UPDATE 24 June 2020
The total number of confirmed cases across the continent is now 328,995 with 8,683 reported deaths.
There are pieces dedicated to individual countries now available.
Click here for Tanzania and Nigeria.
Click here for DRC and South Africa.
Click here for Malawi.
UPDATE 5 June 2020
The total number of confirmed cases across the continent is now 178,257 with 4,913 reported deaths.
South Africa has the most cases at 43,434 with 908 deaths.
Egypt has 31,115 cases and 1,116 deaths.
Nigeria is in third position with 11,000 cases and 323 reported deaths.
Africa as a whole is not seeing the kind of numbers reported elsewhere in the world but it remains very unclear as to what the testing capacity of most countries is. South Africa and Egypt's higher numbers may simply reflect more testing and reporting.
Tanzania still has not submitted any data since 29 April 2020 and it seems unlikely any more will be forthcoming. (1)
UPDATE 25 May 2020
The total number of confirmed cases across the continent is now 115,000 with 3,376 reported deaths. (1)
Tanzania remains a particular concern after the president declared the pandemic over citing a miraculous healing from God. Tanzania has not released any data since 29th April.
The head of the Africa Centers for Disease Control and Prevention, John Nkengasong, has called for transparency from Tanzania saying, “We strongly call on Tanzania, encourage Tanzania, to share data in a timely fashion.” (2) (3)
The number of cases and deaths has remained very low across the continent compared to anywhere else in the world. Whilst this may primarily reflect a lack of testing capability and diagnosis, something acknowledged by the WHO (World Health Organisation), there has been very cautious optimism within the WHO that the younger population demographic of Africa, 60% of the population are under the age of 25, may be having a protective effect in an illness that disproportionately affects the elderly. (4) (5)
(5) https://apps.who.int/iris/bitstream/handle/10665/332150/SITREP_COVID-19_WHOAFRO_20200520-eng.pdf
UPDATE 18 May 2020
With Comoros and Lesotho both now reporting cases of COVID-19 every African nation has now been affected by the pandemic.
The total number of confirmed cases across the continent is now 87,000 and total number of deaths 2,800.
There continues to be a paucity of data for many countries and in particular for the following:
Cameroon, Sudan, DRC, Somalia, Burkina Faso, Tanzania, Chad, Sierra Leone, Congo, Liberia and Eritrea. (1)
Of particular note again is Tanzania where the government has announced it has suspended reporting of COVID-19 figures citing "improvement work" taking place at the National health Laboratory as a reason. No figures have been reported for the last three weeks. (2)
UPDATE 9 May 2020
The total number of cases across the continent is now 60,000.
In the north Egypt, Algeria and Morocco have the highest number of cases, between 6000 and 8000, and in the south South Africa has the highest number of cases at 9000.
Widespread lack of testing remains a key problem across the continent.
UPDATE 1 May 2020
Yesterday, 30 April 2020, the WHO announced it was concerned by the rapid community spread of COVID-19 in west Africa as daily case numbers in Ghana, Nigeria, Cameroon, Guinea and Ivory Coast rise exponentially (see here for an explanation of exponential growth.) (1)
Meanwhile in Tanzania, on the eastern side of the continent, President John Magufuli has ruled out any lockdown measures instead saying that the pandemic is in God’s hands and encouraging people to attend crowded places of worship.
The Tanzanian government is also advising people to inhale steam and eat more fruit and vegetables claiming these measures will help fight the pandemic. (2)
Tanzania claims to have 480 cases with only 16 deaths but this is extremely unlikely. Anecdotal evidence suggests that mass graves have been built outside the capital, Dar es Salaam, with funerals taking place at night. It is virtually impossible to find definitive proof because of extensive censoring of the media. Newspapers and TV stations are fined and/or closed down if they are seen to be criticising the government in any way. (1)
Two East Africa Presidential Summits on COVID-19 have been cancelled, possibly because of distrust of Tanzania. The East African Community (an intergovernmental organisation composed of Burundi, Kenya, Rwanda, South Sudan, Tanzania, and Uganda) has also failed to meet. (3) (4)
The WHO has been providing testing kits, and training health workers on how to use them, and 44 countries in the WHO Africa Region can now test for COVID-19 compared with just two at the start of the outbreak. (see here for a map of the WHO Africa region, it does not include Egypt, Libya, Tunisia, Morocco, Somalia or Sudan.)
