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JOHANNESBURG (Reuters) – Africa’s overburdened public health systems, shortage of testing facilities and overcrowded slums led experts to predict disaster when COVID-19 hit the continent in February.
The new coronavirus was already wreaking havoc in wealthy nations in Asia and Europe, and a United Nations agency said in April that, even with social distancing measures, the virus could kill 300,000 Africans this year.
In May, the World Health Organization (WHO) warned that 190,000 people on the continent could die if containment measures failed. However, as the world marks 1 million deaths from COVID-19, Africa is doing much better than expected, with a lower percentage of deaths than on other continents.
The case fatality count on the continent stands at 2.4%, with approximately 35,000 deaths among the more than 1.4 million people infected with COVID-19, according to Reuters data as of Monday night. In North America it is 2.9% and in Europe 4.5%
The worst affected countries, such as Italy and Great Britain, have recorded fatality figures of 11.6% and 9.0% respectively, compared with 1.6% in Ethiopia, 1.9% in Nigeria and the 2.4% from South Africa, the most affected country on the continent.
Hospitals in many African countries say that admission rates for COVID-19 are declining.
“Based on what we have seen so far, it is unlikely that we will see anything on the scale that we are seeing in Europe, both in terms of infections and mortality,” said Rashida Ferrand, a London School of Hygiene and Tropical Medicine. Professor who works at the Parirenyatwa Hospital Group in Harare, the capital of Zimbabwe.
Experts say that some deaths from COVID-19 in Africa are likely being overlooked. Testing rates on the continent of around 1.3 billion people are among the lowest in the world, and many deaths of all kinds go unrecorded.
South Africa saw an additional 17,000 deaths from natural causes between early May and mid-July, 59% more than would normally be expected, according to a July report by the South African Medical Research Council. That suggests that the death toll from COVID-19 could be significantly higher than the official figure, currently more than 16,000, the researchers say. Still, there is broad agreement that death rates from COVID-19 have not been as bad as predicted.
Why? Scientists and public health experts cite several possible factors, including the continent’s young population and lessons learned from previous disease outbreaks. African governments also had precious time to prepare due to the relative isolation of many of their citizens from airports and other places where they could come into contact with global travelers.
Some scientists are also exploring the possibility that a tuberculosis vaccine that is routinely given to children in many African countries could help reduce deaths from COVID-19.
Another theory being considered is whether previous exposure to other coronaviruses, including those that cause the common cold, has provided a degree of resistance in some of the same communities that were once thought to be the most vulnerable.
“There is a lot of circumstantial evidence,” Salim Abdool Karim, a South African infectious disease specialist who has advised the government on COVID-19, told Reuters, “but there is no evidence.”
LEARNED LESSONS
The virus reached Africa later than other continents, giving medical personnel time to set up field hospitals, obtain oxygen and ventilators, and learn from improvements in treatment elsewhere.
“We received the gift of time,” said Thumbi Mwangi, a senior researcher at the Institute of Tropical and Infectious Diseases at the University of Nairobi. “We had an amount of preparation that others did not have.”
One reason could be that international travel is limited in many African countries, and traveling within the country can be more difficult than on other continents, Matshidiso Moeti, WHO’s regional director for Africa, said at a news conference Thursday.
Governments on the continent have also battled deadly infectious diseases like Ebola, which killed more than 11,000 people in West Africa in 2013-16. So officials took notice when the new coronavirus began to spread rapidly around the world earlier this year.
Many African countries were quick to introduce controls at airports, suspend flights from heavily affected countries, and enforce social distancing measures and the use of masks.
A week after Kenya reported its first case, schools were closed, incoming travelers had to undergo mandatory quarantine, and large gatherings were banned. Nigeria, the most populous nation in Africa, imposed a ban on interstate travel and a curfew. Many of its land borders had already been closed since August 2019 to reduce smuggling, which also helped fight the pandemic.
South Africa introduced one of the toughest blockades in the world in late March, when the country had confirmed only 400 cases.
“Africa toppled the hammer earlier in terms of coronavirus lockdowns,” said Tim Bromfield, regional director for Eastern and Southern Africa at the Tony Blair Institute for Global Change, a UK-based think tank.
Experts also point to the demographics of the continent.
Research has found that the risk of developing severe COVID-19 increases with age.
A 2019 United Nations report said that 62% of sub-Saharan Africa’s population was under 25 years old and only 3% were 65 or older. In the United Nations Europe and North America region, 28% were under the age of 25, while 18% were 65 and over.
Chikwe Ihekweazu, director general of the Nigerian Center for Disease Control, attributed his country’s relatively low case fatality rate in part to the fact that most of the patients were between 31 and 40 years old.
CROSS PROTECTION?
Scientists from several countries, including South Africa, are testing whether the century-old Bacille Calmette-Guérin (BCG) vaccine, widely used on the continent against tuberculosis, provides a degree of cross-protection.
BCG vaccines have been shown to protect against other viral respiratory diseases, and a study published in July in the scientific journal Proceedings of the National Academy of Sciences found that countries with higher rates of tuberculosis vaccination had higher peak death rates. casualties due to COVID-19.
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Studies have also started in South Africa and Zimbabwe to assess the impact of past exposure to other coronaviruses.
More than half of Africa’s urban population is concentrated in slums, where access to water for hand washing is scarce and physical distancing is almost impossible.
Diseases spread rapidly under such conditions, but some scientists wonder if that may have been an unexpected blessing in this case. There is some evidence that T cells developed by the body’s immune system after exposure to other common cold coronaviruses could help fight COVID-19.
“I would say it is at least a plausible explanation for why there are different levels of resistance to the virus in different populations,” said Thomas Scriba, immunologist and deputy director of the South African Tuberculosis Vaccine Initiative.
Others are more skeptical.
“All other regions have been exposed to coronaviruses, have poor people and slums and have received the BCG vaccine,” said Humphrey Karamagi, leader of the data and analysis team at the WHO Africa office. “Most likely, we are seeing a combination of multiple factors working together, and not a single magic formula.”
For Sam Agatre Okuonzi of the Arua Regional Reference Hospital in Uganda, predictions of the end of the world were based on entrenched prejudices, including the fact that the continent is prone to disease.
“COVID-19 has destroyed a lot of prejudices about diseases in general, but also about Africa,” he said in Thursday’s briefing. “The severity of the pandemic has not developed according to the outrageous predictions.”
