Since writing my first piece on Africa on 20 April 2020 (click here to read), there have now been 386,947 confirmed COVID-19 cases in Africa and a documented 9,736 deaths. (1)
Both figures are likely to be enormous under-estimates with concerns being voiced by the healthcare staff of many countries as well as outside agencies, including the United Nations African Union Mission and the WHO (World Health Organisation) that the virus is spreading rapidly and invisibly across the continent.
Doctor Matshidiso Moeti, the WHO’s regional director for Africa, said, “It took 98 days to reach the first 100,000 cases, and only 18 days to move to 200,000 cases..... Even though these cases in Africa account for less than 3% of the global total, it’s clear that the pandemic is accelerating.” (2)
There have been varied responses to the pandemic across the different countries of Africa. In some countries there is no official recognition or even acknowledgement that there is a pandemic, whilst in others they are facing the triple threats of COVID-19, other diseases and terror attacks by extremist groups eager to take advantage of the vacuum created as armies are redeployed to tackle the outbreak.
This piece looks at DRC (Democratic Republic of Congo) and South Africa. There is a piece here on Tanzania and Nigeria.
DRC (Democratic Republic of Congo)
As of 24 June 2020, DRC has recorded 6,213 cases and 142 deaths from COVID-19. The number of new cases per day is rising with between 150 and 200 being reported each day, higher than when lockdown was imposed. (3)
The first four cases were reported on 10 March 2020, three in people returning from France and one in a man who had travelled from the USA via France. (4)
The first death occurred on 21 March 2020. (5)
The COVID-19 pandemic has come as the country reported a new Ebola virus disease outbreak in the Équateur province on 1 June 2020. Six cases, with four deaths, were confirmed in Mbandaka, the provincial capital city of more than 1 million people. DRC has been dealing with a two year long Ebola outbreak, its 10th, in the north-east of the country which was close to being declared over in April 2020 only for new cases to emerge. This new development is DRC’s 11th Ebola outbreak and the WHO have announced it is not connected to previous ones nor has it been imported from the north-east of the country.
(6) (7)
On 22 June 2020, the country announced that there had now been 21 cases and 13 deaths from Ebola in Équateur province. (8)
Meanwhile DRC has been severely affected by a measles outbreak that has raged since January 2019 killing 6,600 people, mainly children. The measles outbreak encompasses DRC, Central African Republic and Chad and is the deadliest on record. (9)
All of this leaves DRC facing a triple threat from three different illnesses - Ebola, measles and COVID-19. The response to the Ebola outbreak has been impeded at times because of a deep mistrust amongst the populace of both the government and foreign aid organizations. Healthcare workers have been attacked and killed and Ebola treatment centres burnt to the ground. (10)
However, the Ebola outbreak also brought into sharp focus the need for robust measures to tackle disease outbreaks. A lot of work has been done at community level during both the Ebola and measles outbreaks to engage and involve the community in responding to the diseases, work which has laid a foundation for tackling COVID-19. (11)
President Denis Sassou Nguesso declared a countrywide lockdown in response to COVID-19 on 26 March 2020 although it was delayed until 31 March as people panicked to buy food and provisions. The borders were closed and a night-time curfew imposed. Lockdown was eased from 18 May 2020 but some measures such as restaurant and bar closures are still in place. (12) (13)
The lack of COVID-19 testing capacity means that the true numbers of cases and deaths are likely to be much higher as David Walubila Mwinyi, MSF's Medical Data Supervisor in South Kivu, Democratic Republic of Congo (DRC) explained “When the first confirmed case of COVID-19 was reported here in DRC in early March, I wondered straight away how people learned about it, and whether it really was the first case. Had other cases had gone unannounced?” (14)
DRC has only one laboratory that can test for COVID-19 in the capital Kinshasa and it can carry out around 100 tests a day. The population of DRC is 80 million and the country is ten times the size of the UK. It is not known how many tests have been performed to date but one can surmise it is a fraction of the population.
The closure of borders during lockdown prevented test kits, vital medical supplies and humanitarian staff from entering the country also hindering the response.
In Kinshasa MSF have helped build a 40-bed isolation tent and mobile teams are supporting community initiatives with infection control measures such as handwashing and wearing masks. MSF have started producing re-usable masks in both Kinshasa and the city of Goma in the east of DRC. They have also set up isolation tents in North & South Kivu and Ituri provinces. (15)
Ongoing security issues in DRC are threatening the humanitarian response against all the disease outbreaks. The Allied Democratic Forces (ADF), who claim allegiance to IS, killed at least 57 people over two days at the end of May 2020 when they attacked villages in the north-east of the country. Rich in resources such as diamonds, gold and coltan, the north-east of DRC is the site of continuing violence as different groups fight for control of the region. (16)
As virtually every country worldwide is affected by the COVID-19 pandemic, few have to also contend with two other disease outbreaks and ongoing extremist attacks but that is the reality for DRC. With concerns that the measles vaccination programme is stalling, a new Ebola outbreak to contend with and ongoing violent attacks on locals and humanitarian workers, the DRC needs global support more than ever to help it cope as COVID-19 also hits the country.
South Africa
To date South Africa has reported 106,108 cases and 2,102 deaths from COVID-19. It is the worst hit country in the continent although this may be a reflection of a lack of testing capacity in other countries which keeps their figures artificially low.
