African
nations are facing a surge of COVID-19 cases with less than one intensive care
bed and one ventilator per 100,000 people, a Reuters survey has found.
Even in a best-case scenario, the continent could
need at least 10 times the number it has now as the outbreak peaks, an analysis
of researchers’ projections showed.
The shortages across Africa’s national health
systems are among the starkest elements to emerge from the survey, which polled
54 countries and received responses from health officials or independent
experts in 48 of them. The results provide the most detailed public picture to
date of the continent’s key resources, testing and personnel for the disease
caused by the new coronavirus, which has killed more than 262,000 people
worldwide, according to a Reuters tally.
The World Health Organization (WHO) has warned that
Africa, home to 1.3 billion people, could become the next epicentre of the
pandemic.
The continent has recorded over 51,000 COVID-19
cases, a fraction of the 3.76 million recorded globally, according to a Reuters
tally. But low levels of testing make it impossible to know the true scale of
infection. The United Nations Economic Commission for Africa (UNECA) has said
Africa could see nearly 123 million cases this year, causing 300,000 deaths.
Assuming a complete lockdown for an indefinite
period, at least 121,000 critical care beds will be needed continent-wide when
the pandemic peaks, according to a Reuters analysis of the projections by
scientists at Britain’s MRC Centre for Global Infectious Disease Analysis at
Imperial College London, on which the UNECA forecasts are based.
That compares with just 9,800 available intensive
care beds found in the survey, conducted through April and May. The survey also
revealed severe shortfalls in testing, personnel and oxygen supplies.
Many African nations moved quickly to contain the
virus, launching high-profile public health campaigns, restricting movement and
repurposing factories to produce protective equipment.
“We are preparing,” said Dr. Juliet Nyaga, chief
executive of Karen Hospital, a private facility in Kenya, as she showed Reuters
an isolation unit they had set up in a nursing school. “But it’s like being in
a movie that no one has ever rehearsed, and we didn’t get the script.”
International organizations including the WHO and
World Bank are helping, but they say they are hampered by problems finding
reliable data to measure the continent’s needs.
Africa’s testing capacity has expanded sharply but
the continent has still carried out only around 685 tests per million people,
according to Reuters’ tally of figures from the Africa Centres for Disease
Control and Prevention (Africa CDC).
By comparison, Europe has carried out nearly 17
million tests, or just under 23,000 per million.
“If you don’t test, you don’t find,” said John
Nkengasong, director of the Africa CDC.
The organization, set up by the African Union in
2017, worked with the WHO to rapidly roll out testing.
In January, only South Africa and Senegal could
test; now all African countries can except for tiny Lesotho and the island
nation of Sao Tome and Principe.
Yet many cannot make full use of their capacity.
Kenya’s labs could carry out 37,000 tests daily, a Senate report based on
information from the health ministry found, but it has only done 26,000 to
date. It lacks laboratory personnel, sample collection kits and supplies, and
has also received faulty test kits as donations, the report said.
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| A nurse demonstrates how to activate a respirator as the hospital prepares for the coronavirus disease (COVID-19) outbreak, at the Karen hospital near Nairobi, Kenya |
Chad and Burundi have carried out fewer than 500
tests each. Mahamout Khayal, Chad’s health minister, told Reuters that testing
levels were low due to a lack of kits, but also because many staff who had been
carrying out tests had themselves fallen ill, so were no longer able to work.
The WHO estimates around 14% of COVID-19 patients
will require hospitalization and oxygen support, and about 5% will need a
ventilator - generally found in an intensive care unit (ICU).
Even in the best-case scenario, the Reuters survey
suggests, an average of 12 COVID-19 patients in Africa could be lined up for
each available ICU bed at the height of the outbreak, although the timing of
peak demand will differ in each country.
The continent’s three most populous nations - Nigeria,
Ethiopia and Egypt - have 1,920 intensive care beds between them for more than
400 million people. Nigeria’s health minister said the country had not had to
use most of its ICU equipment yet, but had still ordered more. The other two
nations did not respond to requests for comment.
