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COVID-19 Situation update for the WHO African Region, External Situation Report 28 (09 September 2020)

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Situation update

The number of coronavirus disease 2019 (COVID-19) cases in the WHO African Region has continued to decrease in the past seven weeks. Since our last External Situation Report 27 issued on 2 September 2020, a total of 34 564 new confirmed COVID-19 cases and 1 173 new deaths were reported from 45 countries between 2 and 8 September 2020. This is a 17% decrease in incidence cases as compared to 41 614 cases registered during the previous reporting period (26 August - 1 September 2020). Similarly, a 14% (1 173) decrease in the total number of deaths was recorded compared to the previous week when 1 363 deaths were registered. South Africa continues to bear the highest burden of COVID-19 in Africa, accounting for majority of all new cases, 35% (12 182), reported in this reporting period, although with a sustained marked decline in new cases for the past two months, and with the lowest daily case count (845) documented on 7 May since 26 May 2020 when 624 cases were recorded.

Twenty-six countries recorded a decrease in new cases; those with a decrease of more than 20% include; Malawi (65%), Liberia (60%), Congo (60%), Zambia (54%), Rwanda (51%), Equatorial Guinea (49%), Senegal (40%), Gabon (40%), Niger (33%), Angola (32%), Kenya (31%), Gambia (28%), Mauritania (23%), Ethiopia (22%), Cameroon (20%), South Africa (20%) and Namibia (20%). We continue to maintain cautious optimism while interpreting these encouraging declining figures as they may be affected by many factors, including the current testing capacity and strategy, and delays in reporting.

During this reporting period, 11 countries reported the highest percentage increase in case-counts (above 20%); Burkina Faso (191%), Botswana (148%), Zimbabwe (128%), Lesotho (119%), Ghana (65%), Mali (52%), Uganda (41%), Sierra Leone (33%), Chad (27%), Central African Republic (25%) and Côte d'Ivoire (25%). Seychelles and the United Republic of Tanzania did not officially submit any report indicating any new confirmed case.

A total of 249 new health worker infections were recorded from eight countries: Kenya (105), Uganda (52), Namibia (38), Mozambique (20), Ethiopia (12), Zambia (12), Eswatini (9), and Mauritania (1). South Africa retrospectively reported 1 519 health worker infections.

During this period, 1 173 new COVID-19 related deaths occurred in 31 countries, with 823 (70%) of the deaths recorded in South Africa. This was followed by Ethiopia, with 121 (10%) deaths, Algeria with 53 (5%) and Nigeria with 44 (4%). South Africa registered a 14% decrease in the deaths reported, while Nigeria, Algeria and Ethiopia recorded an increase in deaths of 175%, 15% and 2%, respectively.

Other countries that reported new deaths during the reporting period include; Kenya (22), Angola (15), Zimbabwe (15), Uganda (14), Madagascar (11), Namibia (8), Ghana (7), Senegal (7), Zambia (7), Togo (6), Guinea-Bissau (5), Mozambique (5), Guinea (4), Rwanda (4), Botswana (3), Gambia (3), Cabo Verde (2), Chad (2), Côte d'Ivoire (2), Eswatini (2), South Sudan (2), Burkina Faso (1), Democratic Republic of the Congo (1), Malawi (1), Mali (1), Mauritania (1) and Sierra Leone (1). Cameroon, which is one of the top five affected countries reported no death in this period.

As of 8 September 2020, a cumulative total of 1 091 012 COVID-19 cases was reported in the region, including 1 091 011 confirmed, with one probable case reported in Democratic Republic of the Congo. South Africa has registered more than half, 59% (640 441), of all reported confirmed cases in the region. The other countries that have reported large numbers of cases are Ethiopia (60 784), Nigeria (55 456), Algeria (46 938), Ghana (45 012), Deaths Kenya (35 356), Cameroon (19 848), Côte d’Ivoire (18 778), Madagascar (15 435) and Senegal(14 014). These 10 countries collectively account for 87% (952 062) of all reported cases.

