Coronavirus: why Africa seems to have few cases

When Egypt confirmed Africa’s first coronavirus infection on 14 February, the World Health Organization (WHO) braced for a serious outbreak across the continent.

Cases of the new virus, which causes Covid-19 disease, have since been confirmed in Algeria, Tunisia, Morocco, Senegal and Nigeria.

Yet Africa remains largely free of coronavirus infections compared with Europe and Asia - a phenomenon that has health specialists scratching their heads, given the continent’s close ties with China.

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So why does Africa have so few cases?

“This is the question that everyone is asking, especially as other regions such as South America or Eastern Europe now have cases,” Amadou Alpha Sall of the Pasteur Institute, in Senegal’s capital Dakar, told Paris-based news agency AFP.

One reason may be that levels of travel to and from China’s Hubei province, the epicentre of the outbreak, are relatively low in Africa compared with other regions.

Another possibility is that cases are going undetected, because Africa’s health officials are less well equipped to carry out testing than those in many other areas of the world.

But undetected cases would result in an outbreak that would be “surely detected, because [undetected] it spreads faster”, says Michael Yao, WHO’s head of emergency operations in Africa.

Some commentators have suggested that the hot climate in Africa might ward off or even kill the virus.

However, “there is no current evidence to indicate that climate affects transmission”, according to Rodney Adam, who heads the infection control task force at the Aga Khan University Hospital in Nairobi.

He adds: “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.”

What is Africa doing to prevent the spread?

The Ebola outbreaks “that have struck parts of West Africa and the Democratic Republic of Congo have generated valuable skills for handling coronavirus”, reports AFP.

“This experience may add value on ground,” says WHO’s Yao.

However, as Yao warned after the first case in Africa was confirmed, “we know how fragile the health system is on the African continent and these systems are already overwhelmed by many ongoing disease outbreaks, so for us it is critical to detect earlier so that we can prevent the spread”.

Many African governments have put in place screening at points of entry, including airports. And African airlines have cancelled scheduled flights to and from mainland China, with the exception of Ethiopian Airlines.

A number of sporting events have also been cancelled or postponed, including the inaugural Basketball Africa League (BAL). The new professional league, a partnership between the International Basketball Federation and the NBA, was due to tip off in Senegal on 13 March, says the CNBC.

Senegal recorded two new cases of coronavirus on Wednesday, bringing the total in the West African nation to four, Africa News reports. One of the newly confirmed patients is a British national who travelled to Dakar on 24 February from London.

In another preventative measure, Tanzania’s football federation (TFF) has banned hand-shaking before games, citing advice from the country’s Ministry of Health. Tanzania’s State House shared photos showing President John Magufuli exchanging a foot greeting with an opposition leader instead of a handshake.

Zimbabwe has announced plans to deport any foreigners who have not been given “medical clearance” by their home countries.

Meanwhile, Kenyans caught sharing “fake news” about the coronavirus could be fined $50,000 (£39,000) or jailed for two years, the government has warned.

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Is a major outbreak likely in Africa?

Africa is vulnerable to the spread of coronavirus, and preventative measures are unlikely to keep the virus contained for much longer, with experts warning it is just a matter of time.

“We think Africa is going to be affected,” said Yazdan Yazdanpanah, head of the infectious diseases department at Bichat Claude-Bernard Hospital in Paris.

However, the delay has bought Africa some time to prepare, and equip countries with laboratories for testing.

“In the beginning we had two, South Africa and Senegal... [now] we have 29 out of 47 countries that have laboratories that can perform the tests. So this is progress,” said Yazdanpanah.

“We were lucky to have a big window of opportunity.”

All the same, a 2016 analysis by US-based think-tank the Rand Corporation found that Africa accounted for 22 of the 25 countries in the world that are most vulnerable to infectious outbreaks.

A study published in The Lancet medical journal last month found that African countries with the highest importation risk - Egypt, Algeria, and South Africa - have “moderate to high capacity to respond to outbreaks”.

But countries at moderate risk - Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya - “have variable capacity and high vulnerability”, the researchers warned.

Of those countries at moderate risk, only Nigeria has so far reported a coronavirus case, in an Italian citizen who works in Nigeria and who returned from Milan to Lagos in February, according to statistics site Worldometer.

When more cases arrive from overseas, however, the vulnerability of many African countries’ healthcare systems is likely to be exposed.

In these countries, a sudden surge in numbers of seriously ill patients could overwhelm intensive care units.

“Africa is at high risk,” says WHO’s Yao.