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How, and Where, Covid-19 Is Spreading in Africa

Lessons from Ebola are being applied continent-wide, and could work in U.S., says WHO doctor

By Noah Smith

Africa currently has the second-fewest number of confirmed Covid-19 cases in the world, except for the World Health Organization’s Western Pacific region, according to the most recent WHO figures. In total WHO Africa member states have 623,851 confirmed cases, including 12,666 in the past 24 hours. More than half of these cases are in South Africa. Across the continent, at least 10,116 have died from Covid-19.

However, African nations also have some of the lowest rates of testing in the world, with Nigeria offering one test daily per 100,000 people (18.44% positive), Ghana at 10 tests daily per 100,000 (10% positive) and South Africa at 26 tests daily per 100,000 (7.25% positive). For comparison, the U.S. offers 168 tests daily per 100,000, with 6.51% coming up positive, according to data sourced by Johns Hopkins University.

Assessing the full scope of the situation among its member states, Dr. Miriam Nanyunja, regional advisor for emergency risk management for WHO Africa, said the pandemic has not spread to all countries within Africa in the same way. In Mauritius, six recent were all imported in Seychelles, local transmission ended in April.

She pointed out that 88% of confirmed cases are in 10 countries, led by South Africa, and also including Nigeria, Ghana, Algeria, Cameroon, Côte d’Ivoire, Kenya, Ethiopia, Senegal, and the Democratic Republic of the Congo. Egypt, which has over 89,000 cases, is not part of WHO’s Africa region. Sixty percent of cases are in people under 60 years old, and the average age of people with confirmed cases of Covid-19 is 38 years old, according to WHO figures.

Community transmission is present in about 70% of WHO Africa countries, but the Nairobi-based Nanyunja said it’s not nationwide in any situation, even as overall rates of increase are problematic.

“It took Africa 100 days to reach 100,000 cases, but then only 18 days to double to 200,000. It took 20 days from there to 400,000 and now we are at over 620,000. We see the increase and we are not happy about it,” she said. Addressing the testing issue, she said capacity is increasing without a correlated increase in cases.

“What we see is that, even with increasing testing, the cases do not rise so significantly,” she said. “What we are seeing is more of a good proxy of what is on the ground.”

Direct Relief’s Research and Analysis team has been tracking vulnerability in the region based on case counts per capita, number of hospital beds, HIV case counts, food insecurity, population over 60 years old, and other factors. This month, Mali, Mauritania, Benin, Chad, and Tunisia have reduced their vulnerability while Lesotho, Namibia, Congo, Swaziland, Zambia, Madagascar, and South Africa’s vulnerabilities have increased.

Nanyunja said many member states, especially in West and Central Africa, have been able to incorporate principles from the 2014 Ebola outbreak, even as Covid-19 presents unique challenges.

“Ebola outbreaks have taught us one big lesson about the importance of communication in effective response: Build trust in the local community. We have to include cultural sensitivity in the response. We have to communicate why we are proposing a change in their social norms, otherwise, they will not listen much.”

During the Ebola outbreak, WHO used anthropologists and social workers in order to tailor their advice to local communities. Survivors of the disease also provided to be effective mobilizers for response initiatives, she said.

“Social distancing and masks have not been a social norm, so we have to engage communities to adjust. In general, we are seeing countries that faced Ebola putting into good consideration all these factors.”

Amongst member states, unlike in the U.S., there has not been widespread resistance to the advice of public health officials, but, “We are seeing increasingly a level of fatigue and complacency resulting in apathy in the implementation of the interventions,” Nanyunja said.

“Initially, the countries took on prevention measures and there was goodwill in the population and they tried their best in social distancing, staying home, and with restrictions on travel. In some circles, there was inadequacy in completing this, more to do with socioeconomic reasons: staying at home was affecting livelihoods. And segments of the population would not comply due to these challenges,” she said.

She said another challenge has been the inconsistent use of masks in several countries, due to misconceptions, including that masks hinder breathing.

Looking at the U.S., Nanyunja said she was “surprised” by the response.

“We all believed the public health system in the U.S. could mount a response that could control the pandemic, like in China, or even faster, but things have turned out different.”

She thinks applying some of the Ebola lessons will help matters in the U.S. as well.

“What would be good is for the U.S. is to adopt strategies to the local context. The principles remain, but it is adapted to the context to the different states in the U.S. and then also using local data to guide the implementation — see which areas are most affected and implement the strategies in those areas.”