Low death toll from coronavirus raises hopes that Africa will be saved worse

Since the first case of African coronavirus was confirmed on February 14 when a Chinese citizen was diagnosed in Egypt, the virus has spread to virtually every corner of the continent.

Bill Gates, the founder of Microsoft whose charitable foundation focuses on the pandemic, warned that if left unchecked in a region of crowded slums and flimsy health systems, the disease could take a horrible life for 10 million Africans.

However, more than two months later, some dare to whisper a more hopeful message. Maybe, just maybe, the continent could be saved from the worst of the pandemic. “I don’t get it,” said Kennedy Odede, a grassroots organizer who said that of 400 people randomly screened in Nairobi’s huge Kibera slum last week, only three were positive. “For me, it was good news.”

Africa has just over 32,000 official cases of the virus that has infected almost 3 million people worldwide and suffered less than 1,400 deaths. Given the limited testability, the numbers may largely underestimate the true burden, although Odede, like others, said there was little evidence of unexplained outbreaks of the virus. To the letter, the figures suggest that a continent of 1.2 billion people had suffered fewer Covid-19 deaths than the United States recorded each day.

“People begin to breathe with relief very cautiously, although it is too early to say we have dodged a bullet,” said Murithi Mutiga, an analyst in Nairobi with the Crisis Group think tank.

John Nkengasong, director of the Centers for Disease Control and Prevention in Africa, warned that it would be a mistake to draw firm conclusions. He said there was no strong evidence that any specific factor in Africa, be it a younger population, a warm climate or even the prevalence of BCG tuberculosis vaccines, had any impact on the spread of the disease.

“I would be extremely cautious at this point to make any statement that we are making slow progress and that there are special factors,” he said, adding that confirmed cases have increased by more than 40 percent in a week. That suggested Africa could simply be behind the curve, with the pandemic accelerating now.

“Our level of proof is extremely low,” he said, implying that many cases could have gone unnoticed. Some 415,000 tests meant that only 400 per million had been carried out, which is much lower than in Europe.

Rather than speculate on unproven factors that delay the spread of the disease, Nkengasong said he preferred to praise the decisive measures taken by governments. “African countries took very radical steps from the beginning by closing borders and making closings,” he said.

Paul Hunter, a professor of medicine at the University of East Anglia, said authorities were right to be cautious. Still, he said, there were reasons to suspect that the virus might be less deadly in Africa, where droplet-spreading diseases, like the flu, tend to spread more slowly. The continent had only one case of severe acute respiratory syndrome (Sars) during the 2002-2003 outbreak, with a single infection in Cape Town.

The slower spread of airborne infections, Professor Hunter said, could be attributed to less dense populations, the effect of ultraviolet light, or a climate that means people spend more time outdoors.

In the case of the coronavirus, he said, the juvenile population in Africa may also help explain the low death rate so far. The median age in Africa is 19.4 years, compared to 40 in Europe and 38 in the United States.

Professor Hunter said: “There have been so few cases of serious illness in people under the age of 20 in the West that, when you have a population of 19 years of age, the risk of a high number of deaths is substantially reduced.”

There was also no strong evidence, Professor Hunter said, that the benefit of young populations was affected by poor nutrition. “Malnutrition may be a contributing factor to mortality, but there is no evidence that at this stage it is only a hypothesis,” he said.

One way to judge whether coronavirus deaths could be underreported was to look in general mortality statistics for deaths that exceed normal levels. In South Africa, deaths in the year through April 14 were “generally within expectations,” according to the country’s Medical Research Council, suggesting few hidden deaths from coronavirus.

In Egypt, a country of 100 million people that has registered 4,782 infections and 337 deaths, an epidemiologist said the data published by the health ministry was insufficient to predict the course of the disease. But he doubted the official statistics were extremely inaccurate: “If infections were dramatically higher, we would see hospitals overwhelm, which is not happening. But it could still happen. “

Trudie Lang, director of the Global Health Network at Oxford University’s Nuffield Department of Medicine, said it would be wrong, and potentially dangerous, to jump to conclusions. According to the available data, it was too early to conclude that the disease was spreading more slowly.

However, Professor Lang said it was possible that the virus was spreading “differently” in Africa, even with more asymptomatic cases. It was also possible that people with underlying conditions, such as tuberculosis, might respond differently to Covid-19, possibly making patients more resistant, due to a previously activated immune response, rather than being more vulnerable, as usually assumes.

“It is really important to have conclusions based on evidence,” said Professor Lang, adding that conducting research on the progress of the disease was vital to help governments implement informed policies.

Until health experts knew exactly what was going on with the disease, he said, governments were right to err on the side of caution. “We need to keep measuring and keep testing,” he said.

Additional report by Heba Saleh in Cairo