Total confirmed coronavirus, officially COVID-19, cases in Africa was 10,427 while the number of recovered patients was 1,074, and the number of confirmed deaths was 519. The virus has spread to dozens of countries within weeks. Governments and health authorities across the continent are striving to limit widespread coronavirus infections. With few doctors and fewer ventilators, countries in Africa fear they are defenseless against the inevitable spread of coronavirus. Many sub-Saharan countries are more vulnerable.

There are now more than 10,000 cases on the continent, with infections in every country but one (tiny, landlocked Lesotho).

The rapid spread of the virus over recent days has worried the World Health Organization (WHO) officials and humanitarian groups worried that the continent is about to tip into massive escalation.

If the virus hits the continent’s overcrowded cities, its underserved refugee camps, or populations already suffering from the multiple health burdens of malnutrition, HIV, malaria, tuberculosis and cholera it could easily overwhelm what little medical services exist. If those cases skyrocket, it may be even harder to rouse the international assistance that the continent will so desperately need to survive.

Without a strong campaign of social distancing, public health practitioners estimate that a quarter, or more, of a population could be infected. In Africa, that could amount to 250 million cases, a terrifying prospect for Dr. Jerry Brown, who helped lead Liberia’s response to the West African Ebola outbreak of 2014 and is now helping prepare his country for a coronavirus outbreak. “Most African nations, if not all, do not have what they need to combat this pandemic,” he says.

There are no continent-wide statistics on the number of ventilators or intensive care units in Africa, but piecemeal reporting paints a grim portrait of available services.

One doctor in Zimbabwe estimates that there may be less than 20 in the country’s public hospitals. A senior hospital administrator in Khartoum told the South African Mail and Guardian newspaper that there were no more than 80 ventilators in the whole country. Nigeria, population 200 million, reportedly has fewer than 500 ventilators. Just three are available in the Central African Republic, a country of almost five million people, says David Manan, Country Director for the Norwegian Refugee Council. “When rich nations are in panic mode stating that thousands of ventilators will not be enough, it just brings to light how poorer nations like the Central African Republic don’t stand a chance in the fight against COVID-19.”

Brown says that to the best of his knowledge, Liberia doesn’t have any ventilators at all. Without the right kind of care for the worst cases, he says, “the five percent of the patients that go to the severe state of the disease will die.” For a patient in severe respiratory distress, “I wouldn’t be able to do anything beyond providing supportive care, and slowly you would die in my presence.”

In many countries, there may not even be a doctor there. Overall, sub-Saharan Africa has the lowest number of doctors per 10,000, a statistic commonly used to measure the quality of healthcare in a country. “I get scared when I read about Italy being overwhelmed despite having one doctor for every 243 people,” Oxfam Pan Africa Programme Director Peter Kamalingin B.L writes in an email. “In Zambia, the ratio is one doctor for every 10,000 people.”

The global shortage of protective gear has hit African nations as well. In Zimbabwe, doctors and nurses are issued with one pair of gloves, two masks and one paper apron per shift, according to Dr. Peter, a general surgeon in a public hospital in Harare who asked not to use full name for fear of government reprisals. It is all the more terrifying, he says, because there are not enough tests to differentiate regular patients from those infected with the coronavirus.

“Officially we have eight cases,” he said in an interview last week. The official count is now up to 10. “But I know we have much more than that. We know many people have symptoms almost certain to be the coronavirus, and we have seen many deaths that could be attributed to the virus.” Without testing, and without safety gear, doctors and nurses will be the hardest hit when the outbreak comes, he says. “It will be like the rapture in the bible. One day you will find that all of the health care workers have been infected, and they will just disappear. Who will help the patients then?”

There is also more widespread understanding of how disease spreads here. Previous outbreaks, such as Ebola and cholera, have taught many public health sectors how to prepare for an epidemic. Many closed their borders and shut down schools at the first sign of the disease, rather than letting it reach a critical mass like some Western countries. At this point most countries on the continent are enforcing nationwide lockdowns, and some are already starting to see results.

