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Is Africa, with its low rates so far, ready to face the coronavirus pandemic?

A man wears a face mask for protection outside a hospital in Yaoundé, Cameroon on March 6, 2020
A man wears a face mask for protection outside a hospital in Yaoundé, Cameroon on March 6, 2020 © AFP

As the global coronavirus outbreak continues to evolve, Africa, so far, has been spared the infection rates seen in countries such as China, Italy, Iran and France. Are these remarkably low rates a matter of alarm, relief, socio-economic factors, fluke, none – or all – of the above? FRANCE 24 spoke to Mathias Altmann, an epidemiologist at the Bordeaux School of Public Health and one of the co-authors of a study of African preparedness and vulnerability to COVID-19 importations.

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Months after the coronavirus outbreak, which appeared in China in late December, had spread to parts of Asia, Europe, the Middle East and the US, Africa did not record a single case of the infection. The continent’s first confirmed case was only recorded on February 14 2020 in Egypt.

The pandemic has since spread, with South Africa reporting the continent’s first case of local transmission on Wednesday, March 12. All previous cases had been patients who had travelled abroad, the South African health ministry revealed. The development raised concerns of sub-Saharan African health systems being overwhelmed if local transmissions accelerate.

The rates on the African continent though have been notably lower than in other areas. As of Thursday, the number of cases across the globe had risen to 126,000 with 4,600 deaths worldwide, according to Johns Hopkins University. In Africa, the number of cases was still in the dozens. Ivory Coast confirmed its first case on Wednesday while Egypt registered seven new cases, bringing the total to 67. South Africa has reported 13 cases so far. Other African countries that have confirmed cases include Algeria, Nigeria, Senegal, Burkina Faso and the Democratic Republic of Congo.

East Africa has not reported any COVID-19 cases so far, but countries have already implemented strategic plans to deal with the outbreak including strengthening health security checks at borders. The governments of Kenya and Rwanda have suspended international gatherings and events until further notice as a precautionary measure. Systematic quarantines have also been imposed on travelers from high-risk countries by several states, including Burundi and Uganda, while many African airlines such as RwandAir and Kenya Airways, have suspended flights to a number of high-risk countries such as China and Italy.

Although the World Health Organisation (WHO) warned on February 22 that African health systems were ill-equipped to deal with the epidemic if the contamination accelerates, a study published in the Lancet medical journal on February 27 noted that the African countries most likely to import new cases – Algeria, Egypt and South Africa – also had the best prepared health systems in the continent.

FRANCE 24 interviewed Mathias Altmann, an epidemiologist at the Bordeaux School of Public Health and one of the co-authors of the study.

How do you explain the relatively low number of recorded COVID-19 cases in Africa?

Mathias Altmann: There are several hypotheses, and only hypotheses can explain this situation. One of them is Africa’s low-travel exposure to China compared to Europe, which is around one Africa-China travel exchange to every 10 Europe-China travel exposures. This could explain the slow introduction of the virus on the continent when the epicentre of the epidemic was in China.

Since then, the situation has changed as the coronavirus has spread globally, with a pandemic that exposes Africa to importations of the virus from Europe. The first confirmed and recorded cases on the continent were imported from Europe, mainly from Italy and France.

Another hypothesis, which remains to be validated, concerns the presumed existence of many undetected cases, which are the subject of many rumours. Except that if this was the case, there would have been numerous alerts in hospitals in African capitals and local intensive care units, which would have recorded a massive influx of patients. This, as far as I know, did not happen. We saw this during the Ebola crisis in Sierra Leone and Liberia, which are not the best-equipped countries on the continent in terms of infrastructure and human resources. Therefore, the idea that there would be unknown chains of transmission seems unlikely to me.

The WHO has recently expressed concern about Africa in the event of massive contamination since the health systems, particularly in countries with pervasive poverty, are weak. Is Africa ready to face the pandemic?

MA: We must remain cautious and wait to see if the number of cases will explode, as is currently the case in Italy and some European countries. No one can predict this. We know that severe cases mainly affect the elderly, but Africa has a younger population than Europe, so that is rather reassuring for the continent, and it’s possible that there will be fewer severe cases.

From a general point of view, the overall mortality rate remains quite high in Africa, especially in terms of infant and maternal mortality as well as endemic diseases such as malaria or measles. Should we be concerned? There is no need to panic since there are few sick people at the moment, although the risk of propagation does exist and it is almost certain that other cases will appear due to the highly contagious nature of COVID-19. We will have to be concerned if the epidemic affects a large number of people with many severe cases. It should be remembered, however, that only 15 percent of the confirmed cases worldwide are severe. It should also be noted that not all health services are currently ready, from a global point of view I mean, because it is difficult to talk about all African countries at once.

The requirements are quite diverse, but overall there are fairly big material needs in most African countries.  There are still, for example, many shortfalls in terms of infrastructure, isolation rooms, treatment protocols, breathing apparatus and medicine stocks. There is also a lack of capacity in a number of countries to make diagnoses linked as closely as possible to health management services, which can cause delays and block beds.

Despite this situation, do you think many African countries appear to have taken prompt action in response to the crisis?

MA: Yes, and it should be remembered that there is already a level of preparedness on this continent, which has had its share of epidemics, and where countries have a huge amount of knowledge on the ground, particularly in West Africa. They have taken risk measures since the influenza pandemic preparedness plans, but especially since the Ebola crisis, and have adopted coordination systems that are valid for any health emergency. The ability to detect the first cases is essential, indeed key, and it’s known to be difficult because most patients are asymptomatic or have very mild symptoms.

Since the risk of importation into Africa is currently lower than elsewhere because several countries have taken the right measures at the right time – such as reducing flights from abroad to limit the risk of importing COVID-19 – if they are able to detect the first cases and isolate them each time, there will be less risk of secondary transmission. The idea is to continue to work on a day-to-day basis to strengthen all elements of the response, from surveillance coordination to early warnings, diagnosis and public health management.

This article has been adapted from the original, which appeared in French

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