This perspective article on the expected spread of COVID-19 in Africa in the coming months was originally published in the New England Journal of Medicine
As the Covid-19 pandemic sweeps the globe, causing tens of thousands of deaths and massive economic disruption, Africa has so far been largely spared the kind of impact that has thrown China, the United States, and Europe into chaos. As of April 13, there were about 14,000 confirmed cases on the African continent (currently more than 20 000 cases and more than 1000 deaths) , as compared with 160 000 in Italy and more than 560 000 in the United States. But rather than inviting relief or complacency, the numbers from Africa are like the early drops of rain before the clouds open up. Despite the slow arrival of Covid-19, a storm is building, and the 1.2 billion people living in Africa are at tremendous risk.
Most African countries remain woefully unprepared for what’s coming. Kenya, for example, has only 200 intensive care beds for its entire population of 50 million. Compare that to the United States, which has 34 beds for every 100,000 people. Countries from Mali to Liberia have only a few ventilators for millions of people. In urban communities throughout Africa, health facilities tend to be overcrowded and understaffed, while in rural areas, poor roads and unreliable transport make it difficult for people to access care. Advanced health care is sorely lacking in nearly every country.
But the obstacles are not limited to care and treatment of people who are sick. In many communities, people live together in close quarters, which makes social distancing, a critical prevention strategy, more difficult. Millions of people live without access to clean running water, which makes frequent handwashing all but impossible. Adding to these concerns, winter is coming to the Southern Hemisphere, where most of Africa lies, and some experts worry that drier, colder weather may increase viral activity.
Confronting epidemics is not new to Africans, and their experience may prove to be an advantage. Responding to infectious diseases for generations has sensitized governments and communities to the dangers and to the need for rapid, proactive measures to save lives. Moreover, a substantial number of countries in Africa have benefited from previous global initiatives to strengthen health systems to address HIV, malaria, tuberculosis, and Ebola. In addition, the Africa Centers for Disease Control has accelerated its work to enhance diagnostic and surveillance capacity on the continent. As a result, health infrastructures are less fragile than they have been in the past.
The biggest advantage, of course, is time. Heads of state, ministries of health, hospitals, clinics, and community health organizations are taking immediate action. As the pandemic makes its first inroads, several countries have vigorously pursued containment efforts involving identifying, assessing, and isolating people with suspected cases and close contacts of each infected person. Countries are also mobilizing virtual learning networks to disseminate information to health and community workers. From Angola to Zimbabwe, governments are putting in place mitigation measures by closing borders, shuttering markets, suspending internal flights, and instituting limits or outright bans on social gatherings.
But despite these intensive preparations, we should have no illusions that Africa can confront this threat alone. Coordinated global support is essential in the face of the Covid-19 pandemic, and the time to act is now. We believe that during the next few weeks, countries around the world should take concrete steps to assist Africa in staying ahead of the curve, even as they confront their own epidemics. These steps may include donations of coronavirus test kits, personal protective equipment, ventilators, and other life-support equipment or, at a minimum, ensuring that African countries are not priced out of the market for these commodities. Support is urgently needed for real-time Covid-19 surveillance systems and for surveys to determine the scope of the epidemic and to inform decisions about how to respond. Funding and technical support are also needed to run national information campaigns to promote safe behaviors and to counter the stigma that often arises against the people thought to be causing the epidemic. Vulnerable populations, particularly the poor and people engaged in the informal economy, will need to be supported during periods when movement of people is restricted. Finally, it is critically important that resources and attention not be diverted from the continent’s ongoing threats from other infectious diseases, such as HIV, tuberculosis, and malaria.
When HIV spread like wildfire across the African continent, it took decades for the world to mobilize a response. Tens of millions of people were infected and many millions died as the epidemic took root — and it persists to this day. Epidemics know no borders, and success in controlling the epidemic in any one country will be limited if epidemics continue to rage elsewhere. Today, we have the chance to avoid a repeat of history. Africans are doing their part. Now is the time for us to do ours.
El-Sadr WM, Justman J. Africa in the Path of Covid-19. Published in the NEJM on 17 April 2020.