The WHO regards the absence of COVID-19 cases in Comoros and Lesotho as a reflection of lack of testing not disease. (5)
Africa is vulnerable. Aside from concerns about COVID-19, in 2019 alone there were over 200 million cases of malaria in Africa and more than 250,000 deaths.
One in four children in Africa is either not immunised at all or has not received full vaccination against diseases such as measles.
If the fragile healthcare infrastructure of these countries collapses under the weight of the pandemic, the death rate from preventable disease has the potential to soar beyond any of the numbers seen from the pandemic.
(1) SOURCE: BBC MONITORING 1 MAY 20
(2) https://africanarguments.org/2020/04/27/president-magufuli-covid-19-we-need-leadership-not-prayers/
(5) https://apps.who.int/iris/bitstream/handle/10665/331935/SITREP_COVID-19_WHOAFRO_20200429-eng.pdf
Original Piece 20 April 2020
The World Health Organization has warned that Africa could be the next epicentre of a coronavirus outbreak.
Speaking on 17 April 2020 Dr Matshidiso Moeti, the WHO Africa director, said that both cases and deaths had risen sharply in the last week and that whilst the virus began in the larger cities it is now spreading.
“The WHO has witnessed the virus spreading from big cities to "the hinterland" in South Africa, Nigeria, Ivory Coast, Cameroon and Ghana” Dr Moeti said. (1)
According to data from the Johns Hopkins University and the Africa Centre for Disease Control on COVID-19 in Africa, 52 out of Africa’s 54 countries now have cases with Comoros and Lesotho the only two still reporting as virus-free. (2)
As of 1 May 2020, there have been 40,000 cases and nearly 1640 deaths across the continent.
North Africa is the worst affected region with Algeria, Egypt and Morocco each having between 4500 and 5500 cases and 200 and 450 deaths.
South Africa has also had more than 5647 cases but a lower number of deaths at 103. (3)
Although those figures are currently lower than Europe and the USA, officials fear that the pandemic will sweep through the continent. Provisional figures from the WHO are predicting up to 10 million cases and 300,000 deaths although it should be emphasised that these numbers are based on data modelling using what we know about the outbreak so far in Europe. The poor availability of testing in Africa also means that their apparent low figures should be treated with extreme caution. (4)
The continents of Europe and Africa are vastly different in terms of population demographics, provision of healthcare, background population health, political stability and occurrence of natural disasters. All of these will influence the pandemic in Africa and show that the European data cannot be easily extrapolated to Africa.
Population Demographics.
Within Africa’s cities, nearly two thirds of the population live in overcrowded conditions and slums. These provide ideal conditions in which the virus thrives.
A third of the continent’s entire population do not have access to clean water supplies or adequate sanitation.
Average life expectancy is lower, and the infant mortality rate higher, in Africa compared with Europe.
Of the world's 25 poorest countries, 22 are in Africa. (5)
Provision of Healthcare.
As highlighted in my previous post "COVID-19 and the Low Income Countries" the African continent as a whole lacks critical care beds and ventilators.
The WHO estimates that there are five intensive care beds per one million people in most African countries. In Europe the average is 4000 beds per million people. Somalia has just four intensive care beds in the capital's only hospital and no ventilators.
Dr Moeti said this was the reason the WHO needs to focusing on prevention saying "We want to minimise the proportion of people who get to the point of needing critical care in an ICU, because we know that these types of facilities are not adequate by any means in the majority of African countries." (1)
Africa has suffered the most in the global competition for badly needed medical equipment but its 54 countries have teamed up to bulk buy items at less prohibitive costs. An initial shipment which includes more than 400 ventilators has arrived. However staff need to be trained how to use them which is another hurdle to face and not easily addressed.
