‘the pandemic is gaining momentum’: africa …...‘the pandemic is gaining momentum’: africa...

7/20/2020 ‘The pandemic is gaining momentum’: Africa prepares for surge in infections | Financial Times

https://www.ft.com/content/1b3274ce-de3b-411d-8544-a024e64c3542 1/12

David Pilling in London 4 HOURS AGO

Within days of his inauguration in June, Evariste Ndayishimiye, Burundi’spresident, ended months of official denial about coronavirus by ordering masstesting in the commercial capital of Bujumbura. Well he might. His predecessor,Pierre Nkurunziza, who had scoffed at the virus and entrusted Burundi’sprotection to God, paid a heavy price for his nonchalance. He died, almostcertainly of Covid-19 itself.

After months in which Africa escaped the worst of the coronavirus pandemic as theglobal centre shifted from Asia to Europe and then to the Americas, the number ofAfrican infections — and deaths — has begun to increase sharply. At least 14,500people have now died out of 667,000 confirmed infections. That has raisedconcern among some experts that the world’s poorest continent may be about toenter a critical phase of the coronavirus outbreak.

“The pandemic is gaining full momentum,” says John Nkengasong, director of theAfrica Centers for Disease Control and Prevention, which has mounted an effectivecontinent-wide response. As transmission of the virus gathers pace, he warns, thedanger is that “our hospital systems will be overwhelmed”.

That is already happening in South Africa, the worst affected country on thecontinent, where confirmed cases are doubling every two weeks and intensive carewards in Johannesburg and Cape Town are overflowing. At the current rate, morethan 1m people will be infected by early August.

The Big Read Africa

‘The pandemic is gaining momentum’: Africa prepares for surge in

infections

A rise in cases is dashing hopes that the continent’s younger population would spare it from the worst of

coronavirus

https://www.ft.com/david-pilling

https://www.ft.com/content/a232c62b-ded1-4dd4-8ca7-a5bb5214987f

http://ft.com/coronavirus

https://www.ft.com/content/a26fbf7e-48f8-11ea-aeb3-955839e06441

https://www.ft.com/content/99d6c1e3-f326-417c-8833-2dfd591d0a7b

https://www.ft.com/the-big-read

https://www.ft.com/world/africa



Deaths have topped 5,000, and the number of fatalities is escalating sharply. Onehealth official caused panic by suggesting, erroneously, that Gauteng province waspreparing 1.5m graves for the dead. Cyril Ramaphosa, the president, in a speech inwhich he compared the virus to a storm blowing in with the cold winter winds ofthe southern hemisphere, warned that few parts of the country would be spared.

Not all of Africa has been severely struck. Some countries, such as Botswana,Namibia and Gambia, have registered few infections and barely any deaths. Theisland of Mauritius successfully stamped out an early rash of imported infectionsand has not recorded a single case of local transmission for nearly three months.

“At the beginning, we thought we were going to see a massive disaster,” says MoIbrahim, a Sudanese businessman who is the head of an eponymous foundation.“The numbers so far don’t show that,” he says. “African governments probablyresponded better than governments in the UK or the US. And fortunately, inAfrica, the virus doesn’t seem to like us.”

https://www.news24.com/news24/southafrica/news/gauteng-is-not-digging-15-million-graves-the-number-is-the-capacity-available-20200709

https://www.africanews.com/2020/05/14/virus-free-mauritius-says-covid-19-battle-won-but-war-still-on//



Residents in Bujumbura, Burundi, wait to be tested for Covid-19 © Berthier Mugiraneza/AP

‘A new phase’However, new spikes of infections in several African countries are clouding suchoptimism. Of the states that have been harder hit, more than half of recorded caseshave been in just five countries — South Africa, Egypt, Algeria, Nigeria and Ghana— although that partly reflects their higher testing capacity.

But the pandemic has spread much further than that. According to the WorldHealth Organization, in 22 of the continent’s 54 countries, cases have more thandoubled in a month, with states such as Ethiopia, Kenya, Cameroon and Djiboutishowing sharp rises. After a long period in which most infections in Africa wereimported, mainly from Europe, two-thirds of countries on the continent are nowreporting community transmission, the WHO says.

Malawi, a tea-producing country of 18m people in southern Africa, is a case inpoint. On the face of it, its numbers look reassuring, with just 51 deaths and around2,700 infections by mid-July. But healthcare workers say they are starting to see asignificant rise in infections.

