Coronavirus: Will Africa’s low death rate survive lockdown easing?
In most African countries, the spread of the coronavirus has been through community transmission. Very few countries have widespread geographic transmission. The cases have been largely confined to capital cities and a few other localities. So is it all good news for the continent?
As of 18 June, the total number of confirmed cases of COVID-19 in Africa is over 260,000, with around 7,219 deaths.
South Africa has the most cases on the continent, with just under 76,000 confirmed; Egypt comes next at nearly 50,000. Algeria, Ghana, and Nigeria all have between 10,000 and 20,000 confirmed cases.
Low death rate, high recovery rate
Across the continent, a large number of those that have been infected by COVID-19 have recovered. The death rate is around 2.7%, and with over 118,000 former patients having recovered, the recovery rate 45%.
The Regional Director for Africa at the WHO, Dr Matshidiso Moeti, defines recovery as “having a couple of negative tests, having been tested positive [earlier].”
However, she adds: “With current capacity for testing, countries are not able to invest a huge number of tests in confirming that people are no longer positive.” That means the recovery rate is even higher than recorded, since many who are no longer carrying the virus are not tested and thus not officially counted.
The fears that Africa would be hit extremely hard by the pandemic have not come to fruition, yet. Compared to other regions, Africa is the least affected so far, accounting for only about 5% of global cases.
On the other hand, it is not all rosy news for Africa and the coronavirus.
Until a vaccine is developed, Moeti warns against a “steady increase in COVID-19 cases” on the continent. She said that strong public measures are needed in the current hotspots in the continent to try to curb this.
Is the data accurate?
The International Health Regulations is an international health treaty whereby member states have committed to sharing data in order to minimise the spread of disease. As some countries have higher coronavirus testing levels, the sharing of data portrays a truer picture of the outbreak, even in countries with limited testing.
Unlike many other diseases such as cholera, the COVID-19 pandemic entered the upper echelons of African societies, with notable figures like the President of Nigeria’s chief of staff, Abba Kyari, dying from complications after testing positive for the virus and possibly Burundi’s former president Pierre Nkurunziza who just died on 8 June.
As a result of this, governments have put more effort into the collection of data on coronavirus than they have been known to do with other diseases in the past.
The WHO collaborates with the African Centres for Disease Control, the US-based Centers for Disease Control and Prevention (CDC) and Public Health England, and works with national incident management systems which have the role of managing how the disease is monitored in terms of data and responses to the outbreak.
In 28 African countries, there are influenza sentinel sites that have come into play during this pandemic, and they are constantly reporting data to the WHO. In addition to collection of data, community-based surveillance has been crucial.
Moeti noted that “in the West Africa Ebola epidemic, villages were quick to notify authorities when sudden inexplicable deaths occurred in their communities. This type of community-based surveillance is also a key feature of the regional polio programme.”
She continued: “For COVID-19, in Kano State, Nigeria, the authorities responded quickly to community alerts.”
When unprecedented numbers of dead bodies began to show up in that community, the authorities had no choice but to take notice.
Although many continue to doubt the true nature of the reported numbers in Africa, it is important to note that dead bodies cannot be ignored – even by officials. It is possible that the number of official cases is less than the true number. But a death has to be taken into account, making the number of deaths close to reality.
Although a steady increase of COVID-19 numbers is predicted across Africa, the doubling time of cases has slowed. In West Africa, it has gone from 4.1 days before the lockdown, to 10.6 days after 1 April. In Central Africa, it has gone from 4.8 days before the lockdown, to 15.2 after 1 April. But with the easing of lockdowns continent-wide, there is a an increased risk that the doubling time might drop again.
Lagos State, Nigeria, has already begun to rescind the easing of restrictions, such as the opening of churches and mosques, after a spike in cases was recorded.
The number of cases currently is lower than predicted, and countries need to ensure that citizens continue to adhere to the new norms of social distancing, and avoid large gathering.