Geneva, Swiss
Whether it's a matter of
faulty detection, climatic factors or simple fluke, the remarkably low rate of
coronavirus infection in African countries, with their fragile health systems,
continues to puzzle and worry experts.
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| Nigeria was the first sub-Saharan country to report an official case of coronavirus, when an Italian working in the country came back from Milan on February 24 carrying the virus. |
To date, only three cases of
infection have been officially recorded in Africa, one in Egypt, one in Algeria and one in Nigeria, with
no deaths.
This is a remarkably small
number for a continent with nearly 1.3 billion inhabitants, and barely a drop
in the ocean of more than 86,000 cases and nearly 3,000 deaths recorded in some
60 countries worldwide.
Shortly after the virus
appeared, specialists warned of the risks of its spreading in Africa, because of the
continent’s close commercial links with Beijing and the fragility of its
medical services.
“Our biggest concern continues
to be the potential for Covid-19 to spread in countries with weaker health
systems,” Tedros Adhanom Ghebreyesus, the head of the World Health Organization, told African Union health ministers
gathered in the Ethiopian capital of Addis Ababa on February 22.
In a study published
in The Lancet medical journal on the preparedness and
vulnerability of African countries against the importation of Covid-19,
an international team of scientists identified Algeria, Egypt and South Africa
as the most likely to import new coronavirus cases into Africa, though they
also have the best prepared health systems in the continent and are the least vulnerable.
As to why the epidemic is not
more widespread in the continent, “nobody knows”, said Professor Thumbi
Ndung’u, from the African Institute for Health Research in Durban, South
Africa. “Perhaps there is simply not that much travel between Africa and
China.”
But Ethiopian Airlines, the
largest African airline, never suspended its flights to China since the
epidemic began, and China Southern on Wednesday resumed its flights to Kenya.
And, of course, people carrying coronavirus could enter the country from any of
the other 60-odd countries with known cases.
Favourable climate factors
have also been raised as a possibility.
“Perhaps the virus doesn’t
spread in the African ecosystem, we don’t know,” said Professor Yazdan Yazdanpanah,
head of the infectious diseases department at Bichat hospital in Paris.
This hypothesis was rejected
by Professor Rodney Adam, who heads the infection control task force at the Aga
Khan University Hospital in Nairobi, Kenya. “There is no current evidence to
indicate that climate affects transmission,” he said. “While it is true that
for certain infections there may be genetic differences in
susceptibility...there is no current evidence to that effect for Covid-19.”
The study in The Lancet found
that Nigeria, a country at moderate risk of contamination, is also one of the best-equipped
in the continent to handle such an epidemic.
But the scientists had not
anticipated that the first case recorded in sub-Saharan Africa would be an
Italian working in the country.
Little more than a week ago,
“our model was based on an epidemic concentrated in China, but since then the
situation has completely changed, and the virus can now come from anywhere,” Mathias Altmann,
an epidemiologist at the University of Bordeaux and one of the co-authors of
the report, told FRANCE 24 on Friday. The short shelf-life of studies testify
to the speed of the epidemic’s spread.
The Italian who tested
positive for the coronavirus in Lagos had arrived from Milan on February 24 but
had no symptoms when his plane landed. He was quarantined four days later at
the Infectious Disease Hospital in Yaba. Several people from the company where
he works have been contacted and officials are trying to trace other people
with whom he might have had contact.
For Altmann, an expert in
infectious diseases in developing countries, the fact that coronavirus appears
to have entered sub-Saharan Africa through Nigeria is “actually good news”,
because the country appears to be relatively well prepared for confronting the
situation.
In a continent that “has had
its share of epidemics and whose countries, therefore, have a huge knowledge of
the field and real competence to react to this kind of situation”, Nigeria is
in a very good position to confront the arrival of Covid-19, Altmann said.
“The CDC [Center for Disease Control] responsible for the
entire region of West and Central Africa is located in Abuja, the capital of
Nigeria, which means that their organisational standard in health matters is
very high,” he added.
The country was already
renowned for “succeeding to pretty quickly contain the Ebola epidemic in 2014,”
Altmann points out. It took the Nigerian authorities only three months to
eradicate Ebola in the country.
The World Health Organization and the European
Centre for Disease Prevention and Control at the time congratulated Nigeria for
its reactivity and “world-class
epidemiological detective work”.
But despite Nigeria’s
strengths, the coronavirus pathogen represents a particular challenge, in that
it is hard to detect. The virus may be present in an individual who has few or
no symptoms, allowing it to spread quietly in a country where, like everywhere
in Africa, there is “a shortage of equipment compared to Western countries,
especially in diagnostic tools”, Altmann said.
Neighbouring countries like
Chad or Niger have “less functional capacity to handle an epidemic,” Altmann
said. But they also have an advantage: these are agricultural regions where
people are outdoors more, “and viruses like this one prefer closed spaces and
are less likely to spread in a rural setting,” he added.
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