By
Adamu Vaughan
Experts
still don’t know why so few cases of the new coronavirus have
been reported in Africa, despite China – where the virus originated – being the
continent’s top trading partner and the continent having a population of 1.3
billion people.
Moroccan health workers scan passengers arriving from Italy |
Although
the official number of cases in Egypt spiked from two to 59
over the weekend, including 33 people who were on a Nile cruise,
across Africa the number of cases has stayed low.
As of
Tuesday morning there were just 95 official cases on the continent, though two
countries – Togo and Cameroon – reported their first cases over the weekend.
The
spread in Africa is of concern because of the fragility of some countries’
healthcare systems, and the continent already faces big public health issues,
particularly malaria, TB and HIV.
The
World Health Organization (WHO) has rushed to beef up the ability of African
countries to test for the virus and train health professionals in caring for
people affected by it. Only Senegal and South Africa had labs that could test
for the virus at the end of January, but 37 countries now have testing capability.
Mary
Stephen of the WHO, who is based in Brazzaville in the Republic of the Congo,
says she believes the running tally of cases is accurate because more than 400
people have been tested for covid-19 across Africa so far. “I wouldn’t say it’s
an underestimate,” she says.
“It
will always be possible to miss cases and that’s always been admitted in the
UK,” says Mark Woolhouse at the University of Edinburgh, UK. But given
heightened awareness in Africa, the lack of coronavirus-linked deaths on the
continent implies there aren’t yet big undetected outbreaks, he says. “If there
were major outbreaks, of the scale that Italy or Iran have had, anywhere in
Africa, I would expect those deaths to be well above the radar by now.”
On the
question of whether the low cases are due to a lack of detection or the virus
simply not having yet spread to many African countries, David Heymann at the
London School of Hygiene and Tropical Medicine (LSHTM) says simply: “Nobody can
answer that.”
Jimmy
Whitworth at LSHTM says he doesn’t think we can say why the numbers are so low
but one possible reason could be isolation measures implemented by countries.
Most cases in Africa have been imported not from China but from Europe.
Four
African countries have imposed quarantines on visitors from coronavirus
hotspots. Unlike virus cases, quarantine numbers aren’t being reported.
More
broadly, on the monitoring efforts to detect the virus at airports and other
entry routes, Whitworth says “a lot’s being done”, citing coordination by the
WHO and both the African and US Centres for Disease Control.
Rwanda,
for example, has recruited final year medical students to undertake screening
at airports, says Woolhouse.
Vittoria
Colizza at Sorbonne University in France, author of a paper about African
countries’ vulnerability to covid-19, says a combination of factors
could account for the low case numbers.
One reason
could simply be the nature of the virus: a lot of people may be travelling
around infected but without symptoms, says Colizza. She suggests
under-detection of incoming cases and a lack of capacity to monitor and do
active surveillance could also be involved.
Colizza’s
analysis of the first 300 cases exported from China suggests that about 60 per
cent of people who were infected were missed by detection. Other research led
by Ashleigh Tuite at the University of Toronto, Canada, has suggested
under-reporting by 27 to 75 per cent in Italy, taking into account both
imported cases and transmission within the community.
The WHO
says “most” of the 37 countries in Africa with testing capacity have between
100 and 200 testing kits. Researchers think many more will probably be needed
as cases spread, but that this is a start. “It is much better to have some than
no capacity at all,” says Woolhouse.
African
countries are both vulnerable and potentially more resilient to the
coronavirus. On the one hand, the population is much younger than in Europe and
China. The median population age in the UK is 40.2 and in China it is 37, but
this figure is 17.9 in Nigeria, Africa’s most populous country. “If you look at
the statistics from China, the people that have worse prognosis are the older
people, not necessarily the young,” says Stephen.
The
flipside is healthcare systems are generally more fragile in many African
countries, says Stephen. “If this outbreak comes in, it’s going to collapse the
healthcare systems,” says Heymann.
The big
risk is that fighting a coronavirus outbreak becomes a distraction for
healthcare systems tackling other diseases that burden the region, including
malaria and measles, says Woolhouse. He points to the 2014-16 Ebola outbreak,
where many of the thousands of resulting
deaths were due to resources being diverted away from other
diseases. - Africa
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