Of the 1 091 012 COVID-19 cases reported, 895 469 (82%) have recovered from across all the 47 countries in the region. Seven countries are still reporting fewer than 1 000 cases: Sao Tome and Principe (898), United Republic of Tanzania (509), Burundi (466), Comoros (456), Mauritius (357), Eritrea (341) and Seychelles (135). The total number of deaths reported in the region is 23 323, reported in 45 countries, giving an overall case fatality ratio (CFR) of 2.1%. Two countries, including Eritrea and Seychelles have not registered any COVID19 related deaths since the beginning of the pandemic.

Since the beginning of the outbreak in the region, the majority of the deaths have been reported from: South Africa 65% (15 086), Algeria 6.7% (1 571), Nigeria 4.6% (1 067), Ethiopia 4.1% (949), Kenya 2.6% (599), Cameroon 1.8% (415), Zambia 1.3% (297), Senegal 1.3% (291), Ghana 1.2% (283), Democratic Republic of the Congo 1.1% (260), and Zimbabwe 0.9% (218). The top five countries: South Africa, Nigeria, Algeria, Cameroon and Kenya account for 83% (19 272) of the total deaths reported in the region. Chad (7.6%), Liberia (6.3%), Niger (6.0%), Mali (4.4%), Angola (4.1%), Burkina Faso (3.8%) and Sierra Leone (3.5%) have the highest country specific case fatality ratios.

The current figures in the region represent 4.0% of confirmed COVID-19 cases and 2.6% of deaths reported worldwide. South Africa remains the hardest hit country on the African continent and is ranked seventh globally, although with relatively low numbers of deaths. Table 1 shows the affected countries and their corresponding number of cases and deaths. The daily and weekly distribution of cases by date and week of reporting are presented in Figures 1 and 2, respectively. Figures 2, 3 and 4 show the distribution of cases and deaths with case fatality ratio by reporting date in all countries in the African region without South Africa, in South Africa, and in the other top six countries.

Health worker infections continue to increase gradually with 41 936 (3.8%) infections reported in 42 countries since the beginning of the outbreak. South Africa remains the most affected, with 27 360 (65%) health workers infected, followed by Algeria (2 300), Ghana (2 065), Nigeria (2 025), Ethiopia (1 210), Kenya (970), Cameroon (803), Equatorial Guinea (429), Namibia (372), Senegal (349), Mozambique (303), Malawi (280), Guinea-Bissau (268), Democratic Republic of the Congo (256), Eswatini (255) and Guinea (244). The other 27 countries that have recorded health worker infections are shown in Table 1. Liberia 16% (208/1 311), Niger 16% (184/1 178), Guinea Bissau 12% (268/2 245), Equatorial Guinea 8.6% (429/4 985) and Sierra Leone 8.5% (175/2 064), have the highest country specific proportion of health worker infections among confirmed cases.

Complete data on age and gender distribution is only available for 1.1% (11 825), males (61%) 7 202 in the 31- 39 and 40-49 age groups are more affected than females (39%) 4 623 across the same age groups in the African region. The male to female ratio among confirmed cases is 1.6, and the median age is 37 years (range: 0 - 105). The distribution of cases by age and sex is presented in Figure 6.

Similar to the previous reporting period, the transmission pattern across the region remains heterogeneous, with established community transmission seen in 35 (74%) of countries, only nine (19%) countries showing clusters of cases and three (6%) with sporadic cases. The region continues to observe increased incidences of importation of cases from affected countries within the region, largely fueled by long-distance truck drivers and illicit movement through porous borders.

As of 8 September 2020, the seven African countries in the WHO EMRO Region reported a total of 223 136 confirmed COVID-19 cases: Egypt (100 228), Morocco (75 721), Libya (19 583), Sudan (13 437), Djibouti (5 388), Tunisia (5 417) and Somalia (3 362). Additionally, a total of 8 384 deaths has been recorded from Egypt (5 560), Morocco (1 423), Sudan (833), Libya (314), Somalia (97), Tunisia (96) and Djibouti (61).

Cumulatively, a total of 1 314 148 confirmed COVID-19 cases 31 707 deaths (case fatality ratio 2.4%) with 1 051 498 cases that have recovered have been reported in the African continent.