COVID-19: Immediate and sustainable actions required in Africa
Africa was the last continent to confirm its first case of the corona virus (COVID-19) on 14 February in Egypt with speculation that the delay in the number of confirmed cases in the region is due to weak travel connections between Africa and China, effective border screening and travel restrictions, local climate effects and a lack of screening or reporting (France 24, 2020; Vaughan, 2020). The late arrival of COVID-19 has enabled multilateral agencies and governments to rapidly prepare by placing measures to detect, manage and contain infected people. To date 586 cases have been reported in Africa across 29 countries with the majority reported in Egypt, Nigeria, South Africa (Wordometer, 2020). In this commentary, we outline African countries current responses and key priorities that need to be driven and supported to mitigate COVID-19.
As of March 23, more than 40 African countries were capable of testing for COVID-19. Kenya and Ghana were the first two nations to place blanket travel bans on travellers from countries affected by COVID-19. Travel restrictions have also been placed on people on going to Europe, China and the US. Other countries have followed a similar pattern with early detection systems set up at ports of entry and quarantine measures imposed on travellers arriving from high incidence countries. Some countries such as South Africa, where reported cases of infections are rapidly increasing, COVID-19 has been declared a national disaster; schools have been closed and tertiary institutions programmes have been suspended; gatherings of more than 100 people are prohibited. In some countries, there has been an intensification of work by “Outbreak Reponses Teams” to trace people that have been potentially infected. Even in countries where there is instability, such as South Sudan, coordination mechanisms have been mapped out to reach health workers and patients. With the recent experience of Ebola, most of the countries have isolation infrastructure present.
Africa’s response to COVID-19 has been varied and dependant on number of infections in each country and each country’s ability to respond. Given the economic and social links between regions on the continent, the virus is likely to spread unchecked if the necessary measures are not implemented.
Necessary measures to mitigate the impact of COVID-19
First, we need to act with speed to reduce the transmission of COVID-19 by ‘flattening the incidence curve’ (Roser, Ritchie, & Ortiz-Ospina, 2020). Early diagnosis, quarantine, and treatment of symptoms will provide much needed time to treat severely ill patients’. This strategy is necessary especially since Southern Africa has large scale and dual epidemics of HIV and TB. Further ‘social distancing’ measures will be difficult to implement in Africa because of large households, communal transport and dense concentrations of people in urban areas (Madhav et al., 2017). South Africa, has more than seven million people known to be living with HIV (UNAIDS, 2019), with roughly a third not on HIV treatment. While, estimates of mortality from COVID-19 are between 2-3 percent in a national population these rates will be much higher with more cases of severe illness requiring hospitalisation (estimated at 15 percent of COVID-19 reported cases, Minister of Health, South Africa, 16th March). Lessons from China, Singapore, Taiwan and Hong Kong show that quick action can influence the trajectory of new infections through compliance and collective efforts. Delayed action, incorrect messages and misguided epidemic control strategies can place the best public health systems under enormous strain as seen in Europe and the US.
Second, we need to fully implement commitments to International Health Regulations (IHR, 2005) norms. The recent GHSI has shown key deficiencies in health systems of many African countries. Most countries are not equipped to cope with health threats of this magnitude. The index scores of the north and west countries range from 74-85, with most countries in Africa scoring in the 30s or below (maximum score, 100). In Africa, constraints include inadequate surveillance and laboratory capacity, lack of tests, scarcity of public health human resources, lack of availability of hospital facilities for acute and longer term care (Suthar et al, 2018). We must rapidly scale up surveillance capabilities, strengthen health systems to treat large numbers of seriously ill people, while protecting the health care workforce. Procurement and supply chain management must also be enhanced to ensure adequate stocks of personal protective equipment and essential medications and to enable equitable access to new diagnostics, therapeutics, and vaccines (Jacobsen, 2020).
Third, rapid resource mobilisation to contain COVID-19 is crucial on the continent faced with a poor and overwhelmed health infrastructure. The Africa Centres for Disease Control and Prevention (Africa CDC) has recently set up the Africa Task Force to co-ordinate surveillance systems with WHO in February (Africa CDC, 2020), with the prioritisation of 13 countries for support, (high prevalence countries, Egypt, South Africa, Morocco, Algeria), including a US$675 million fund to improve surveillance and treatment systems response to COVID-19. The IMF has also made US$50 billion to low income and emerging market countries. The Gates foundation has allocated funding (about US$20 million), to help public health authorities in poor regions to strengthen their emergency operation centres, implement effective disease surveillance efforts and improve their capacity to safely isolate and treat patients. The UN humanitarian agency has also set aside funds to help countries with fragile health systems boost their detection and response operations (WHOa, 2020). More recently, Gates and Zuckerberg have funded an effort to bring metagenomic sequencing software to assist poor countries to trace the spread of the coronavirus (Molteni, 2020). Given that a vaccine may only be available in two years, more resources are required support our fragile health systems, access to running water and managing the economic fall-out as a result of COVID-19.
Fourth, given that Africa has different demographics from European and Asian countries (Africa has a younger and mobile population, people living with co-morbidities, vast disparities in health care between urban and rural areas), we need to develop our own technical capacity to produce robust data to enable predictive modelling on epidemiological, economic and health impacts of COVID-19. WHO has also produced a Global Research Roadmap with immediate, mid-term and longer-term priorities to build a robust global research response (WHOb, 2020) and a global treatment protocol on hospitalised patients. We however need to supplement global research agendas with reliable local knowledge on trajectories of country epidemics, local patterns of community transmissions and health and cost impacts of interventions (e.g., public health messaging, testing and treatment measures and implementation of social distancing methods) to guide decision on effective health system responses. Equally global health security must adhere to the doctrine of equal sharing of information on novel virus strains and access to vaccines (Fidler, 2008).
COVID-19 has shown that our health interdependence is greater than ever and the window of opportunity to contain the spread of the virus is closing fast in African countries. As with previous challenges brought on by HIV and AIDS, TB and Malaria, we have seen the effectiveness of collection action. We now require active leadership and solidarity from countries and continental bodies like the African Union (AU), Economic Community of West African States (ECOWAS), East African Community (EAC) and Southern African Development Community (SADC) to deal with this global health threat.
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