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United States could learn from Africa's coronavirus response

United States could learn from Africa's coronavirus response
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After nearly six months, West Africa was cautiously re-opening its airports for international arrivals and so I could navigate my return.

Given that Americans remain unwelcome in Europe because of our high COVID-19 positivity rate, and fearing that a missed connection could trap me in an airport health quarantine, I opted for DELTA’s direct flight from JFK to Kokata International Airport in Accra, Ghana.

As I was queuing at my pharmacy for an expedited Polymerase Chain Reaction (PCR) test, required 72-hours before departure for entry (not cheap and not covered by insurance), media reports emerged from the continent about how Africa had defied COVID-19 expectations.

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The stories expressed a shared disbelief that — as the pandemic was wreaking havoc around the world, with a second spike in cases in the U.S. and Europe — Africa had not been as hard hit as had been predicted.

Eight months in, Africa, which accounts for 17 percent of the global population, was only registering 3.5 percent of global COVID-19 deaths. According to the World Health Organization Director General Tedros Adhanom Ghebreyesus, Africa is the only region where COVID-19 cases are not increasing.

The experts are trying to explain this phenomenon.

They point to the continent’s comparative youth, with a median age of 19 years old. The median age in Europe is a 44. Others speculate that it could be the greater use of outdoor spaces, or that Africans could have pre-existing protective immune responses due to exposure to other pathogens.

The most recent study looks at the impact of Bacillus Calmette-Guérin (BCG) vaccination provided at birth in most African countries to guard against tuberculosis.

The above, no doubt, are factors. But let’s not let the scientific examination take away from the agency of the African people themselves.

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After watching from afar, and experiencing first-hand, I would suggest the possibility that the public health response of African countries, with weak and fragile systems, prepared by previous experiences, was simply more effective in limiting the transmission.

I would argue that it is the policies that have been adopted and their community acceptance — augmented by shared protocols that have been executed regionally, and across the continent — that have made the difference.

I would point out that this solidarity and commitment to the collective is absent — unfortunately — in the United States and elsewhere.

“The continent can take credit for taking bold, aggressive and courageous steps in locking down their economies very early on,” Dr. John Nkengasong, the Director of Africa Centres for Disease Control and Prevention told The Telegraph. He notes that countries went into a state of emergency when they had only four to six recorded cases, which slowed the spread of the virus on the continent significantly. This was tough medicine for some of the world’s poorest countries with nearly 90 percent of economic activity in the informal sector.

In addition, public health measures — including frequent hand washing, social distancing and mask wearing — were swiftly introduced, and won community-buy in. A survey conducted in in August by Partnership for Evidence-Based Response to COVID-19 found that public support for safety measures was high, enabling African Union member states to contain the virus between March and May.

And Africa proved again the age-old adage that experience is your best teacher.

West African states, which from 2013 to 2016 battled the world's worst-ever outbreak of Ebola that killed more than 11,000 people, were able to reactivate those public health measures — testing, contact tracing, and quarantining — fundamental to containing COVID-19. 

Moreover, the prevalence of Lassa fever, yellow fever, cholera, measles and other infectious diseases had taught African nations the importance of deploying resources at the disease onset.

African leaders also learned from Ebola that that infectious diseases do not respect borders and that leaders must act collectively. This led to the African Union setting up the Africa CDC in 2017. Africa CDC launched the Partnership to Accelerate COVID-19 Testing, and a continent-wide platform for procuring laboratory and medical supplies: the Africa Medical Supplies Platform.

Low testing rates outside of South Africa and Egypt continue to undermine the ability to conduct surveillance, but even so, there is no indication that a substantial number of African COVID-19-related deaths have been missed. “I’m absolutely sure there are no massive death [events] going on,” says Dr. Nkengasong

Outcomes will continue to be uneven, because leadership is uneven across 54 nations. Nonetheless, researchers from Oxford and George Washington University sum up the African mantra as: Act decisively, act together and act now.

In West Africa, the airport re-openings, have been coordinated with the West African Health Organization, and include thermal scanning or temperature checks. Moreover, all visitors are registered by health authorities and must take a COVID-19 PCR test within 72 hours of arrival, as I did.

Some nations, including Ghana and Togo, have taken it one step further, requiring the traveler to submit to a Rapid Diagnostic Test (RDT) upon arrival.

I admit I was a bit nervous when I landed in Accra. I had heard about false positives in these antigen-based tests, with one international visitor hauled away in ambulance only to test negative 24 hours later. But I sailed through the health screening in 20 minutes and have since learned that a PCR machine has been brought on-site to re-test.

But that was only my first hurdle, as I would be traveling onward to Liberia, requiring yet another PCR test, within 72 hours of that departure.

In the U.S., it took the combined effort of my primary care physician and me to find testing with results within three days, and I was dreading another coronavirus testing hunt, this time without my doctor. But turns out there was no need to fret.

Sixteen public and private facilities in Accra had been accredited to test for COVID-19, and I was able to secure an appointment at the Nyaho Medical Centre, with guaranteed results in 24 hours — at less than half the price I paid in northern Virginia. Done with a deep nasopharyngeal swab, it was eye-watering, and came with a signed certificate.

The moral of my traveler’s journey is that it is time to recalibrate our historically-ingrained perceptions of who holds the knowledge and who owns the expertise. 

We might consider taking a page from the Africa playbook, shed the go-it-alone approach and find strength in the collective — as a nation, and as a global community.

K. Riva Levinson is president and CEO of KRL International LLC, a D.C.-based consultancy that works in the world’s emerging markets, award-winning author of "Choosing the Hero: My Improbable Journey and the Rise of Africa's First Woman President" (Kiwai Media, June 2016). You can follow her @rivalevinson