With Cases on the Rise, Why is Africa Still Ahead of the Coronavirus Curve?
By Ryan Mathura, B.S.
Mr. Mathura is pursuing his Master of Public Health degree from Emory University in Atlanta, GA, USA. This summer, he is also working as a COVID-19 contact tracing intern for the Georgia Department of Public Health.
Since the pandemic of COVID-19 has taken root in our daily lives, public health professionals, who are often hidden in shadows, are now in the spotlight and so is their jargon. Epidemiologists are public health professionals who study the distribution, incidence, and control methods of diseases and other health-related conditions. In the case of COVID-19, these professionals take a multidisciplinary approach that includes biology, statistics, computer programming, and many other fields. Within each of those areas of studies, there are words and concepts that most people are not familiar with.
Key Medical Terms to Know:
COVID-19: COrona VIrus Disease 2019
R0 (R Naught): This is the basic reproductive number of a disease. It refers to the average amount of cases that arise from one case. If R0 is greater than 1, it means the disease is spreading, but if it is less than 1, the disease is decreasing. R0 for COVID-19 was initially measured at 4.71 before interventions and decreased to 2.08 after interventions like stay-at-home orders, mask requirements, and school closures.
Infectious Period: This is the time that the virus can be spread from person to person. For COVID-19, studies show that the infectious period typically starts two days before symptoms appear and lasts until the final three days of continual symptom improvement after fevers have stopped.
Asymptomatic: This term refers to those who are infected with a disease but do not show symptoms of infection
PCR: This is the abbreviation for “Polymerase Chain Reaction”. PCR is one the method scientists and clinicians used to determine if an individual is infected with COVID-19.
Figure 1. CDC Graphic of SARS-CoV-2
Key Epidemiology Terms to Know:
Incidence: This is the occurrence rate or rate of new cases for a disease during a particular time period.
Prevalence: This is the number of cases of a disease that are present in a particular population, e.g., amount of current cases at a specific point in time.
Case-Fatality Ratio: This is the percentage of those who contract the disease and die from it.
Non-pharmaceutical interventions: These are methods used to mitigate transmission that do not involve the use of drugs
Social Distancing: This is the practice of increasing space and decreasing contact between people to reduce the risk of spreading disease. This is particularly important during the pandemic while there is no vaccine available.
Quarantine: A quarantine separates and restricts the movement of people who have been exposed to a contagious disease to see if they become sick. The duration of a quarantine depends on the typical duration of time it usually takes to develop symptoms. For COVID-19, this duration is 14 days. If symptoms do not occur by the end of the quarantine, then a quarantined person can reduce the restrictions on her movements. However, if symptoms develop, the person should enter isolation.
Isolation: Isolation separates sick people with a contagious disease from people who are not sick. The necessary duration of isolation depends of the duration of sickness. For COVID-19, this is typically 14 days.
COVID-19 was first characterized in late 2019 and has spread across the globe. As of August 3, 2020, Johns Hopkins University confirmed over 18 million cases and nearly 700,000 deaths in the world. That means that the global prevalence of confirmed cases is 0.23% and the case-fatality ratio is just below 4%. If we just look at the African continent’s numbers, there have been 957,000 cases and 20,288 deaths. With a population of over 1 billion, there is less than 0.1% prevalence rate and about a 2% case-fatality ratio.
So why is Africa faring better than average for COVID-19 prevalence and case-fatalities?
A lot of the answer has to do with the way people live around the continent. Since COVID-19 is spread from person to person through mucosal droplets, certain conditions need to be in place for the disease to take hold in communities. These are:
High travel rates: Since the virus originated in China, it must be spread via travel routes from China or elsewhere that the virus is now present.
Adequate population density. Once somebody in a community has the virus, they need to get close enough to others to infect them.
Figure 2. Daily new confirmed COVID-19 cases over time by location: Africa, South Africa, and Egypt. Figure made available at OurWorldInData [1].
Two countries in Africa fit the bill and are currently the hardest hit: Egypt and South Africa.
According to the Africa CDC, Egypt has had about 95,000 cases with 5,000 deaths making up nearly 10% of African cases and 25% of African deaths. South Africa’s numbers are even worse with just over 500,000 cases and 8,000 deaths. Over 50% African cases and 40% of African deaths are in South Africa.
A closer look at these hardest-hit countries tells us more about the epidemiology of COVID-19. Egypt has a larger population than South Africa (approximately 98 million vs 58 million inhabitants respectively) as well as higher population densities in its largest cities and lower GDP per capita. Correspondingly, Egypt has a higher case-fatality ratio: 5% in Egypt vs 1.6% in South Africa.
South Africa’s economy heavily relies on global relations and tourism. Travelers from out of the country brought infections with them, which is why we see high rates of COVID-19 in large cities such as Johannesburg and Cape Town. Both cities are major tourist and business destinations on the continent. Ironically enough, the secondary effect of high rates of business and tourism - high GDP - is likely helping to keep the case-fatality rate low.
Figure 3. Case fatality of the COVID-19 pandemic over time by location: Africa, South Africa, and Egypt. Figure map available by OurWorldinData.org [1].
Access to testing and sufficient healthcare are crucial to staying ahead of the curve. Testing metrics are difficult to find for Egypt, but the country only has an estimated 40 PCR machines – not nearly enough to meet the demand for tests. Many believe that the prevalence of COVID-19 in Egypt is much higher than reported due to this lack of testing. Nonetheless, the Egyptian government has promised to provide free testing at all hospitals. On the other hand, South Africa has performed over three million tests since early May.
Between lack of testing and probable high prevalence rate of asymptomatic cases, the global COVID-19 pandemic won’t be under control for some time. Even with improved treatments and effective vaccinations, global distribution comes with its own challenges. Until then, non-pharmaceutical interventions are imperative to curbing infection rates and keeping people safe and healthy. Strict implementation of these interventions can help keep Africa ahead of the curve. Without these efforts, however, COVID-19 could ravage more remote African towns and villages with limited access to healthcare.
Mr. Mathura 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.
Roser, M., et al. Coronavirus Pandemic (COVID-19). 2020 August 9, 2020]; Available from: 'https://ourworldindata.org/coronavirus.