Background Population Health
Unlike Europe diseases such as malaria, HIV, tuberculosis and polio are prevalent in Africa. There is an ongoing major measles outbreak in many countries with the Democratic Republic of Congo (DRC), Angola, Cameroon, Chad, Nigeria, South Sudan and Sudan particularly affected. Ebola virus disease continues to be problematic in the DRC as new cases have emerged after six weeks without any. (6)(7)
The prevalence of these diseases causes a two-fold problem. They put the already fragile heath care structures under repeated strain and increase the vulnerability of those already infected with one disease to a new pathogen such as coronavirus.
The one exception is South Africa which already has an extensive programme for monitoring both HIV infection and tuberculosis in both cities and remote communities. It has been able to draw on this wealth of experience and quickly mount a similar response to COVID-19.
The news that America has withdrawn its funding from the WHO comes at the worst possible time as it will have dire consequences for its work in Africa in particular. The USA usually contributes 15% of the WHO’s budget.
Dr Moeti expressed her concerns saying “The impact, potentially, of this decision will be quite significant on areas such as polio eradication, just when Africa was close to being declared polio-free.” (8)
She went on to say that the WHO needs in the region of an extra $300 million to help African governments respond to the pandemic. To lose funds at this time could be catastrophic for the pandemic outcome in Africa.
Also of concern is evidence emerging in the UK and the USA that people within the BAME (Black, Asian and Ethnic Minority) community are disproportionately dying from COVID-19.
I covered this in my piece “COVID-19 Why is Race Playing a Role in Outcome?"
The implications for the countries of both Africa and Asia are obvious if a genetic pre-disposition to disease severity and adverse outcome is established.
Political Instability
Against the background of the pandemic, militia groups sympathetic to IS (Islamic State) have been increasing their activities in Somalia, DRC and Mozambique. Ambushings, kidnappings and killings have been on the rise after a period of dormancy.
Concerns are growing that attacks will be extended to neighbouring countries including Uganda, Tanzania and Kenya. IS fighters from Iraq and Syria are being recruited, particularly into the Somalian groups, raising fears that attacks will be launched to coincide with Ramadan which begins at the end of April. The extremist group al-Shabaab controls much of Somalia’s rural areas and it is highly unlikely any kind of healthcare will reach the people outside of the capital Mogadishu. (9)
Natural Disasters
Having already had one wave of locusts in January this year, a second and much larger wave of locusts is spreading in east Africa threatening to dwarf the first wave by a factor of at least 20 fold. A swarm the size of approximately 300 football pitches can, in one day, eat the same amount of food as 35,000 people. Locust swarms can cover 90 miles in a day. (10)
This second wave is coming from Somalia and rapidly spilling into Kenya, Ethiopia and Uganda. Kenya and Ethiopia have established spraying programmes to try and control locust invasions but most other countries do not. Left unchecked locust swarms can devastate the land in much the same way as uncontrolled bush fires do. Keith Cressman of the WHO encapsulated this saying, “A locust outbreak is a lot like a wildfire: Put it out early, and you're good. Delay, and the swarm will spread and spread until it runs out of fuel—the food that subsistence farmers across Africa rely on to survive.”(11)
In Conclusion
The pandemic is likely to hit harder in Africa than anywhere else. Resources to cope with a pandemic are low at best and practically non-existent in some countries. Countries across Europe have struggled to cope with the pandemic and this has been against a backdrop of good healthcare facilities and relative stability compared to most African countries.
Somalia and the DRC are particularly vulnerable but, with the possible exception of the better resourced South Africa, the outlook is grim for every country.
It is sobering to contemplate how the combination of underlying poor health, lack of resources, militia group resurgence and devastating locust swarms are creating the so called “perfect storm” at a time when the African continent faces the COVID-19 pandemic.
Pre-occupied with their own problems the rest of the world appears to have taken its eyes off Africa. The withdrawal of key funds from the WHO at such a critical time can only make any response eventually made even more diminished.
