COVID19: The African Mystery or Why so low cases for a continent with a Billion inhabitants?

This week would mark the fourth month and half since the first case of COVID19 was isolated in Africa. It was on the 14th of February 2020 in Egypt by a Chinese national. Two weeks later, on February 27th, a second case was reported in Nigeria involving an Italian citizen.

These first cases sent a wave of fears among the local populations and the world’s health experts. Bill Gates warned that the virus could overwhelm the health services of Africa potentially leading to 10 million deaths on the continent. Gates’ wife, Melinda Gates expressed her fear in a more poignant way: “It’s going to be horrible in the developing world. Part of the reasons you are seeing the case numbers still do not look very bad is because they don’t have access to many tests. Look at what is happening in Ecuador, they are putting bodies out on the streets, you are going to see that in countries in Africa,” Mrs Gates said .

The UN Secretary General António Guterres said he fears millions and millions of contamination and death in Africa. “We can still prevent the worst in Africa but without a massive mobilisation we will have millions and millions of people contaminated, which means millions of deaths,” said Guterres adding that Africa’s booming youth population will not be spared.

The French minister of Foreign Affairs in an internal note speculated a possible total collapse of African states. “The shock wave to come […] could be too much the blow to the State apparatuses” said the document titled “The pangolin effect: is a storm brewing in Africa?”

Tedros Adhanom Ghebreyesus, the Director of the World Health Organization (WHO), urged African countries to “wake up” and “prepare for the worst”.

Referring to a 2016 analysis by the RAND Corporation, a US think tank, experts pointed out that of the 25 countries in the world that are most vulnerable to infectious outbreaks, 22 are in Africa.

Those worries expressed by these different people and institutions were based on real concern. At the time of the first cases in Africa, Italy became the new epicentre of the COVID crisis, witnessing around 500 deaths a day. French cases were surging with a rising death toll. These countries are supposed to have modern health care infrastructures and professionals; while at the time in sub-Saharan Africa there were only two laboratories capable of testing and confirming samples for the virus — in Senegal and South Africa.

On paper Africa is the perfect target for COVID

About 2 million Chinese live and work on the African continent. Africans are also increasingly visiting China for business and study. Strangely, the main route for transmission of the coronavirus to Africa was from European visitors and Africans returning from Europe.

Furthermore, COVID is an opportunistic disease. It kills mainly those who are already weakened by other diseases. One needs to look into the underlying conditions of the populations it is affecting, and here again Africa seems to be a fertile ground:

  • Africa is home to 26 million people with HIV, which in a normal year kills over 500,000 persons.
  • Diabetes kills about 1.5 million Africans every year, and Africans are 60% more susceptible to diabetes than any other race. Furthermore, diabetes is one of the fastest growing diseases in Africa.
  • Hypertension kills around 2.5 million Africans every year. Here too, Africans are more affected by hypertension than any other race in the world.
  • Malaria kills about 300,000 Africans every year. However, the disease is endemic and weakens the immune system of millions of people every month. It is the most costly disease to the African economy.
  • Typhoid fever affects about 10 million Africans and kills about 100,000 every year.

COVID19 prevention requires good sanitation and the wearing of facemasks. WHO estimated that 40% of sub-Saharan African population still lacks access to clean water to wash their hands, and most people cannot afford the face mask which unit price reached up $2.5 in many countries.

In addition to the above conditions, weak healthcare systems, poor hygiene conditions, coupled with poor leadership, makes Africa a perfect target.

In case of a large outbreak, according to WHO, the total number of beds in the intensive care units (ICU) available to be used during COVID-19 in 43 African countries, is less than 5000. This represents around 5 beds for a million people in the countries concerned, compared to 4,000 beds for a million people in Europe. The number of functional ventilators in public health facilities is less than 2000 for the whole African continent. Countries like Togo had only 2 ventilators at its main Hospital in Lomé for a 7,5 million inhabitants. Central African Republic has three ventilators for a country of five million; and Burkina Faso has a grand total of 12 critical care beds for its 20 million citizens.

Two months after the first cases, however, and regardless of all the above perfect storm conditions, the numbers of cases for the whole continent is limited and pales in comparison to single countries in Europe, with total number of cases and death toll inferior to that of a small country like Belgium?

The one billion plus strong continent has seen only 258,000 confirmed cases of COVID-19 and about 5600 deaths so far – relatively few compared with other regions.

The virus incubation period estimated to be 14 days, had been found to extend up to 37 days in some cases. So why after 60 days, Africa still has so low cases?

What is the Vodun?