“Our first case was in early April and since that time we have had this very gradualtrickle, trickle, trickle,” says Mina Hosseinipour, professor of medicine at theUniversity of North Carolina’s Malawi project in Lilongwe, the capital. “We werelike: when is this thing going to come?”

https://www.ft.com/content/6dd451ce-e2b7-470f-bf9a-a215ccf6c10f



People queue to wash their hands to prevent the spread of coronavirus before they vote in June in Lilongwe, Malawi © AmosGumurila/AFP

The lack of deadly infections was all the more remarkable, she says, given a seriesof blunders that might have been expected to spell disaster. Many of the Malawianswho were sent home by the busload from South Africa, where they had beenworking, returned with Covid-19. Some escaped from ill-equipped quarantinecamps, risking spread in their communities. Nor was Malawi’s government able toimpose a lockdown after civil society groups, concerned at the dire impact onpeople’s livelihoods, successfully challenged the measure in court. Like Burundi,Malawi even ran a national election, the incumbent losing power in a rerun of lastyear’s poll.

Yet, despite these potential superspreader events, deaths from the virus in Malawiremained stubbornly low, says Prof Hosseinipour. Until now. “The last two weeksis changing our perspective,” she says, adding that more deaths are beingregistered and many more people are coming to hospital seeking emergencyrespiratory care. “The new government is mandating face masks across the countryand recommending more serious isolation and social distancing measures,” shesays of the sense of urgency the rise in infection has engendered. “We have entereda new phase.”



Huge gaps in the dataThe recent experience of Malawi, and many other African countries like it, hastempered, if not entirely scotched, early hopes that the continent might somehowavoid the worst of the pandemic.

“What we are seeing is just the effect of the delayed timeline,” says FrancescoChecchi, professor of epidemiology and international health at the London Schoolof Hygiene and Tropical Medicine, who adds that the disease came late to thecontinent. “I don’t really see any evidence that we’re seeing a qualitatively differentcourse of the pandemic in Africa.”

Prof Checchi says that countries with good air links to the rest of the world, such asSouth Africa, Egypt and Morocco, were the first to import “seed cases”, causing thepandemic to spread more quickly. He praises early efforts by many Africangovernments — all too familiar with the threat of infectious diseases such astuberculosis and Ebola — to contain the virus through screening, public healthcampaigns, curfews and lockdowns. But in the end, he says, this is just a delayingtactic. “Lockdowns only gain you time.”



Sema Sgaier, executive director of Surgo Foundation, a non-profit organisation,agrees that the pandemic has much further to run in Africa. Her foundation hascompiled an index from open source data of regions most vulnerable to the social,economic and health impacts of Covid-19. Among those highlighted are Cameroon,the Democratic Republic of Congo, Madagascar, Malawi, Ethiopia and Uganda —all countries where the pandemic is yet to really take hold.

There remains some cause for cautious optimism, Ms Sgaier says. Even if the virusends up spreading as widely in Africa as in Europe and the Americas, it is likely tokill fewer people, she says, because of the continent’s more youthful population.Africa has a median age of 19.4 years against 38 in the US and 43 in Europe.

http://surgofoundation.org/



Based on age and gender distribution, the Surgo Foundation estimates Africa’sinfection fatality rate — the proportion of deaths among those infected — at 0.1 to0.15 per cent. Adjusting for the poor quality of health services with a lack of oxygenand ventilators as well as for co-morbidities, such as HIV/Aids, it puts the infectionfatality rate at an average 0.55 per cent, with the best countries in Africa at 0.22and the worst at 0.76 per cent. That compares with 1.3 per cent in the US, meaningthat an African infected with Covid-19 is between twice and six times more likely tosurvive than an American.

A worker has his temperature measured before his shift at the Sibanye-Stillwater platinum mine in South Africa. The country isthe worst affected by coronavirus on the continent © Michele Spatari/AFP

Still, even if those lower estimates prove correct, it implies that, if 60 per cent ofAfricans eventually become infected, more than 4m will die.

Such calculations are guesses at best. Researchers have to take into accountestimates for the rate of non-communicable diseases for which data is almost non-existent in many countries. Diseases such as hypertension and diabetes, whichraise the probability of death in Covid-19 patients, are almost certainly lower inmany African countries than in relatively affluent South Africa, where such co-morbidities help explain the higher number of deaths. With a median age of 28,South Africans are also nearly a decade older than the rest of the continent.



The task of modellers — who must also juggle factors such as malnutrition and HIV— is further impeded by limited records of deaths in many countries. This hasforced statisticians researching some countries to turn to satellite imagery ofgraveyards for clues about the so-called “excess deaths” that may be down toCovid-19. “We’re really fumbling around in the dark here,” says Ms Sgaier.



There is also tentative evidence emerging that African countries may have a highprevalence of asymptomatic cases thanks to its young population. An antibodystudy conducted by the Mozambican government in the northern city of Nampulawith a population of 750,000 found that some two-thirds of people infected hadsuffered only very mild symptoms or no symptoms at all.

