Taye Balcha, MD, PhD, MPH, is a former MP in the Federal Democratic Republic of Ethiopia (2010-2015) and former (2016-2018) Director General of Armauer Hansen Research Institute, a biomedical research facility for infectious disease located in Ethiopia’s capital, Addis Ababa.

With the number of cases and deaths soaring, the world is facing a health and economic crisis of draconian proportion. The global death toll due to COVID-19 and its complications are upwards of a quarter of a million people. With no end of the pandemic in sight, both the numbers of confirmed cases and fatalities are growing.

The number of cases reported from African countries is very low. A little less than 50,000 confirmed cases have been reported from 43 nations in Africa. The death toll in the continent stands at 1,843. These numbers may look acceptable at first glance, but it is still too early to assess the full impact on the continent.

WHY ARE THE CONFIRMED CASES AND FATALITIES LOW IN AFRICA?

In April 2020, several experts and institutions projected that the virus Africa could reduce the continent to fields of cadavers. Fortunately, these grim projections have not become a reality. To date, only a fraction of the COVID-19 numbers predicted by several renowned academic institutes has been detected in Africa. As the pandemic has continued unabated in the rest of the world, it is too early to declare that Africa is already out of the woods. Only the actions of the African nations and potential support from high-income countries can determine the full scale of this pandemic and its broader impact on the region.

Several factors could have helped the region to avoid early crisis following the outbreak. First, Africa is not highly interconnected with the rest of the world, and this resulted in a crucial delay in the pandemic reaching it. Travel abroad in general is often a luxury for an overwhelming majority of Africa’s 1.3 billon people. Also, fewer travelers visit Africa compared with millions of travelers visiting other emerging or generally developed continents for economic and related reasons. In this particular pandemic, the virus established a strong foothold in Asia, Europe, and the United States before sporadic imported cases were first reported in African nations.

Second, also related to the first factor, the time function of the pandemic epidemiology has substantially favored Africa. Taking quick stock of the accumulating cases and deaths abroad, African leaders agitatedly learned important lessons. They were convinced that the pandemic could be one of the worst scourges to hit Africa if their response was anything less than extraordinary. In a rare demonstration of leadership of in the moment, African leaders passed and implemented aggressive and sweeping public health measures to at prevent community transmission. Uganda led the way in declaring a complete lockdown even before a single confirmed COVID-19 case was reported in the country. Nearly all countries in Africa took unprecedented and extreme physical distancing and other related measures in the early phase of the pandemic, including closing borders and enacting mandatory quarantine of travelers, banning gatherings at places of worship, and closing schools and universities. Although the virus is far from being contained, it is fair to highlight that the measures have substantially suppressed its transmission, especially in local communities.

Third, disease outbreaks, epidemics, and pandemics are not a new phenomenon to several nations in Africa. Malaria, measles, yellow fever, and other infectious diseases have seen perennial outbreaks in many African countries. This has long forced these nations to invest in primary care and community empowerment. Ethiopia should be cited as a champion in investing in primary care and empowering communities for better health. For years, the country’s health-extension program has been a de facto gatekeeper for health emergencies across the country. Health-extension workers have been embedded in communities, where they play critical roles in providing a package of essential health services, conducting active surveillance of outbreaks at the household level and daily reporting of any unusual incidents. Currently, Ethiopia has slightly pivoted the responsibilities of health extension workers to focus sharply on COVID-19 risk communications, contact tracing, and active-case surveillance.

Fourth, Africa has the world’s youngest population, with a mean age of about 20 years. While this might have generally reduced COVID-19 related vulnerability, low case fatality rates reported in African nations have no better explanation. Relatedly, inexistent or scarcity of nursing homes, which currently drives virus transmission in several settings have imperative impact on the low case and death numbers in Africa.

Anecdotally, some experts attribute few COVID-19 cases in Africa to highly prevalent Bacillus Calmette-Guérin (BCG) vaccination rates. This has not been substantiated by a standard-quality evidence but merits further investigation. Further, geographic factors including altitudes, weather, and humidity have been implied to have protective effects. More empirical data and real-world evidence are warranted to make scientific conclusions on the impact of these factors. It should also be noted that African countries are heading into flu season and novel coronavirus (SARS-CoV-2) could share similar characteristics with several strains, and the numbers could rapidly increase. Further, largely limited testing capacity in Africa could mislead policymakers regarding the true number of COVID-19 cases. However, there is no evidence that significant numbers of cases are missed and silently dying in the communities.

WHAT LIES AHEAD

The suppression of the transmission of the virus could continue for the foreseeable future, and this could put Africa on a compelling path to contain the pandemic. This is only contingent on continued current public health measures, especially those which have no or minimal adverse impact on the economy and livelihoods of the nations. Also, the intensity of the interventions and the number of cases in the rest of the world will have a direct impact on how the pandemic unfolds in Africa as borders cannot remain closed indefinitely. The timeline for the success of a vaccine or drug discovery as well as equitable access to a new standard of care or prevention could also have tremendous impact on the fate of African countries.

The second scenario is based on the fact that African countries currently report few cases and deaths, which could set them up for failure and potential human catastrophe. Nations could get complacent and lift all or a subset of effective physical distancing measures. The lack of healthcare workers, shortage of supplies, including personal protective equipment and mechanical ventilators, and the inelasticity of the health system could all predispose African nations to one of the worst disasters in recent memory. This may occur in this round of the pandemic or during potential subsequent global waves. If this is allowed, the continent could be doomed to a downward spiral in regards to loss of lives, livelihoods, and national economies. Recovery could also take decades if not centuries. This path can only be avoided with the sustained commitment of African leaders, intensified discovery efforts, and a renewed sense of solidarity by high-income countries.

African countries should continue to implement a distinct set of tough measures by striking the right balance between saving lives and safeguarding livelihoods. Cautious, staggered opening up is important by starting with relaxation of public health measures with lesser impact on virus transmission but greater adverse economic consequences. All arriving travelers should be quarantined and tested for the virus before they mix with local communities. The current mandatory quarantine practiced in several countries should include all airports, sea ports, and land borders.

Widespread testing is the first line of prevention of virus transmission. Nations should scale testing, targeting viral antigens or antibodies based on community contexts. Enhanced contact tracing, active case finding, and isolation of cases are very critical measures to slow or stop transmission. Training and deploying community health workers like the health-extension workers of Ethiopia could institutionalize prevention efforts and help nations successfully intercept any possible local community transmission. As far as the virus is not contained globally, governments and stakeholders should continue to maintain a standardized awareness of the community.

While bolstering preventive efforts is essential, it is important to concurrently prepare healthcare workers for possible worst-case scenarios through training and improving their living and working conditions. Sufficient stocks of personal protective equipment should be made available. Access to treatment facilities, including intensive care units, oxygen therapy, and mechanical ventilators should be expanded substantially. Most importantly, governments should invest in building resilient health systems so that they can better crises like the COVID-19 pandemic and other potential emergencies, as well as regular health services. Africa could register a rare success against the COVID-19 pandemic by maintaining and accelerating its current non-pharmaceutical measures. On the contrary, be lulled into complacency by the few case numbers being reported amounts to begging for a human catastrophe in the region.

 

Read more: https://www.diplomaticourier.com/posts/africas-response-to-covid-19