Why Africa is at risk of a coronavirus catastrophe

 

The coronavirus pandemic spreading across the globe has been slow to spread through Africa, but public health experts are worried that what appears to be an inevitable outbreak on the world's poorest continent could become a catastrophe of unprecedented proportions.

So far, there are only 6,575 confirmed cases across 49 African countries, according to the European Center for Disease Prevention and Control. That's a smaller number of cases than has been reported in Portugal, and only slightly higher than the number of cases confirmed in Israel.

But it is likely that the true number of cases is far higher. Many African nations have little ability to test potential cases, and many Africans themselves do not have access to modern health facilities.

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"The fear is that the numbers we're seeing are a reflection of testing capability and people presenting symptoms at regular health facilities. A lot of people self-medicate, a lot of people use herbs, so we don't know the full picture," said Gyude Moore, a visiting fellow at the Center for Global Development and Liberia's former minister of public works.

African nations have among the youngest populations in the world, thanks to a youth boom in recent decades. That could help stem the number of serious cases of a disease that causes more serious symptoms in older people.

But widespread under- and malnutrition put tens, if not hundreds, of millions of Africans at risk, both of the virus itself and of the economic ramifications that are likely to reverberate for years. A recent study found 53 percent of Africans regularly faced food shortages.

"It's a young continent, but it's not particularly healthy in terms of underlying conditions. The prospect of the disease spreading across Africa is frightening," Moore said.

In the absence of aggressive action, experts fear, will come a cascade of COVID-19 cases that quickly overwhelms weakened health care systems, coupled with an economic cataclysm that compounds the risk of a human tragedy on a continental scale.
 
"The worst case scenario is large caseloads complicated by large population movements, social disruption, political instability and food instability," said Amanda McClelland, a senior vice president at Prevent Epidemics, a project of the global public health nonprofit Resolve to Save Lives. "All of that is preventable if we work together, if we work quickly and if we use evidence to make decisions."
 
Several high-ranking officials in African governments have tested positive for the virus, underscoring the relative few who have access to the tests.
 
The first vice president of Burkina Faso's parliament succumbed to the virus last month. A top aide to Nigerian President Muhammadu Buhari tested positive, while Buhari tested negative. The head of Liberia's Environmental Protection Agency came down with COVID-19 after visiting Switzerland.
 
If – or when – a broader outbreak develops, the continent does not have anything approaching the resources necessary to fight it on a broad scale.

African nations have some of the least developed health systems in the world, both because of extreme poverty across the continent and because of fraught relations between federal governments and traditional tribal groups drawn together by European cartographers who cared about little more than their colonistic enterprises a century ago.

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"The pandemic is testing the health systems in Africa especially around the readiness to handle public health emergencies. The capabilities of handling a large number of critically ill patients would be the most challenging especially in countries with poor health systems," said David Meya, an infectious disease expert at the College of Health Sciences at Makerere University in Uganda.

Making matters worse, the global nature of the coronavirus outbreak means that African nations are not likely to benefit from a surge in aid that has accompanied past outbreaks. The countries who took so much from their former colonies are now occupied fighting their own outbreaks.

"It's happening everywhere in the world. So in the normal places where you'd expect help to come, they're going to have to deal with this on their own," Moore said.

But after several high-profile outbreaks in recent years – measles and Ebola in the Democratic Republic of the Congo, Ebola in three West African countries and Cholera in several other countries – African nations have taken concrete steps to both improve their health care systems and to take the threat of future outbreaks seriously.

In the weeks after the threat of the coronavirus outbreak in China became clear, many countries issued orders limiting big public gatherings, and others like Nigeria, Ghana and Botswana have ordered broader lockdowns to stop the virus's spread. Most of the continent is under a nightly curfew. The Africa Centers for Disease Control and Prevention established a task force on the virus even before the first case was identified.

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African nations took some of the world's earliest steps to shut down air travel with Asia. As a consequence, while the hardest-hit areas in the world imported their first coronavirus patients from the outbreak's epicenter in Wuhan, China, the international spread into Africa has likely come from Europe.

In some cases, the lessons from past outbreaks are working. Liberia, which has reported just six cases, mobilized a contact tracing program it established during the Ebola outbreak to minimize the coronavirus's spread. Some telecom companies have waived transaction fees to promote mobile commerce instead of exchanging bank notes that might carry the virus.

In Uganda, the government has begun providing food relief, a critical bridge for those whose subsistence depends on daily work.

But in other cases, the crackdowns are spurring angry reprisals from populations that are being asked to choose between staying home and starving or working for the wages that buy them food.

"The challenge here remains a lack of proper thought in maintaining other health care services, and other essential services, how these lockdowns are enforced while allowing people to access food and health care have been problematic at best," Meya said in an email.

In Kenya, police have attacked civilians as they try to enforce a curfew; a 13-year old boy was shot dead in Nairobi earlier this week; and police fired tear gas on a crowd in Mombasa.

Police beatings have been reported in Zimbabwe, Uganda and Senegal. In South Africa, the only African nation that has reported more than 1,000 cases, the national lockdown forced more than 20,000 miners from neighboring Mozambique to rush for the border to get home. Three children were reportedly injured when police fired at someone else.

Africa's struggles with convincing their populations to stay inside illustrate the continent's relative poverty, a contrast with Southeast Asia, where wealthier populations were less susceptible to extremes like starvation.
 
"The way isolation measures have been used in Southeast Asia aren't going to work in Africa," McClelland said.

And the situation is likely to become more combustible if prolonged lockdowns strain families who do not have regular access to food.

"I think there are going to be riots. They're going to violate the movement bans as the hunger bites," Moore said. "In places where the peace was already fragile, there's a possibility that the countermeasures against the spread of the disease might lead to instability."