In addition, the study found that 5 per cent of people in the community and 10 percent of market vendors had been infected with coronavirus. Yet only four Covid-19deaths have been recorded in Nampula province out of nine in the country as awhole.

Even Mr Nkengasong at the Africa CDC, who has strongly cautioned againstcomplacency, acknowledges that the continent’s young population means thedeath rate is likely to be lower. “We see these young people running around withCovid, just living their lives normally,” he says. “But we need to back this up withappropriate studies.”

John Nkengasong of the Africa Centres for Disease Control and Prevention: ‘We see these young people running around withCovid, just living their lives normally’ © Michael Tewelde/AFP

A plea for more testingThis competing evidence makes it difficult for African governments to determinewhat to do next. But, say researchers, they must persevere with policies to mitigaterisk. There is a middle way between full lockdowns — difficult to maintain in poorcommunities — and letting the pandemic take its course, they say.

https://covid19.ins.gov.mz/wp-content/uploads/2020/07/Inquerito-SARS-CoV-2-em-Mocambique_vfinal.pdf

https://www.ft.com/content/7ecd5ded-9b90-4052-b849-0e153f701e1f



Cooper/Smith, a Washington-based professional services organisation that usesdata to inform policymakers, has run statistical models indicating that socialdistancing could stop millions of infections and save 9,000 deaths in Malawi alone.Hannah Cooper, its managing director, says: “African countries don’t need to makea Sophie’s choice” between damaging lockdowns and “letting the epidemic runrampant”. Even in the absence of robust data, she says, there is enoughinformation to tailor responses to specific communities.

Ibrahima Kassory Fofana, the prime minister of Guinea, says his government hasimplemented mitigating measures that stop short of full lockdown. Its experiencewith the 2014-16 Ebola epidemic — which killed more than 11,000 people in westAfrica — has stood it in good stead, he says. Guinea has closed its airspace,encouraged hand washing, banned mass gatherings, including in churches andmosques, and sealed off the capital, Conakry, from the rest of its territory. Thecountry of 13m people has recorded 6,200 cases with 38 deaths.

“In terms of managing the pandemic, so far it is under control,” says Mr KassoryFofana. “We are optimistic because our population is much younger.”

Members of the Guinean Red Cross inform people about coronavirus in a market in the capital Conakry, which has been sealedoff from the rest of the country © Cellou Binani/AFP

The second lesson is that more testing is urgently required. South Africa is testingaround 50,000 people a day and countries such as Djibouti, Ghana and Moroccohave made concerted efforts to test widely. Yet, according to an analysis byReuters, African countries had on average tested 4,200 per 1m people by July 7,compared with 74,255 in Europe.

https://coopersmith.org/projects

https://graphics.reuters.com/HEALTH-CORONAVIRUS/AFRICADATA/dgkplxkmlpb/



Copyright The Financial Times Limited 2020. All rights reserved.

Strive Masiyiwa, a Zimbabwean businessman appointed as a special envoy of theAfrican Union, says that a pan-African medical supplies digital platform he hashelped establish should enable a massive ramp-up in testing capacity. Theplatform, which went live in July, is backed by a $3.8bn credit line from theAfrican Export-Import Bank. It allows African governments and organisations topool their orders, making it easier to benefit from bulk pricing.

“There is now no excuse to say we can’t get test kits and therefore we can’t test,”says Mr Masiyiwa, who adds that governments can also use the platform to equiphospitals with oxygen units, protective equipment, medicines and ventilators inpreparation for a coming wave of infections.

Graves in Westpark Cemetery, Johannesburg, where intensive care wards are overflowing © Kim Ludbrook/EPA

Armed with greater testing capacity and policies aimed at slowing the spread of thedisease, many African governments are gearing up for the next, possibly moreserious, phase of the pandemic.

In the coming months, says Prof Checchi of the London School of Hygiene andTropical Medicine, some countries will have to move from the suppression stage toone where they seek to reduce the impact of the virus.

“There is no shame in saying that we cannot suppress this epidemic for anotheryear and a half until we get a vaccine,” says Prof Checchi. “That we are going to tryto mitigate it through social distancing, curtailing unnecessary gatherings andsubsidising soap and water,” he says. “A few policies like that can make asignificant difference in terms of the ultimate death toll.”

http://help.ft.com/help/legal-privacy/copyright/copyright-policy/

https://amsp.africa/

https://www.ft.com/content/72edfd6a-8300-4944-893d-54d08954df6f

‘the pandemic is gaining momentum’: africa …...‘the pandemic is gaining momentum’: africa...

Documents