Introduction

As of September 8, 2020, seven months after the first Covid-19 case was officially reported in Africa on February 14, 2020, Africa Centres for Disease Control and Prevention (Africa CDC) reports show that the entire continent recorded 1,306,157 cases, with 31,494 deaths.1“Outbreak Brief #34: Coronavirus Disease 2019 (COVID-19) Pandemic,” Africa CDC, September 8, 2020, https://africacdc.org/download/outbreak-brief-34-covid-19-pandemic-8-september-2020/. These are thousands of deaths too many, but a far cry from the catastrophe analysts and health professionals had projected in relation to the continent. When the number of new coronavirus cases began to spike globally in March, gloomy predictions expected that Africa would become the epicenter of the pandemic. The reasons were obvious; foremost among them were the weak health-care systems in most countries on the continent. However, six months later, compared to cases and figures from other regions of the world, Africa continues to defy all these pessimistic predictions, a trend that requires critical examination for explanatory and other purposes.

Challenges

Low testing capacity in most African countries obscures the true number of cases and blurs the real transmission rate of the Covid-19 virus. A Reuters report on August 6 indicated that Africa had conducted nearly 9 million tests.2Giulia Paravicini, “10 Countries Account for 80% of Africa COVID-19 Testing: Africa CDC,” Reuters, August 6, 2020, https://www.reuters.com/article/us-health-coronavirus-africa-testing/10-countries-account-for-80-of-africa-covid-19-testing-africa-cdc-idUSKCN2521QZ. In contrast, according to Statista, as of September 14, China had conducted over 160 million tests, while the United States had conducted over 92 million tests.3“Number of Coronavirus (COVID-19) Tests Performed in the Most Impacted Countries Worldwide as of September 14, 2020,” Statista, accessed September 14, 2020, https://www.statista.com/statistics/1028731/covid19-tests-select-countries-worldwide/. In Africa, apart from inconsistency in testing updates, there have been concerns as to the reliability of tests and figures. Nonetheless, with the sometimes-asymptomatic nature of the virus, it is generally difficult to know the true number of Covid-19 cases in any region, unless widespread tests are conducted simultaneously. Testing remains indisputably the main channel to ascertain the actual spread and death rates.

The continent’s poor health-care infrastructure remains the most widely referenced challenge. Often, what exactly constitutes this challenge is lost in sweeping generalizations. Emphasis is usually placed on inadequate numbers of hospitals and medical equipment such as beds, ventilators, personal protective equipment (PPE), drugs, testing, and surgical kits, among others. However, the brain drain of medical doctors and nurses from African countries and the redundancy of other medical workers exacerbates the weak health sector. A 2011 Reuters report on nine sub-Saharan African countries, namely, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe, showed a loss of $2 billion invested in training doctors who then migrated to the UK, US, Canada, and Australia.

Other challenges include the distrust of government treatment centers, as well as public stigmatization that leads to some symptomatic victims avoiding tests or absconding from treatment facilities and recovered patients being avoided like the plague by their families and communities. Meanwhile, skeptics have diverse opinions about Covid-19, referring to it as a foreign, urban, or rich people’s disease. Some even go as far as to deny its existence. Another set of challenges is linked to preventive measures such as social distancing, which are made difficult due to housing proximity, lack of basic infrastructure, and poor living conditions in densely populated cities or suburbs. These conditions are further compounded by the lack of access to potable water for handwashing as required for coronavirus prevention.

However, in spite of these challenges, the numbers of known Covid-19 cases in Africa have remained comparatively low. This may be due to certain factors that have inadvertently worked against the spread of the virus.

Favorable Factors

Demographically, Africa’s youthful population has been the most cited reason for the continent’s low death rates. Estimated at about 1.2 billion people, Africa has the youngest population globally. A Statista report shows that 41 percent of its population is under 15 years of age.4“Proportion of Selected Age Groups of World Population in 2019, by Region,” Statista, accessed September 14, 2020, https://www.statista.com/statistics/265759/world-population-by-age-and-region/. With a high fatality rate for mostly the aged and sick, a youthful and healthy population is believed to be less vulnerable to the virus compared to the elderly and those with underlying illnesses.

Indeterminate Factors

In June, unproven assertions from two Italian doctors over the possibility that the virus had evolved into a milder strain5Markham Heid, “Could the Coronavirus Be Weakening as It Spreads?,” Elemental, June 4, 2020, https://elemental.medium.com/could-the-coronavirus-be-weakening-as-it-spreads-928f2ad33f89. drew swift backlash. Their hypothesis that it had weakened was not based on any scientific proof but rather on the number and severity of new cases, compared to cases in March and April. Though an unpopular view at the moment, other health officials acknowledge the possibility of a milder strain, but argue it is too early to draw any definitive conclusions. Declining death rates in many countries have been attributed to a combination of multiple factors, mainly lockdowns, wearing of face masks, social distancing, and health officials learning new protocols for managing and treating the disease. Further research on the number and potency of the various strains of the virus, where they exist, and how best to treat them is required.