It reported its first case on 5 March 2020 in a man who had returned from Italy. A National State of Disaster was declared on 15 March 2020 which was followed by a nationwide strict lockdown on 26 March 2020. Initially it appeared that the outbreak was being contained but since lockdown restrictions began to be eased on 1 May 2020, followed by a further easing on 1 June 2020, the number of new cases reported each day has risen rapidly. (17)
Some South African politicians, including the chair of the health minister’s advisory committee, have claimed that the disease models decisions have been based on were flawed. There has been only sketchy information released on the disease modelling used although at the end of May the health minister announced a peak of 8 million infections was expected in the middle of August 2020 and in the region of 40,000 deaths. (18)
As is the case in some other African countries, notably Nigeria as discussed here, the early cases of COVID-19 in South Africa were imported amongst the wealthier population who have the means to travel and it was initially viewed as a disease of the rich. However the first cases soon transmitted it to their staff who usually live in much poorer communities where measures such as social distancing are not possible.
It was hoped that South Africa would be able to use to its advantage the fact it already has community programmes in place to trace and screen for diseases such as TB and HIV. However, although the infrastructure was in place to reach out into communities the availability of COVID-19 testing has been problematic (as it has been virtually worldwide.)
South Africa's state run laboratories announced in April they hoped to do up to 36,000 COVID-19 tests per day but the reality is that the total number of tests done so far is in the region of 1,400,000 less than one third the amount hoped for. (17)
The turn round time for results can be up to two weeks with an average of 12 days. The Western Cape is rationing testing to those over the age of 55 and is reporting that its intensive care beds are filling up. (19) (20)
Researchers at the University of the Witwatersrand in Johannesburg are hoping to start a trial on a rapid breath test for COVID-19 that delivers results in just five minutes. The test relies on an internet connection to analyse the results which could prove problematic in rural areas. Researchers in the UK, US and Israel are looking at conducting similar trials. (21)
Meanwhile many African countries have come together and set up the Africa Medical Supplies Platform which is an internet initiative that aims to make supplies, including test kits and PPE, available at a low cost across the continent. The platform will be run as a not-for-profit project by the Africa Centres for Disease Control and Prevention in Ethiopia and Afreximbank in Egypt who are already tasked with managing the COVID-19 fund for Africa. (22)
Health workers in South Africa are concerned by the drop they have seen in patients accessing their TB and HIV medications. MSF has started combining TB and HIV checks with COVID-19 screening at some of its locations in South Africa. Until now South Africa's TB and HIV programmes have been stand-alone projects but there is hope that COVID-19 will lead to the integration of the programmes and an increase in resources to run them.
Emily Wong from Africa Health Research Institute (AHRI) explains, "For years, South Africa's public health-care sector has tried to integrate its relatively well-resourced but stand-alone HIV and TB programs with its under-resourced general health services. The coronavirus crisis could be a catalyst for this transformation. We see the COVID response as a chance to accelerate that. (23)
South Africa is also taking part in the trial of the Oxford COVID-19 vaccine. (Click here to read more on the vaccine.) The trial began on 23 June 2020 and is being done in conjunction with the University of the Witwatersrand in Johannesburg. Trials are also beginning in the UK and Brazil. (24)
South Africa will also play a pivotal role in the supply of dexamethasone after the announcement by UK scientists on 16 June 2020 that it cuts the death rate in cases of severe COVID-19. (Click here to read more on dexamethasone.) South African drug company Aspen has announced it could supply 10 million dexamethasone tablets within one month. The government has asked Aspen to source the drug for both the domestic market and the African continent as a whole. (25)
The surge in cases in South Africa is of grave concern and the WHO is warning that COVID-19 is spreading out of the cities and into the rural areas. When South Africa started to come out of lockdown it was averaging around 1,500 new cases per day. It is now 4,500 and still rising but, with no appetite amongst politicians or the public for a second lockdown, it is likely that the worst is yet to come. (26)
(17) https://www.worldometers.info/coronavirus/country/south-africa/
(18) https://theconversation.com/south-africas-use-of-covid-19-modelling-has-been-deeply-flawed-heres-why-140002
(19)https://www.economist.com/middle-east-and-africa/2020/06/20/african-countries-are-struggling-to-keep-track-of-covid-19
(20) https://www.bbc.co.uk/news/world-africa-52801190
(21) https://www.the-scientist.com/news-opinion/in-south-africa-covid-19-breath-test-trial-set-for-june-67631
(22) https://www.theguardian.com/global-development/2020/jun/22/the-power-of-volume-africa-unites-to-lower-cost-of-covid-19-tests-and-ppe
(23) https://www.nationalgeographic.co.uk/science-and-technology/2020/06/why-south-africas-coronavirus-outbreak-could-be-a-catalyst-for
(24) http://www.ox.ac.uk/news/2020-06-23-trial-oxford-covid-19-vaccine-south-africa-begins
(25) https://uk.reuters.com/article/us-health-coronavirus-safrica-aspen/south-africas-aspen-could-supply-10-million-dexamethasone-pills-in-covid-19-crisis-idUKKBN23U20U
(26) https://www.telegraph.co.uk/global-health/science-and-disease/south-africas-draconian-lockdown-relaxed-cases-begin-soar/
