There are serious concerns that the situation might escalate in the next weeks modelling the epi curve of other regions. The interlinkages between human mobility and the current pandemic of COVID-19 are well established, and while international flights have been suspended in the region, the porous borders on land and water crossings remain difficult to control.
Laboratory testing for COVID-19 is available in most countries, either in-country or abroad, but the capacity is limited and often only individuals with symptoms are identified for testing, meaning the risk of transmission from asymptomatic cases remains unknown. Furthermore, the current availability and capacity for (COVID-19) testing is likely to be insufficient, given the different epi-scenarios. If Africa experiences similar COVID 19 epi- curves observed elsewhere (such as in China, Europe and the United States), increasing laboratory testing capacity so as to improve early detection and diagnosis, across all countries in the region, will benefit the population, country, region, and will contribute to the overall global efforts to tackle the COVID-19 pandemic.
The impact of the COVID-19 outbreak on the East and Horn of Africa is expected to be far reaching and more catastrophic than for high income countries given concurrent co-morbidity among the general population, the population size, and status of health systems and health workforce, which both have low resilience to external shocks and have insufficient critical care capacities. The underlying health issues in the region are represented by higher HIV and Tuberculosis prevalence, higher burden of respiratory tract infections and malnutrition, even in the young populations, compared to high income countries. These pre-existing conditions are expected to worsen any health impacts from COVID-19. It can be estimated that the number of COVID-19 cases with severe progression of the disease may be exacerbated by all of the above, creating an unmanageable and unaffordable burden on the already overstretched health systems.
Communal living and the high density of urban and peri-urban areas in Africa, including slums and informal settlements, pose another significant challenge to containing COVID-19. With the rainy season already upon the East and Horn of Africa, individuals who may already suffer from respiratory illnesses and water borne diseases are likely to be acutely vulnerable to COVID-19. Of great concern will be the potential flooding, landslides, or other disasters that could induce the displacement of communities, further complicating COVID-19 transmission patterns and prevention strategies.