As the global coronavirus epidemic continues to evolve, Africa has so far been spared the infection rates seen in countries such as China, Italy, Iran and France. Are these remarkably low rates a matter of alarm, relief, socio-economic factors, luck, none – or all – of the above? FRANCE 24 spoke with Mathias Altmann, epidemiologist at the Bordeaux School of Public Health and one of the co-authors of a study on the preparation and vulnerability of Africans to imports of COVID-19.
Months after the coronavirus outbreak, which started in China in late December, spread to parts of Asia, Europe, the Middle East and the United States, Africa did not register no case of infection. The first confirmed case on the continent was not registered until February 14, 2020 in Egypt.
The pandemic has since spread, with South Africa reporting the continent’s first case of local transmission on Wednesday March 12. All previous cases have been patients who have traveled abroad, the South African ministry of health said. Development has raised concerns that health systems in sub-Saharan Africa will be overwhelmed if local transmission accelerates.
Rates on the African continent, however, were significantly lower than in other regions. By Thursday, the number of cases worldwide had risen to 126,000, with 4,600 deaths worldwide, according to Johns Hopkins University. In Africa, the number of cases is still several tens. Côte d’Ivoire confirmed its first case on Wednesday while Egypt registered seven new cases, bringing the total to 67. South Africa has reported 13 cases to date. Other African countries that have confirmed cases are Algeria, Nigeria, Senegal, Burkina Faso and the Democratic Republic of the Congo.
East Africa has so far not reported any cases of COVID-19, but countries have already implemented strategic plans to respond to the epidemic, including by strengthening health security controls at borders. The governments of Kenya and Rwanda have suspended international gatherings and events until further notice as a precaution. Systematic quarantines have also been imposed on travelers from high-risk countries by several states, including Burundi and Uganda, while many African airlines such as RwandAir and Kenya Airways have suspended flights to a number of high-risk countries such as China and Italy.
Although the World Health Organization (WHO) warned on February 22 that African health systems are ill-equipped to cope with the epidemic if contamination accelerates, a study published in the Lancet medical journal on February 27, the African countries most likely to import new cases – Algeria, Egypt and South Africa – also had the continent’s best prepared health systems.
FRANCE 24 interviewed Mathias Altmann, epidemiologist at the Bordeaux School of Public Health and one of the study’s co-authors.
How do you explain the relatively low number of COVID-19 cases registered in Africa?
Mathias Altmann: There are several hypotheses and only hypotheses can explain this situation. One of them is Africa’s low exposure to China compared to Europe, which accounts for about one Africa-China travel exchange for 10 Europe-China travel exhibitions. This could explain the slow introduction of the virus on the continent when the epicenter of the epidemic was in China.
Since then, the situation has changed with the spread of the coronavirus worldwide, with a pandemic which exposes Africa to imports of the virus from Europe. The first confirmed and registered cases on the continent were imported from Europe, mainly from Italy and France.
Another hypothesis, which remains to be validated, concerns the presumed existence of many undetected cases, which are the subject of numerous rumors. Except that if this were the case, there would have been numerous alerts in hospitals in African capitals and local intensive care units, which would have recorded a massive influx of patients. As far as I know, that did not happen. We saw this during the Ebola crisis in Sierra Leone and Liberia, which are not the best equipped countries on the continent in terms of infrastructure and human resources. Therefore, the idea that there are unknown chains of transmission seems unlikely to me.
WHO has recently raised concerns about Africa in the event of massive contamination, as health systems, particularly in countries where poverty is pervasive, are weak. Is Africa ready to face the pandemic?
MY: We must remain cautious and wait to see if the number of cases will explode, as is currently the case in Italy and in certain European countries. No one can predict. We know that serious cases mainly affect the elderly, but Africa has a younger population than Europe, which is rather reassuring for the continent, and it is possible that there are fewer serious cases.
From a general point of view, the overall mortality rate remains quite high in Africa, especially in terms of infant and maternal mortality as well as endemic diseases such as malaria or measles. Should we be worried? There is no need to panic as there are few patients at the moment, although the risk of spread exists and it is almost certain that other cases will arise due to the highly contagious nature of COVID- 19. We will have to worry if the epidemic affects a large number of people with many serious cases. However, it should not be forgotten that only 15% of confirmed cases worldwide are serious. It should also be noted that not all health services are currently ready, from a global point of view, I mean, because it is difficult to speak of all African countries at once.
The requirements are quite diverse, but overall, the material needs are quite significant in most African countries. There are still, for example, many gaps in terms of infrastructure, isolation rooms, treatment protocols, breathing apparatus and medicine stocks. There is also a lack of capacity in a number of countries to make diagnoses as closely as possible to health management services, which can lead to delays and block beds.
Despite this situation, do you think that many African countries seem to have taken swift action in response to the crisis?
MY: Yes, and we must not forget that there is already a level of preparation on this continent, which has experienced its share of epidemics, and where countries have a huge amount of knowledge on the ground, especially in Africa. ‘Where is. They have taken risk measures since the flu pandemic preparedness plans, but especially since the Ebola crisis, and have adopted valid coordination systems for any health emergency. The ability to detect early cases is essential, if not essential, and is known to be difficult because most patients are asymptomatic or have very mild symptoms.
Given that the risk of importing into Africa is currently lower than elsewhere because several countries have taken the right measures at the right time – such as reducing the number of flights from abroad to limit the risk of importing COVID- 19 – if they are able to detect the first cases and isolate them each time, there will be less risk of secondary transmission. The idea is to continue to work on a daily basis to strengthen all the elements of the response, from the coordination of surveillance to early warning, diagnosis and public health management.
This article is adapted from the original, which was published in French.