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COVID-19 Situation update for the WHO African Region, External Situation Report 32 (7 October 2020)

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1. Situation update

The number of coronavirus disease 2019 (COVID-19) cases in the WHO African Region is now at 1 201 111 with 26 475 deaths. Since our last External Situation Report 31 issued on 30 September 2020, a total of 25 840 new confirmed COVID-19 cases and 659 new deaths were reported from 44 countries between 31 September and 6 October 2020. This is a 2% increase in incidence cases and a 20% decrease in deaths compared to 25 327 cases and 817 deaths registered during the previous reporting period (23 - 29 September 2020). Countries reporting the highest number of cases in the past seven days include; South Africa 10 670 (85%), Ethiopia 5 419 (43%), Kenya 1 208 (10%), Uganda 1 065 (9%) and Algeria 1031 (8%). The region observed a slight increase in case incidence in the past seven days for the first time since epidemiological week 30 (mid-July 2020).

Twenty-two countries recorded a decrease in new cases compared to 31 countries in the previous period, with 13 of them registering a decrease of more than 20%; Botswana (100%), Congo (100%), Burundi (78%), Rwanda (62%), Mauritania (59%), Lesotho (58%), Mozambique (56%), Niger (43%), Cameroon (42%), Zimbabwe (38%), Côte d'Ivoire (37%), Malawi (27%) and Madagascar (20%).

During this reporting period, 21 countries reported an increase in case-counts with 14 showing an increase of 20% or more; Seychelles (150%), Equatorial Guinea (140%), Eritrea (109%), Guinea-Bissau (81%), Benin (69%), Togo (61%), Liberia (57%), Democratic Republic of the Congo (46%), Zambia (40%), Senegal (39%), Mali (32%) and Ethiopia (30%). Mauritius, Namibia and Sao Tome and Principe did not record any significant change in their case incidence.

United Republic of Tanzania did not officially submit any reports indicating any new confirmed cases.
A total of 237 new health worker infections were reported from seven countries: Uganda (137), Kenya (59),
Mozambique (11), Namibia (8), Eswatini (7), Liberia (7), Burkina Faso (5) and South Sudan (3).

During this period, 650 new COVID-19 related deaths occurred in 26 countries, with 436 (67%) of the deaths recorded in South Africa. This was followed by Ethiopia, with 48 (7%) deaths, Algeria with 47 (7%) and Kenya with 36 (6%). Ethiopia, Kenya and South Africa recorded a 27%, 25% and 21% decrease in deaths, respectively; while the number of deaths in Algeria increased by 27%. The other countries that reported new deaths during the reporting period include; Angola (13), Cabo Verde (13), Uganda (9), Mozambique (7), Gambia (5), Namibia (4),
Madagascar (4), Eswatini (4), Zambia (3), Senegal (3), Lesotho (3), Chad (3), Nigeria (2), Ghana (2), Guinea (2),
Burkina Faso (2), Cameroon (2), Democratic Republic of the Congo (2), Togo (1), Malawi (3), South Sudan (1), and Zimbabwe (1).

As of 6 October 2020, a cumulative total of 1 201 111 COVID-19 cases was reported in the region, including 1 201 110 confirmed, with one probable case reported in Democratic Republic of the Congo. South Africa has consistently registered more than half, 57% (683 242), of all reported confirmed cases in the region. The other countries that have reported large numbers of cases are Ethiopia (80 003), Nigeria (59 583), Algeria (52 399),
Ghana (46 829), Kenya (39 586), Cameroon (20 924), Côte d’Ivoire (19 885), Madagascar (16 570) and Senegal (15 141). These 10 countries collectively account for 86% (1 034 191) of all reported cases.

Six countries are still reporting fewer than 1 000 cases: Sao Tome and Principe (914), Burundi (515), Comoros (487), Eritrea (398), Mauritius (395) and Seychelles (146). To date, a total of 1 014 255 (84%) case-patients reported from all the 47 countries have recovered.

The total number of deaths reported in the region is 26 475, reported in 45 countries, giving an overall case fatality ratio (CFR) of 2.2%. 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% (17 103), Algeria 6.7% (1 773), Ethiopia 4.7% (1 238), Nigeria 4.2% (1 113), Kenya 2.8% (743), Cameroon 1.6% (420), Zambia 1.3% (335), Senegal 1.2% (312), Ghana 1.2% (303), Democratic Republic of the Congo 1.0% (274), and Madagascar 0.9% (233). The top five countries: South Africa, Algeria, Ethiopia, Nigeria, and Kenya account for 83% (21 970) of the total deaths reported in the region. Chad (7.1%), Liberia (6.1%), Niger (5.8%), Mali (4.1%), Angola (3.5%), Algeria (3.4%) and Sierra Leone (3.2%) have the highest country specific case fatality ratios.

The current figures in the region represent 3.4% 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 tenth 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 3 and 4 show the distribution of cases and deaths with case fatality ratio by reporting date in South Africa and in the other top six countries.

The number of health worker infections continue to increase gradually with 43 868 (3.6%) infections reported in 43 countries since the beginning of the outbreak. South Africa remains the most affected, with 27 360 (63%) health workers infected, followed by Algeria (2 300), Nigeria (2 175), Ghana (2 065), Ethiopia (1 506), Kenya (1 029), Cameroon (808), Uganda (592), Guinea (513), Mozambique (484), Namibia (464), Equatorial Guinea (363), Senegal (349), Eswatini (291), Guinea-Bissau (282) and Malawi (280). The other 28 countries that have recorded health worker infections are shown in Table 1. Liberia 16.3% (221/1 354), Niger 15.3% (184/1 200), Guinea Bissau 12.0% (282/2 362), Sierra Leone 10.1% (230/2 277), Sao Tome and Principe 9.6% (88/914), Mauritius 7.6% (30/395) and Equatorial Guinea 7.2% (363/5 052) have the highest country specific proportion of health worker infections among confirmed cases.

Basing on available data 1.0% (11 874) on age and gender distribution, males (61%) 7 240 in the 31-39 and 40- 49 age groups are more affected than females (39%) 4 634 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 5.

Diverse transmission patterns continue to be observed across the region, with established community transmission seen in 39 (83%) countries, five (11%) countries have clusters of cases and three (6%) with sporadic cases.

As of 6 October 2020, the seven African countries in the WHO EMRO Region reported a total of 325 892 confirmed COVID-19 cases: Morocco (137 248), Egypt (103 902), Libya (38 468), Tunisia (23 453), Sudan (13 653), Djibouti (5 423), and Somalia (3 745). Additionally, a total of 10 330 deaths has been recorded from Egypt (6 001), Morocco (2 410), Sudan (836), Libya (602), Tunisia (321), Somalia (99) and Djibouti (61). A cumulative total of 1 527 003 confirmed COVID-19 cases, 36 805 deaths (case fatality ratio 2.4%) with 1 267 136 cases that have recovered have been reported in the African continent.