According to the famous French physician and microbiologist Didier Raoult, the fact that Africans use a lot of anti-malaria drugs, might confer to them some protection against the virus. “It is also possible that there is a kind of protection that may be due to the African ecosystem. And among these is the fact that many anti-malarial drugs are effective against the coronavirus. So it is possible that the distribution of the virus is different in sub-Saharan Africa than it is in Europe“ said Didier Raoult, who was very forceful to recommend the malaria Drug hydroxychloroquine to treat COVID19.

According to preliminary results from a lab experiment conducted the National Biodefense Analysis and Countermeasures Center in the United States show that the coronavirus does not survive long in high temperatures and high humidity, and is quickly destroyed by sunlight. The study found that the risk of “transmission from surfaces outdoors is lower during daylight” and under higher temperature and humidity conditions “Sunlight destroys the virus quickly”.

It has also been reported that in general Africans are not that affected by the different coronaviruses, and even the seasonal flu often has limited impact. “Droplet diseases don’t seem to be as big an issue in Africa. SARS, a respiratory disease that is also a coronavirus, spread through 26 countries in 2003 but failed to gain a hold in Africa. Influenza epidemics are also less intense on the continent” pointed out Paul Hunter, a UK-based specialist in infectious diseases and epidemics There is no proof however that Africans are immune to coronavirus.

A recent study says that the BCG vaccination might be playing some role in the limitation of the spread of the virus in Africa. “Countries with mandatory policies to vaccinate against tuberculosis register fewer coronavirus deaths than countries that don’t have those policies” reports Gonzalo Otazu, assistant professor at the New York Institute of Technology and lead author of the study, after noticing the low number of cases in Japan

Another drug widely used in Africa to treat many types of parasite infestations including head lice, scabies, river blindness, strongyloidiasis, trichuriasis, ascariasis, and lymphatic filariasis, called Ivermectin, has been found by Researchers at the University of Melbourne in Australia to inhibit the replication of COVID-19 virus SARS-CoV-2 in less than 48H.

According to the World bank, Africa has learned ‘what it takes’ the hard way during the Ebola crisis and is applying to COVID19 lessons learned like cross border control protocols, regional technical workgroups, and coordination teams. Also During the height of the Ebola response, CDC trained 24,655 healthcare workers in West Africa on infection prevention and control practices. The legacies of the response to the Ebola epidemic are now leveraged for the Covid crisis.

Additional thesis tout that the African population is young, and the disease affects more older people. Africans above 60 years old account for less than 5% of their population compared to 25% in Europe.

Question of time?

Everything comes to Africa late. From high techs to latest management trends, new technologies and world trends tend to take years before reaching the shores of Africa.

Could it be the case for COVID19?

Many voices are warning against the optimism highlighted above. It is possible the low cases have nothing mysterious, but simply are due to limited testing. Recently in the USA, cases exploded from the moment mass testing had started, and African Americans were disproportionately represented in the number of cases and death .

For example, the whole Nigeria did only 132,304 tests for a country of 180 millions and 21 millions in the City of Lagos. Countries like Togo conducted only 10000 tests for a population of 7,5 millions. However, South Africa conducted 1.4 million tests, Ghana 218,425, Egypt over 1 million.

Some however pointed out that the lack of tests can’t explain the mystery, and speculated that if the virus was spreading silently in Africa, hospitals should be crowded with people with respiratory distress. That’s not the case.

Michel Yao, head of emergency operations for WHO Africa, said the worst-case predictions for the Ebola outbreak in Africa had not come true because people changed their behaviour in time. However he warned that the number of cases might surge from just thousands now to 10 million within three to six months.

African leaders got the message and drastic measures were since initiated. Schools are shut, gatherings banned, market closed, public transportation restricted, cross regional transportation filtered, airspace closed for passenger airplanes, and curfews imposed.

As on June 29th, 2020, the overall feeling here is that Africa will be ok, with lower cases than in other parts of the world. In the civil societies people are disappointed that some foreigners “are longing for a Corona Virus ravaged Africa so that their photo journalists can have a golden chance of capturing an award winning photo of an African street filled with heaps of dead bodies of Africans who are succumbing/succumbed to COVID-19” said Kinoti Mwirigi Naftaly

On a final note, we might just wonder like this editorialist in a Ghanaian newspaper, “Why doesn’t the world praise Africa fighting the coronavirus? Africa always gets the blame for everything wrong, I think many Africans and other people around the world know that and many accept that. Let’s look at the African statistics on Coronavirus death rates and compare them to the rest of the world … Africa is by far the best … Ivory Coast, South Africa, my beloved Ghana and Senegal are doing far better than the all over-praised South Korea and Germany.”

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