Amid the ongoing Covid-19 carnage, there are fears that Africa will be blown apart by the virus. World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus issued a chilling warning to African countries: “The best advice for Africa is to prepare for the worst.”1“Burkina Faso Reports Sub-Saharan Africa’s First Coronavirus Death as WHO Warns ‘Prepare for Worst,’” France 24, March 19, 2020, https://www.france24.com/en/20200319-burkina-faso-sub-saharan-africa-coronavirus-covid19-death-who-tedros-adhanom-ghebreyesus. It was not an idle warning. Africa has been the stage for pandemics before. Besides, as two French doctors unconsciously expressed on television, sub-Saharan Africa is occasionally where ethical boundaries are pushed when developing vaccines.2Stephanie Busari and Barbara Wojazer, “French Doctors’ Proposal to Test Covid-19 Treatment in Africa Slammed as ‘Colonial mentality,’” CNN, April 7, 2020, https://www.cnn.com/2020/04/07/africa/french-doctors-africa-covid-19-intl/index.html. Meanwhile, many global media outlets are foretelling another African disaster. An editorial in The Guardian notes, “the moment has not quite arrived. But an axe is poised to fall on untold numbers of largely defenceless heads, a massacre almost too appalling to contemplate.”3“The Observer View on Coronavirus, a Tragedy with No Clear End for Poorer Nations,” The Guardian, April 5, 2020, https://www.theguardian.com/commentisfree/2020/apr/05/the-observer-view-on-coronavirus-a-tragedy-with-no-clear-end-for-poorer-nations. Philanthropist Melinda Gates was quoted as saying, “I am worried.… I see dead bodies in the streets of Africa.”4“Melinda Gates Said She Feared Coronavirus in Africa Would Lead to Dead Being Put out in Street, as in Ecuador,” Africa Check, April 20, 2020, https://africacheck.org/fbcheck/melinda-gates-said-she-feared-coronavirus-in-africa-would-lead-to-dead-being-put-out-in-street-as-in-ecuador/. The juxtaposition between a Covid-19 pandemic in Africa and genocidal violence is nothing new. It draws from a racialized history of objectifying black bodies, and a despondency frame in which Africans are cast as defenseless victims, lacking autonomy and agency and needing a savior. While the menacing spread of Covid-19 is treated with shock elsewhere, in Africa, the onslaught of Covid-19 is considered inevitable.

There is no denying that sub-Saharan Africa would, given a full-blown pandemic, be overwhelmed. On the surface, the odds are stacked against the region. For a disease that often requires treatment in intensive care units (ICUs), many sub-Saharan African countries lack the capacity to deal with a surge in cases. In Kenya, for instance, there are only about 518 ICU beds countrywide.5April Zhu, “Kenyan Physicians Cope with ICU Shortages During Coronavirus Pandemic,” Voice of America, April 10, 2020, https://www.voanews.com/science-health/coronavirus-outbreak/kenyan-physicians-cope-icu-shortages-during-coronavirus. The Central African Republic (CAR) has only eight. Uganda has only fifty-five ICU beds,6Patience Atumanya et al., “Assessment of the Current Capacity of Intensive Care Units in Uganda; a Descriptive Study,” Journal of Critical Care 55 (2020): 95-99, https://doi.org/10.1016/j.jcrc.2019.10.019. while Nigeria has less than 500.7Aryn Baker, “Few Doctors, Fewer Ventilators: African Countries Fear They Are Defenseless against Inevitable Spread of Coronavirus,” Time, April 7, 2020, https://time.com/5816299/coronavirus-africa-ventilators-doctors/. Meanwhile, vast populations are thought to be immunocompromised with a host of ailments.8Dwyer-Lingren et al., “Mapping HIV prevalence in sub-Saharan Africa between 2000 and 2017,” Nature 570, no. 7760 (2019): 189-193, https://doi.org/10.1038/s41586-019-1200-9. 9GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, “Global, Regional, and National Incidence, Prevalence, and Years Lived with Disability for 354 Diseases and Injuries for 195 Countries and Territories, 1990–2017: A Systematic Analysis for the Global Burden of Disease Study 2017,” The Lancet 392, no. 10159 (2018): 1789-1858, https://doi.org/10.1016/S0140-6736(18)32279-7.

