Coronavirus: “We’ve gone from looming threat to looming disaster”
John Nkengasong, the director of the Africa Centres for Disease Control and Prevention (Africa CDC), part of the African Union, is leading the continental response to the Covid-19 pandemic.
In the course of a wide-ranging interview on 21 March, the Cameroonian virologist, who is based in Addis Ababa, detailed the measures Africa is taking to prepare for the health crisis that lies ahead.
He highlights the coordination across member states of the African Union, which has been far greater than within the European Union, but also shared his growing fear that the continent would not be able to cope with this outbreak. He called for the solidarity of the international community.
Last month you warned that Covid-19 might have a “devastating” impact on Africa. Are you even more concerned now?
John Nkengasong: I said then that it was a looming threat for the continent; now I can actually say that it’s a looming disaster for the continent. We see what went on in China and what is going on in North America and Europe: it is devastating.
The exponential spread of the disease, the number of deaths, and how much money these countries that are extremely developed are injecting in their economies.
We don’t have – not remotely – those kinds of resources. I am extremely concerned with what could happen in Africa. We have to see this pandemic as an economic disaster, a security disaster and a humanitarian disaster – and they’re all interrelated.
A model published in the medical journal The Lancet last month showed Nigeria to be among the African countries least at risk of importing the virus from China. Now cases are multiplying there, too. What happened?
A viral infection is very, very unpredictable, because it takes just one case for it to expand very quickly.
Now, you can begin to see that those countries that were predicted to become most affected in that modeling have been affected, but they have been affected almost at the same time as a vast majority of countries.
I think we’re probably now close to 38 countries [in Africa with at least one confirmed case]. The whole model was based on the threat coming from the east – from China – but the threat for the continent has now come from the north, from Europe.
Airlines are now halting travel between Europe and Africa, and are reducing the number of intra-African flights, too. Can this help, considering that the virus has already arrived in most countries?
I doubt it. These are measures we are very concerned about because it makes it harder for us to support countries to fight the virus.
Ethiopia used to be a wonderful hub to provide support, but now we can’t move to any countries to support them because of air travel being down.
It’s clear that all countries in Africa will be affected because the borders are extremely porous. How do we contain the virus without bringing in diagnostics, without bringing in personal protection?
Is your ability to provide aid already hindered by restrictions on airborne travel?
Absolutely. I’m working on the shipment of a donation from [Chinese billionaire] Jack Ma, which is an initiative with the prime minister of Ethiopia to provide over 1.5 million tests and other personal protective equipment to many countries in Africa.
The shipment is going to arrive tomorrow by cargo flight from China to Addis Ababa, but we will struggle very much to get it to the countries quickly.
There should be a corridor open so that we can provide support. We will be providing guidance to the leadership of the African Union Commission so that they can interact with member states adequately and at least allow us to be able to travel.
Any delays in delivering any of these supplies and diagnostics will be catastrophic. Africa CDC has already sent out 70,000 tests, but it is not enough.
A first meeting of Africa’s health ministers was convened on 22 February. Did it result in greater pan-African coordination of the response?
The African Union Commission exercised leadership very early on. Remember that our first case on the continent was reported on 14 February.
A week later, the Commission convened a meeting of all ministers. They agreed on the need to have a continent-wide strategy and established a coronavirus taskforce, which has six technical groups that have been working closely with the member states, the WHO and Africa CDC to prepare the continent.
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In the first week of February, there were only two countries that had diagnostic capacity – Senegal and South Africa – but through our coordinated partnership we scaled it up to 48 countries.
That is remarkable. It shows what a coordinated strategy across the continent can bring.
Health care across Africa was already either stretched or overwhelmed by existing epidemics. Will it quickly break under the pressure of this new disease?
It is one of my greatest concerns. We already received a distress call from South Africa because this outbreak is coinciding with their seasonal flu outbreak.
The Congolese virologist Jean-Jacques Muyembe Tamfum fears a 10% mortality rate in the DRC. Is such a high rate possible?
I don’t know on what basis he has made those assumptions, but we are dealing with a virus for which we have no pre-existing immunity on the continent, and we are also faced with a lot of comorbidity.
We don’t know how a widespread infection of Covid-19 will interact with tuberculosis, malaria and HIV. We just don’t know.
What is being done to increase the number of available respirators and intensive care beds, both vital tools to adequately tend to the most severe cases?
We look at the entire continent and there are shortages across the board. We have to think of innovative ways of responding to that and are mapping which companies are willing to provide us with this equipment.
We’re looking at Morocco, South Africa and Egypt as potential places that can repurpose manufacturing and bring that to bear. Outside the continent there are other places we are exploring, including Thailand.
But very importantly, this is a time for global solidarity.
Even as the West is battling its own pandemic, Africa has to be remembered. We cannot produce these instruments ourselves overnight, so we have to also rely on support from the West.
Some scientists believe the virus may retreat at warmer temperatures, as the flu and common cold typically do. Might Africa’s climates, on average warmer than Europe’s, help slow the pandemic?
We remain hopeful for anything that can slow the pandemic in Africa. I can only tell you that this is a hypothesis for now. We will need to observe the pace of transmission.
Again, it’s not a question of months, it’s a question of weeks.
How about Africa’s demography, younger people being on average less affected than the elderly?
That is true, but we need to take a nuanced view on that.
We are now beginning to see data from the US showing that, among those who require intensive care, there are also very young people. Yes, 70% of our population is less than 30 years old, but there are a lot of other underlying conditions like malnutrition, and other coinfections, here.
Some have leaped on the unconfirmed news that chloroquine might help against the disease to self-prescribe this anti-malaria drug. Nigeria has already reported a number of cases of chloroquine poisoning. What do you say to those turning to it for protection?
I would say that there have been no controlled clinical trials that show that.
My general advice to the continent is that, if you need information, go to the WHO and Africa CDC websites.
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We’ll be doing a series of podcasts in coming days, in French and English, where people can hear from the experts what the reality is.
There is a lot of confusion and fear, and people are trying to help themselves as much as possible. But there is really no scientifically proven data to justify that.
Malawi has declared coronavirus a national disaster before confirming a single case, while Tunisia has gone into lockdown just one day after the country announced its first death. Might these early measures be overly drastic?
We have designed a step-by-step guideline of what countries should do. We are encouraging social distancing, which means to stop gatherings.
We don’t encourage locking down an entire country where you have no case or just one case. That is difficult to sustain and will lead to other consequences, such as shortages of food, medicine and other basic supplies.
People need to increase the frequency of washing their hands and maintain their distance from one another. These are things that we can all begin to do to deny the virus the opportunity to spread.