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In early August, the African Centers for Disease Control and Prevention (CDC Africa) reported that the number of Covid-19 cases in Africa had reached one million. However, since there were 30,000 victims of the epidemic as of August 28, the number of deaths here is lower than on any other continent. Africa appears to be handling the pandemic surprisingly well.
As the coronavirus turned into a global pandemic in early 2020, there were well-founded fears that Africa could be hit particularly hard. Weak health systems, scarce emergency resources, and a long history of outbreaks did not bode well.
According to the May forecast of the WHO Regional Office for Africa, in the first year of the pandemic alone, up to 190,000 deaths and 29 to 44 million people infected by coronavirus were expected on this continent. Why did this scenario not come true? This can only be explained by the interaction of many factors that, on the one hand, make Covid-19 less visible in Africa and, on the other, weaken its impact.
Notification and control of Covid-19 cases relies primarily on testing, and there is a shortage of tests and examinations in Africa. The testing resources are inadequate. The WHO recommends one test per 1,000 people per week, but in Africa, on average, only half of that is done. Also, laboratory facilities for testing in African countries are completely different: in South Africa, a lot of tests are carried out, but in densely populated Nigeria, on the contrary, there are few.
The paucity of evidence likely hides significantly more people with Covid-19. Donor antibody testing in Kenya, conducted by the Kenya Medical Research Institute in conjunction with the Wellcome Trust, has shown that approximately one in 20 Kenyans aged 15 to 64, a total of 1.6 million people, has antibodies against SARS-CoV-2, that is, these people are probably infected. But since March 12, Kenya has reported only 450,146 infections.
Due to the lack of massive evidence, the spread of the virus can be assessed by increased mortality, the so-called increased or excess mortality. In South Africa, the number of deaths from the beginning of May to the end of June was four times the normal rate. But in other parts of the continent, this figure is difficult to determine. Recording mortality during a pandemic is complicated by the fact that many public health workers are involved in testing and tracking virus chains, or unable to move freely due to restrictions.
According to the International Rescue Committee, due to huge gaps in testing and control of the pandemic, Africa is fighting it “in the dark”. And yet it appears that healthcare facilities are not experiencing the same pressures that might be seen at the peak of the pandemic in Europe or the United States. Here, too, factors of another kind are involved.
One of the leading causes of death in Africa is upper respiratory tract infections, particularly pneumonia or bronchitis, which account for 10% of deaths across the continent. Covid-19 and other respiratory diseases cause similar symptoms and can lead to pneumonia. Many doctors may attribute their patients’ airway symptoms to common infections rather than a new type of virus that they cannot detect. Thus, due to an incorrect diagnosis, a significant number of cases of Covid-19 infection can hide behind common respiratory diseases.
The African population is young. Young people, although they do not have immunity, are less likely to develop a serious illness or die from Covid-19 and, therefore, the pandemic is easier. 65% of the African population is under 35 years old, almost 50% is under 19. For comparison: in the EU the average age is 42 years, in Africa 19.7 years.
The young age of the African population, as well as the particularly active spread of the virus in urban areas where people live even younger, may provide an answer to the question of why most infections in Africa are asymptomatic or mild. According to the Kenyan Ministry of Health, in 78% of cases, Covid-19 is asymptomatic or mild and in Ghana, according to the country’s health service, this occurs in 82% of all cases.
Although health systems in Africa are relatively weak, African countries have gained experience in treating a pandemic in the recent past.
In the wake of the Ebola outbreak in West Africa, the African Centers for Disease Control and Prevention were established to improve control of the epidemic across the continent and ensure coordination between countries.
This could explain the rapid response of many African countries to the Covid-19 pandemic. They have introduced various forms of travel restrictions and other restrictive measures to conserve the capacity of their health systems, cope with the virus and slow its spread. Additionally, states not only encouraged social distancing rules, hand hygiene, and the use of face masks, but in many cases made them mandatory and people easily complied with them. Despite the lack of testing facilities, there are a large number of local medical volunteers across the continent to monitor the spread of infection and encourage people to follow rules of conduct to ensure personal safety. This could contribute to the current slowdown in the spread of Covid-19.
If a few months or even years, we would see which of these factors most counteracts the spread and negative consequences of Covid-19. What is clear is that global pandemics manifest themselves locally and regionally in accordance with the complex environment that affects the severity of their course. As we continue to fight the virus and prepare for potential future outbreaks, to effectively address the pandemic, we must align our mechanisms with this set of interconnections.
Thus, the rest of the world can learn some lessons for itself from the experience of Africa. First, when symptoms of a disease appear, quick action is needed, even if the measures taken are imperfect. Second, low-cost solutions, such as employing community health workers and encouraging changes in people’s daily behavior, can have a profound impact on the minds of the general population.
Africa will be able to return to normal life faster than in other regions. While almost everyone fears a second wave or an increase in the number of cases in winter, most African countries, for lack of an alternative, rely on herd immunity. Due to the paucity of evidence, it is not possible to trace the chains of contagion that spread among a large part of the African population, which could stop or slow it down.
However, due to the relatively young population, in many cases the disease is asymptomatic or mild, so the virus does not have such devastating consequences as in other regions. This is the reason why most African governments are now in the process of kick-starting and rebuilding their economies severely affected by the pandemic. On a continent with most of its inhabitants struggling to make ends meet, the recession could be as devastating as the coronavirus.
Eugene Ngumi
Read the original text in IPG-Journal
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