However, the progression of Covid-19 infections and fatalities in the region appears to be upsetting earlier epidemiological predictions and mathematical models. Africans are not dying in the streets, and the chances of widespread deaths are decreasing with time. Although the most optimistic scientists are cautious, the Covid-19 crisis on the African continent is more in the economic and political space. Not only are hospitals virtually empty, even the everyday emergencies and medical procedures that surgeons and physicians encounter are few and far between. Months after recording their first cases, we see images of clean and glossy makeshift isolation centers for sick Covid-19 patients in Addis Ababa, Lagos, Accra, Kigali, and other parts of sub-Saharan Africa still yawningly empty.

In South Africa, which has the most sophisticated health infrastructure in Africa and some of the highest infection rates, doctors have been waiting for gravely ill patients to present themselves in hospitals with flu-like symptoms for weeks.10Linda Nordling, “‘A Ticking Time Bomb’: Scientists Worry about Coronavirus Spread in Africa,” Science, March 15, 2020, https://www.sciencemag.org/news/2020/03/ticking-time-bomb-scientists-worry-about-coronavirus-spread-africa. The expected torrent has been more of a trickle since the first case was reported on March 5, 2020.11Navid Mamoon and Gabriel Rasskin, “Covid-19 Visualizer,” https://www.covidvisualizer.com. With low Covid-19 testing capacity, there is a high possibility that infections are far higher than reported, but few seem to require hospitalization.12Andrew Harding, “Coronavirus in South Africa: The Lull before the Surge?” BBC News, April 10, 2020, https://www.bbc.com/news/world-africa-52228932. The two hardest-hit countries in continental Africa, Cameroon and South Africa, still have low ratios of both critically ill patients and fatalities. In Kenya, where there are over 700 infections, there are only a handful of critically ill patients, with most showing mild symptoms. Several countries, like Uganda, Namibia, Mozambique, Rwanda, and Burundi, have yet to record a single death. The data is still evolving, but the latest statistics show that, compared to other regions, sub-Saharan Africa has one of the lowest fatality rates, with the ratio of deaths per 1 million people in the minutest of decimals. In addition, South Africa has flattened its coronavirus curve and is already easing restrictions. The rates of fatalities do not reflect a crisis that even comes close to the usual killer diseases Africa faces, such as malaria. In 2018, for instance, malaria killed nearly 200,000 people in Nigeria, the Democratic Republic of the Congo, Uganda, Côte d’Ivoire, Mozambique, and Niger alone.13“Malaria,” World Health Organization, last modified January 14, 2020, https://www.who.int/news-room/fact-sheets/detail/malaria. While the numbers of Covid-19 infections and fatalities will increase, the current data point to the possibility that most sub-Saharan African countries will likely ride out the Covid-19 storm. With the possibility of an African epidemiological cataclysm receding, it is worth noting the several social and medical factors that may have prepared the continent for this moment.