Other rather controversial explanations are genealogy and immunity. After the myth in Africa about black people being immune to the disease was shattered by high death rates of African Americans in the US, there has been no consensus as to why Covid-19 numbers in Africa are significantly lower. Hence, the role of genealogy remains unclear. In April, figures showed a highly disproportionate death rate among black people in the US, while a similar pattern also emerged in the UK. This has been linked to several factors related to health and socioeconomic status—for instance, higher uninsured rates and underlying illnesses attributed to standard of living, including diet. Of note are socioeconomic inequality between racial groups and classes and higher exposure to the disease due to the nature of work. In relation to diet, the quality and availability of richer nutritional content in food may have an impact.

In addition to these factors is the impact of weather. Hotter temperatures commonly experienced in Africa are considered a limiting factor in the survival and spread of the virus. A study published in Physics of Fluids indicates that “the survival time of the virus depends on the surface on which [an infected droplet] falls, along with the temperature and humidity of the ambient air.”6Rajneesh Bhardwaj and Amit Agrawa, “Likelihood of Survival of Coronavirus in a Respiratory Droplet Deposited on a Solid Surface,” Physics of Fluids 32, no. 6 (2020), https://doi.org/10.1063/5.0012009.

Another factor in declining or low infection rates in Africa may be the long-term effect of certain drugs and vaccines. The impact of known treatments such as the Bacille Chalmette-Guerin (BCG) vaccine for tuberculosis and chloroquine, an erstwhile popular antimalaria drug now touted to be a cure for the virus, may be a factor. According to the foremost global vaccine alliance body, GAVI, on the possible effect of BCG on Covid-19, “what we do know is that, the way in which BCG vaccination reacts with the human immune system suggests it can have general immune-boosting effects.”7“Can the BCG Vaccine Protect against COVID-19?,” GAVI, May 19, 2020, accessed September 14, 2020, https://www.gavi.org/vaccineswork/can-bcg-vaccine-protect-against-covid-19. Similarly, a Cell Death and Disease study on BCG and chloroquine found that countries with universal BCG vaccination fared better with disease than others. While acknowledging the side effects, the report also says that chloroquine treatments “are widely used in patients affected by the COVID-19 disease and reports from hospitals and doctors who treat patients frequently suggest beneficial effects.”8Abhibhav Sharma et al., “BCG Vaccination Policy and Preventive Chloroquine Usage: Do They Have an Impact on COVID-19 Pandemic?,” Cell Death and Disease 11 (2020).

The Economy and the Way Forward

A World Bank analysis on the economic impact of Covid-19 on sub-Saharan Africa reports that the pandemic has sparked a recession in the region for the first time in 25 years.9“For Sub-Saharan Africa, Coronavirus Crisis Calls for Policies for Greater Resilience,” The World Bank, April 9, 2020, https://www.worldbank.org/en/region/afr/publication/for-sub-saharan-africa-coronavirus-crisis-calls-for-policies-for-greater-resilience. It also projects a $37 to $79 billion loss in 2020, severe food crisis, and contraction in agricultural production. The way forward requires multipronged interventions from both governments and international parties, one of which could be a bilateral debt servicing moratorium from the World Bank and International Monetary Fund.

Despite comparatively lower testing and death rates, some health officials believe community transmission rates are on the decline in Africa. As the race for a vaccine intensifies, it will be helpful to unravel the full ramifications of the new coronavirus, which may well point researchers in the direction of a cure. It is also important to note how Africa has leveraged past experience managing previous outbreaks, such as those caused by Ebola, HIV/AIDS, and tuberculosis, by adopting a uniform strategy through the Africa CDC. The CDC’s prompt response in building the capacity of governments for enhanced surveillance at ports of entry, creating public awareness, and utilizing community health-care professionals also helped in stemming the initial tide of Covid-19 infections across the continent. On a cautionary note, after the initial lockdowns, most countries in the region appear to be reducing restrictions and lowering the standards of preventive measures. This reflects a policy of living with, rather than preventing or seeking a cure for, Covid-19 and may not portend well for the region in the long run. A continuous rise in numbers without the backing of strict restrictions has always spelled doom. Italy, Spain, the UK, the US, and Brazil have paid heavily and face the likely threat of a second (or third) wave of infections. Africa risks suffering a similar fate by treading the same path. What happens in the months to come will be a defining factor.

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