Intensive care beds are expensive, difficult to
run, and unevenly distributed. Chad, an oil-rich but impoverished nation of 15
million people, has only 10, whereas the island nation of Mauritius, a
financial hub home to 1.2 million, has 121.
Most COVID-19 patients who need critical care also
need a ventilator. However, Reuters found that just over 9,300 of the
continent’s 9,800 intensive care beds have them.
Some nations, such as Guinea Bissau, have no
ventilators at all. Mauritania has one; Liberia said it has six; Somalia has
19.
Tumane Balde, head of an inter-ministerial
commission to tackle COVID-19 in Guinea-Bissau, said the country only had 10%
of the equipment it needs. “Our staff are under-equipped and unmotivated,” he
said. “We need three times more beds than we have.”
Officials at Mauritania’s health ministry, and a
representative for Liberia did not respond to requests for comment.
South Africa has 3,300 ventilators, but about
two-thirds are in private hospitals, which most people cannot afford. The
health ministry said the state has the right to use private facilities in an
emergency.
Ventilators need oxygen, which can come from oxygen
plants, cylinders or machines. Kenya has nearly 300 ventilators but a “critical
shortage” of oxygen, the Senate report found.
Last month, its ministry of health implored
hospitals to pay outstanding bills to the company that supplies many of them
with cylinders.
Information is as important as equipment. Some
nations have been quick to provide health data. In others, information is
patchy, out of date or secret. Some leaders may fear public criticism over
crumbling public services, said Michel Yao, emergency operations manager in
Africa for the WHO.
“Information is critical for us to better help,” he
told Reuters. “It’s difficult to anticipate their overall needs if you don’t
have accurate information.”
The East African nation of Tanzania, publicly
criticised by the WHO for not restricting large gatherings, has sometimes gone
for days without updating its coronavirus figures.
It won’t tell donors about its public health
resources, a diplomat told Reuters. A government spokesman denied allegations
Tanzania was not sharing information and referred Reuters to the health
ministry, which did not respond.
And official figures don’t always match frontline
experience.
Uganda said it has 268 ICU beds in public hospitals.
But only about 70 ICU beds countrywide have enough staff and equipment to
function, said Arthur Kwizera, a lecturer in anaesthesia and intensive care at
Makerere University College of Health Sciences, whose team carried out a study
on intensive care capacity late last year. The government did not respond to
requests for comment on that point.
Many ICU beds are also already in use. Kenya, for
example, has 518 beds in its public and private facilities, but 94% are already
occupied by non-COVID-19 patients, said the Senate report.
Even where equipment is available, power and
personnel may not be. In nations such as Nigeria, South Sudan and Zimbabwe,
electricity is extremely unreliable. Hospitals depend on diesel-powered
generators, but some can’t afford refueling and maintenance.
Doctors, critical care nurses, anaesthesiologists
and biotechnicians - essential for maintaining equipment - are in short supply,
data from the World Federation of Societies of Anaesthesiologists (WFSA) and
World Bank shows - although figures from many countries date back years.
Continent-wide, one doctor serves an average of
80,000 people, World Bank data shows.
Anaesthetists often run critical care units in
Africa. But only nine countries have one or more physician qualified to
administer anaesthetics per 100,000 people, according to the WFSA.
Equipment and personnel are arriving: The World
Bank is helping more than 30 African nations obtain more than $1 billion worth
of equipment. And planeloads of aid are arriving from Turkey, China, Europe and
the Middle East.
The private sector is also gearing up. Private
hospitals are generally better staffed, but their revenues have been squeezed
by a decline in elective surgeries and regular outpatient chronic treatment, said
the Africa Healthcare Federation, an umbrella organisation for private
healthcare.
Some governments on the continent are trying to
negotiate access to private hospitals for patients who can’t afford the fees.
But most private hospitals need some form of
payment and - mindful of governments that pay bills late or not at all - some
want an internationally-administered independent fund to handle the payments. - Reuters
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