First among them is how the elderly are cared for. In much of Africa, institutionalizing the elderly is a taboo. Grandparents and great-grandparents, across social categories, receive care in their home villages, away from the city, and among their kin. Press reports have linked a wave of infections and deaths of elderly people in Seattle to caregivers and staff who worked while sick at multiple long-term care facilities.14Carla K. Johnson and Mike Stobbe, “Sick Staff Fueled Outbreak in Seattle-Area Care Centers,” AP News, March 19, 2020, https://apnews.com/7994b669d63c73db4d3f73d444e53b25. In a similar facility in the Seattle area, residents began dying in late February from a coronavirus outbreak that would eventually take forty-three lives. In New York, the epicenter of the pandemic in the US, a 360-bed facility in an upscale section of Brooklyn listed over fifty-five deaths within a short time in March. Most nursing homes around the city recorded an average of forty deaths each.15Bernard Condon, Matt Sedensky, and Jennifer Peltz, “‘Under Siege’: Brooklyn Nursing Home Reports 55 Deaths,” Time, April 20, 2020, https://time.com/5824169/brooklyn-nursing-home-coronavirus/. In Cranford, a small town in New Jersey, two-thirds of the deaths recorded were in one long-term care facility. Most of the infections are thought to have been from staffers who went to work sick.16Caren Lissner, “Two-Thirds of Cranford Coronavirus Victims Died in Nursing Homes,” Patch, April 15, 2020, https://patch.com/new-jersey/cranford/two-thirds-cranford-coronavirus-victims-died-nursing-homes. While the Global North struggles to control the rapid spread of the coronavirus in nursing homes, where the most frail and vulnerable live together, the established modes of caring for the elderly within families in Africa may be a bulwark against the spread of Covid-19.

Second, and partly related to the first point, research on the Covid-19 virus shows that elderly victims do not respond efficiently to the novel coronavirus or previously encountered pathogens (antigens) with similar structural resemblance. From an immunologic perspective, decreased immune strength predisposes the elderly to infections. With a median age of 19.7 years in sub-Saharan Africa, compared to parts of Europe and North America where the median age is above forty-five, populations there are better placed to absorb the blows from infections such as Covid-19.

The environment and climate may also be key factors. While the comparative sanitary contexts and the frequent exposure to multiple microbes from early childhood may compromise health in sub-Saharan Africa, it may also have some advantages. These early exposures to various microbes prepare the immune system to fight off contaminants found in everyday life. In addition, for many countries in sub-Saharan Africa, dealing with virulent killers like Ebola, Marburg, Zika, and other viruses was more than a dry run for Covid-19, comparatively a mild infection. Scientists have also drawn links between disease transmission and climatic contexts. Researchers at Stanford University found that warmer temperatures increase transmission of vector-borne disease up to an optimum temperature or “turn-over point,” above which transmission slows.17Rob Jordan, “How Does Climate Change Affect Disease?” Stanford Earth, March 15, 2019, https://earth.stanford.edu/news/how-does-climate-change-affect-disease#gs.4lqsug. With infections rising in countries such as Brazil, it may still be too early to establish how weather changes currently being experienced in parts of Africa relate to the progression of the virus. There is also ongoing debate within the scientific community surrounding the link between universal compulsory Bacillus Calmette–Guérin (BCG) vaccination policies in sub-Saharan Africa and mortality of Covid-19 virus patients.18Aaron Miller et al., “Correlation between Universal BCG Vaccination Policy and Reduced Morbidity and Mortality for COVID-19: An Epidemiological Study,” medRxiv, March 28, 2020, https://doi.org/10.1101/2020.03.24.20042937. Additional epidemiological investigations in multiple different locations comparing the effects of Covid-19 against national policies on BCG are needed to ascertain the association.

At the political level, most sub-Saharan African countries reacted fast, with most shutting down international travel before recording their first cases. A familiarity with crisis, which Elísio Macamo refers to as a “normal condition” for Africans, meant that the Covid-19 crisis was embedded as part of the quotidian. However, this was undermined by a lot of “mimicry” and a “post-colonial irony” in how some African countries reacted.19Elísio Macamo, “The Normality of Risk: African and European Responses to Covid-19,” Corona Times, April 13, 2020, https://www.coronatimes.net/normality-risk-african-european-responses/. There were also uniquely local responses, drawing from the resilience communities have built in the past. In nearly all sub-Saharan countries, heads of state convened “national prayers.” Although ridiculed as distracting from actuality, these in fact did the opposite. They allowed states to put a global health crisis into a proximate, familial frame. They also facilitated the public buy-in of lockdowns and restrictions that followed. Uganda enforced unprecedented militarized control of civil affairs in the country. In Kenya, the Ministry of Internal Affairs, a relic of colonial times, took charge of the country by imposing selected lockdowns. In Tanzania, President John Magufuli played a populist script no different from that of Jair Bolsonaro or Donald Trump. With an eye on the elections later this year, he backed the controversial concept of herd immunity and used the crisis to fragment opposition and fashion an obedient media.

