Scope of COVID-19 in Africa
By Sabere Traore, MD, MPH
Dr. Sabere is a physician and a public health professional from Burkina Faso, currently pursuing, as a Fulbright Fellow, another degree in Health Policy and Management at Emory University in Atlanta, GA, USA.
As of August 14, 2020, the World Health Organization (WHO) confirmed over twenty million cumulative cases of COVID-19 and over 750,000 deaths (case fatality rate of 3.62%). Africa was the last continent to be hit by the pandemic as it recorded its first COVID-19 case in Egypt on February 14, 2020.
Six months after first recording COVID-19 on the continent, Africa has recorded over one million cumulative cases with a case fatality rate of 2.27%.
All five regions of Africa have been affected and are continuously facing the health consequences of the COVID-19 pandemic. However, the major burden of the outbreak remains on the Southern and Northern regions. These regions are also leading the death count in Africa[1].
Figure 1. Cumulative COVID-19 cases in Africa. This map is made available by OurWorldinData.org [1].
Leadership from African Institutions and decision makers has been essential to slowing the spread of the outbreak. Unprecedented measures have been implemented at regional, national, and local levels. With the support of international partners, the African Union’s Center for Disease Control and Prevention (Africa CDC) has led the way with the following actions:
Formulating COVID-19 policies and guidelines
Strengthening the capacity of Africa’s public health institutions
Partnering with individual countries to detect and respond to the COVID-19 outbreak
Nationally, governments have responded to Africa CDC and WHO recommendations and have implemented policies of varying stringency to combat COVID-19.
These policies include physical distancing & face mask use; healthcare worker training to use personal protective equipment effectively; expansion of laboratory testing capacity; contact tracing; quarantine; and travel restrictions. More locally, governments have closed schools and markets, imposed curfews, promoted handwashing campaigns, and distributed soaps and hand sanitizers. Some researchers suggest that other factors, such as the young age of the African population or the climate, may be protective against the spread of COVID-19 [2]. However, more evidence is needed to support these early studies.
Figure 2. Median Age by Country. This map is made available by OurWorldinData.org [1].
The success of these efforts in flattening the curve of the disease in most African countries in Africa is threatened, however.
Threats include clean water scarcity, poor hygiene, lack of face masks and soap for vulnerable populations, lack of testing kits and medical equipment, misinformation, and denial [3, 4]. For example, testing scarcity has prevented mass screening in many African countries, instead requiring targeted screening and contact tracing. This targeted strategy has a higher likelihood of missing infections, resulting in inability to control transmission. Misinformation, spread both by Internet and word-of-mouth, has also significantly undermined the strategies to combat COVID-19 in nearly all African regions. Such misinformation has led to a complete denial of the disease in many regions, especially in remote areas. Indeed, BBC News Africa has started a COVID-19 MisInfo hub to debunk these claims.
Fortunately, despite its devastation, this pandemic has also revealed brilliant talents and innovative solutions in Africa.
For example, Senegalese researchers have reported producing a COVID-19 immune-based diagnostic test at a low cost (around $1) to enable mass testing campaigns. Senegalese engineers constructed a medical robot that may help reduce unnecessary contacts between healthcare workers and patients. Ghanaian researchers also developed a reliable lower-cost COVID-19 antibody test. Other initiatives include face mask manufacturing, soaps and hand sanitizer production, and ventilator development using local materials.
Figure 3. Artemisia annua. This image was made available by Wikimedia with a creative commons license.
Scientists in Madagascar have turned towards their country’s wealth of ecologic resources for potential antiviral treatments. Artemesin-based combination therapies (ACTs), which are recommended by the WHO as anti-malarial treatment, contain a bioactive compound from the Malagasay sweet wormwood plant (Artemisia annua)[5]. Artemesin has been proposed as a novel treatment for COVID-19. The Africa CDC is currently supporting the Malagasy government to conduct research in this area, though efficacy remains unproven and some scientists worry about the spread of artemisin-resistance, already a problem in parts of Southeast Asia.
When it comes to vaccination, only South Africa is conducting a clinical trial to develop a COVID-19 vaccine. This trial from the University of Witwatersrand is called Ox1 Cov-19 Vaccine VIDA Trial and intends to test the ChAdOx1 nCoV-19 vaccine. More clinical trials to develop possible COVID-19 vaccines are expected to start in the upcoming months, reviving hope for an elimination of the disease in Africa and elsewhere.
In conclusion, strong leadership and a relatively delayed presentation of the novel coronavirus on the continent have helped protect many Africans from the pandemic’s devastation. While misinformation and poverty do leave vulnerable groups at high risk, African scientists and entrepreneurs are actively responding with novel solutions to keep flattening the curve. We hope that the resources provided here at the BioAfrica Scientific Resource Hub will benefit these innovators to protect the African population.
Dr. Traore has no financial involvement or interest in the Bio Africa Marketplace or products mentioned therein or elsewhere within the BioAfrica Innovation Hub websites. His role in the Scientific Resource Hub does not constitute endorsement or recommendation of specific products or suppliers mentioned within the Bio Africa Innovation Hub websites.
References
Publicly available websites and news articles are linked in the text. Full references for peer-reviewed articles or other sites not publicly accessible are available below.
1. Roser, M., et al. Coronavirus Pandemic (COVID-19). 2020 August 9, 2020]; Available from: 'https://ourworldindata.org/coronavirus.
2. Njenga, M.K., et al., Why is There Low Morbidity and Mortality of COVID-19 in Africa? Am J Trop Med Hyg, 2020.
3. Haddout, S., et al., Water Scarcity: A Big Challenge to Slums in Africa to Fight against COVID-19. . Science & Technology Libraries, 2020. 0(0): p. 1-8.
4. Okoi, O. and T. Bwawa, How health inequality affects responses to the COVID-19 pandemic in Sub-Saharan Africa. World Development, 2020. 135.
5. Kapepula, P.M., et al., Artemisia Spp. Derivatives for COVID-19 Treatment: Anecdotal Use, Political Hype, Treatment Potential, Challenges, and Road Map to Randomized Clinical Trials. Am J Trop Med Hyg, 2020.