South Africa’s Health Minister Zweli Mkhize noted that after a week of strict shelter-in-place orders, the daily increase in positive cases was slowing notably, a welcome respite that gives the country more time to obtain enough protective equipment and prepare enough isolation wards. “We were thinking we would have 4,000 or 5,000 cases by now,” he said on March 31. The current total of cases stands at 1,686, the highest number in Africa.

But the lockdowns, however good for combating the virus, bring economic misery that is especially acute here. Seventy per cent of Africa’s population depends on the informal economy for daily survival. With no houses to clean, no motorcycle taxis to drive and no markets to vend their wares, many face eviction and starvation. “If this continues for more than a month, it’s not going to be corona that kills us, it will be starvation,” says Moyo, the Zimbabwean activist.

While lockdowns may work for single-family households that have indoor plumbing and can afford to stock up on food, they could backfire in areas where communal living is the norm. Most families in Moyo’s neighborhood line up at a public well for their daily needs, she says. “Imagine, I have to queue for water. I have to queue for food. Now, I catch the virus and I come home to my crowded house and spread it to everyone who is confined in there with me. A lockdown in these kinds of areas might actually end up spreading the virus even more.” Not letting people out of their homes at all is tantamount to asking people to willingly starve, she says. “Unless you deliver food and water to every single household every single day, the only way you are going to keep people inside is at the point of a gun.”

African nations are doing what they can with what they have, says Liberia’s Dr. Brown, but unfortunately, it is still not enough. It’s a hard ask, but even countries currently caught up with their own outbreaks need to spare a thought for those who can afford even less.

Stopping a pandemic that threatens millions of lives in Africa will require a global response, says Dr. Brown, not just for the benefit of the continent, but for the good of the world. “This pandemic has proven that no one nation is supreme. If we think that this is a disease of the west alone, we are getting it wrong. If we think it is a disease belonging to the Africans alone, we are getting it wrong. As long as we have the disease in one country, the rest of the world is not safe.”

On April 2, 20020, the WHO said:

The virus is threatening fragile health systems on the continent. Infections are increasingly spreading not only between African countries but within different localities in the hardest-hit countries. For instance, in the Democratic Republic of the Congo, where COVID-19 cases were at first confined to Kinshasa, now a handful of cases have been reported in the easternmost regions of the country that were until recently in the grip of an Ebola outbreak. In South Africa, all provinces have now reported cases. The outbreaks in Burkina Faso, Cameroon and Senegal are also widespread.

“Case numbers are increasing exponentially in the African region,” said Dr Matshidiso Moeti, the WHO Regional Director for Africa. “It took 16 days from the first confirmed case in the Region to reach 100 cases. It took a further 10 days to reach the first thousand. Three days after this, there were 2000 cases, and two days later we were at 3000.”

To contain COVID-19, many countries in Africa are implementing measures, which restrict gatherings and the movement of people. Nationwide lockdowns are in effect in Kenya, Uganda, the Republic of the Congo and elsewhere. However, governments must use these measures in a considered, evidence-based manner, and make sure that people can continue to access basic necessities. As many people in the region live in crowded conditions or work in the informal sector and need to earn money daily to survive, it is important that countries make provisions to ensure that people can still access essential services. WHO is working closely with national governments and United Nations partners including the World Food Programme (WFP) to plan for these needs.

During the broadcast, WHO Director General detailed Africa’s plan to deal with the new coronavirus as “a continental strategy.” The WHO Director General Said Africa will need more resources to fight the COVID-19.

Healthcare systems are already underfunded and poorly equipped. Conflict, climate change and natural disasters have driven some 18 million people across the continent into poorly serviced and crowded camps for refugees and the internally displaced where social distancing, or even hand washing, is impossible. Poverty turns lockdowns into a death sentence. In countries where trust in government is poor, rumors and misinformation thrive in the place of leadership.


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