While economic growth in sub-Saharan Africa is expected to decline by 2.1 to 5.1 percent in 2020,20Payce Madden, “Figures of the Week: The Macroeconomic Impact of COVID-19 in Africa,” Brookings, Africa in Focus, https://www.brookings.edu/blog/africa-in-focus/2020/04/16/figures-of-the-week-the-macroeconomic-impact-of-covid-19-in-africa/. there are other positives. Sabelo Ndlovu-Gatsheni argues that Covid-19 has opened the world’s eyes to the reality of planetary human entanglements and the need for a “decolonial love” predicated on conviviality and care for one another.21Sabelo Ndlovu-Gatsheni, “Planetary Human Entanglements and the Crisis of Living Together,” webinar hosted by the Institute for Health and Social Sciences, University of South Africa, April 22, 2020, https://www.youtube.com/watch?v=LgHxsXIMNRM. It indicates an epistemic revolution that demands also looking to the Global South for fresh knowledge. A news report recently documented how Senegal was on the road to 100 percent mass testing through a local handheld innovation that takes about ten minutes to return results and costs the local equivalent of only one US dollar. The innovation disrupts the taken-for-granted North-South flow in innovation.22Yomi Kazeem, “A Senegalese Innovation Lab Is Helping the UK Develop a 10-Minute Coronavirus Test Kit,” Quartz, March 12, 2020, https://qz.com/africa/1816621/coronavirus-rapid-test-kits-to-be-made-in-senegal-with-uk-help/. With the “white savior” increasingly becoming an endangered species in Africa, countries there are looking inwards for solutions. Liberian scholar Robtel Neajai Pailey explains how previous pandemics, such as Ebola in West Africa, revealed the resilience of Africa’s populations and spurred creative and innovative responses to the disease.23Robtel Neajai Pailey, “Africa Does Not Need Saving during This Pandemic,” Al Jazeera, April 14, 2020, https://www.aljazeera.com/indepth/opinion/africa-saving-pandemic-200408180254152.html. It is no different with Covid-19. Textile industries are filling up a critical gap by manufacturing medical apparel. Several local industries in Africa are pushing for approvals to manufacture prototype ventilators locally. Meanwhile, internet access is expanding from the centers to the margins, and online learning, once a utopic component of Afrofuturism, is fast becoming a reality. At the same time, health is moving to the center of both public discourse and practice, with countries putting up health infrastructure and hiring health professionals in ways that were unthinkable only a few months earlier.24David Herbling, “Kenya to Hire 6,000 Health Workers to Fight Virus Pandemic,” Bloomberg, April 2, 2020, https://www.bloomberg.com/news/articles/2020-04-02/kenya-to-hire-6-000-health-workers-to-fight-virus-pandemic. In Kenya, county governments are setting up ICU facilities in some of the remotest regions.25H.E Governor Ali Roba, “REMARKS BY H.E. CAPT ALI IBRAHIM ROBA ON THE VISIT TO COVID-19 ISOLATION WARDS AT MCRH ON 1st APRIL, 2020,” Facebook, April 1, 2020, https://www.facebook.com/HEaliiroba/posts/remarks-by-he-capt-ali-ibrahim-roba-on-the-visit-to-covid-19-isolation-wards-at-/3646064805466789/. The major challenge for countries in sub-Saharan Africa will be navigating the post-Covid-19 social environment. At the end of the day, although its economies may be in shambles, sub-Saharan Africa looks likely to ride out the Covid-19 storm.

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