cameroon, Côte d’Ivoire, Kenya, Ethiopia, Senegal, and the Democratic Republic of theCongo. Egypt, which has over 89,000 cases, is not part of WHO’s Africa region. Sixty percent of cases are in people under 60 yearsold, and the average age of people with confirmed cases of Covid-19 is 38 yearsold, according to WHO figures.

Community transmission is present in about 70% of WHO Africa countries,but the Nairobi-based Nanyunja said it’s not nationwide in anysituation, even as overall rates of increase are problematic.

“It took Africa 100 days to reach 100,000 cases, but then only 18 days todouble to 200,000. It took 20 days from there to 400,000 and now we are at over620,000. We see the increase and we are not happy about it,” she said. Addressing the testing issue, she said capacity is increasingwithout a correlated increase in cases.

“What we see is that, even with increasing testing, the cases do not riseso significantly,” she said. “What we are seeing is more of a good proxy of what is on the ground.”

Direct Relief’s Research and Analysis team has been tracking vulnerability in the region based on case counts per capita, number of hospital beds,HIV case counts, food insecurity, population over 60 years old, and otherfactors. This month, Mali, Mauritania, Benin, Chad, and Tunisia have reducedtheir vulnerability while Lesotho, Namibia, Congo, Swaziland, Zambia,Madagascar, and South Africa’s vulnerabilities have increased.

Nanyunja said many member states, especially in West and Central Africa,have been able to incorporate principles from the 2014 Ebola outbreak, even asCovid-19 presents unique challenges.

“Ebola outbreaks have taught us one big lesson about the importance ofcommunication in effective response: Build trust in the local community. Wehave to include cultural sensitivity in the response. We have to communicatewhy we are proposing a change in their social norms, otherwise, they will notlisten much.”

During the Ebola outbreak, WHO used anthropologists and social workersin order to tailor their advice to local communities. Survivors of the diseasealso provided to be effective mobilizers for response initiatives, she said.

“Social distancing and masks have not been a social norm, so we have toengage communities to adjust. In general, we are seeing countries that facedEbola putting into good consideration all these factors.”

Amongst member states, unlike in the U.S., there has not been widespreadresistance to the advice of public health officials, but, “We are seeing increasingly a level of fatigue and complacency resultingin apathy in the implementation of the interventions,” Nanyunja said.

“Initially, the countries took on prevention measures and there wasgoodwill in the population and they tried their best in social distancing,staying home, and with restrictions on travel. In some circles, there wasinadequacy in completing this, more to do with socioeconomic reasons: stayingat home was affecting livelihoods. And segments of the population would notcomply due to these challenges,” she said.

She said another challenge has been the inconsistent use of masks inseveral countries, due to misconceptions, including that masks hinderbreathing.

Looking at the U.S., Nanyunja said she was “surprised” by the response.

“We all believed the public health system in the U.S. could mount aresponse that could control the pandemic, like in China, or even faster, butthings have turned out different.”

She thinks applying some of the Ebola lessons will help matters in theU.S. as well.

“What would be good is for the U.S. is to adopt strategies to the localcontext. The principles remain, but it is adapted to the context to thedifferent states in the U.S. and then also using local data to guide theimplementation — see which areas are most affected and implement the strategies in thoseareas.”