By Eunice Kamwendo and Chaltu Daniel Kalbessa
With very weak health systems and overall capacity constraints to effectively respond to the deadly coronavirus disease, Africa’s fate against the invisible enemy, was going to be nothing short of catastrophic, according to early predictions.
With the exception of a few countries with relatively strong health systems and the economic muscle to respond to the pandemic effectively, the rest of the continent’s fate was pretty much at the mercy of the deadly virus. Although Africa is yet to reach its peak, many countries are not seeing the exponential growth in case numbers, or in mortality rates as seen in other regions of the world.
While confirmed cases gives a sense of prevalence of the disease, testing capacities remain a challenge. Mortality rates might be a better indicator of the impact that Covid-19 has on the general population. So far, the continent has the lowest mortality rates with higher recovery rates compared to other regions of the world.
The slower than normal onset gives reason for some cautious optimism for the possibility of Africa weathering this storm. What is working in Africa’s favour? Three key factors in our view which provide important lessons for strategies to fight similar disease outbreaks in future.
Africa’s aggressive response to the pandemic:
First, was the swift and what seemed like an aggressive response to the pandemic by Africa as a whole. The continent reacted aggressively and proactively to Covid-19 as a preventative measure. By April 5, many African countries had imposed either localised, partial or full lockdowns of their countries, economies and large gatherings in an effort to contain the disease.
These measures included travel restrictions, flight cancellations, bans on public gatherings including religious gatherings, event cancellations, school and border closures. Many of these measures were implemented long before any significant number of cases were recorded on the continent.
At least 27 countries had imposed full lockdowns, including border closures and travel restrictions on 42 countries while States of emergencies were declared in 17 countries.
For a continent that had only 99 confirmed cases by March 20, the above measures seemed extreme, especially because many countries did not have full-fledged implementation plans for the lockdowns.
Looking back, this was a bold response and rightly so. Stopping and containing the virus was not only a first line of defence for most, it constituted the main strategy between life and death given already overwhelmed, underfunded and incapacitated health systems that have long struggled with responding to non-emergency cases.
Such wholesale lockdown measures were complemented by community responses along the way which for the African context have long proven to be effective in responding to communicable disease outbreaks.
Granted, the socio-economic costs to these measures will be large but for Africa and the world, however, the brunt of Covid-19 offered few policy choices. Health and safety had to come first. The aggressive measures might be paying off. For now, Africa is counting its blessings.
Africa’s population structure
Africa’s demographic structure might be one of its mitigating features against Covid-19. The continent remains the most youthful globally, with a median age of 19.4 compared to 29.6 for the rest world. More than 60 percent of the continent’s population are below the age of 25 compared to around 42 percent globally. This trend is in stark contrast to developed regions where the proportion of aging populations are higher.
Going by what we have seen so far, it is a fair conclusion to make that the virus is affecting different population groups differently, with higher rates of deaths in older people, those with severe illnesses including respiratory and HIV among other underlying health conditions. For Africa, the Covid-19 battle may be half won given its demographic structure.
Available evidence corroborates with high-risk population groups above, with age accounting for more deaths, without discounting other underlying causes that may have been present in most Covid-19 patients or victims. In China, Europe and America, for example, more than 80 percent of Covid-19 related deaths are among the aging population of 65 years and above. In addition, all countries that have had the highest record of cases and deaths are among the top 50 countries with the largest share towards aging populations globally. Most European countries have an aging population of above 20 percent on average compared to three percent and five percent sub-Saharan Africa and North Africa, respectively. The US, China and a few others also have relatively large shares of the old, hovering between the 12 percent to 16 percent range.
Thus far, Africa is seeing similar trends with age accounting for most deaths in the 55 years and above age group. Granted, a much lower threshold when compared to developed regions but this is already against a backdrop of relatively low life expectancy of about 61 years for sub-Saharan Africa. Interestingly, countries that have on balance, higher proportions of adults over 65 years in Africa such as Tunisia (eight percent), Morocco (7.1 percent); Algeria (6.2 percent), South Africa (six percent) and Egypt (five percent)—account for up to two thirds of all Covid related deaths. This is quite instructive.
Exposure to a wide range of treatment regiments:
It is well known that the continent has the highest communicable and infectious disease burden, with HIV, malaria and diarrhoea among its top five killers. Africa had approximately 25.7 million people living with HIV amd Aids by the end of 2018, with a little over 90 percent of those affected on antiretroviral drugs. Malaria has long been widespread just as widespread is the use Bacillus Calmette–Guérin (BCG) vaccinations which are believed to offer broad protection against respiratory infections. What is less known however, is the interaction between the prevalence of other diseases on the continent, related treatments and SAR-Covid-2 which may be counteracting Covid-19 effects broadly.
The question remains, whether the combined treatments for malaria, HIV and continent-wide BCG inoculations are contributing to the high recovery rates and relatively low Covid deaths in Africa, especially when some of the treatment regiments (or their derivatives) are now being experimented as possible treatments for Covid-19.
In Senegal for example, Covid-19 patients on hydroxychloroquine have been observed to recover faster from the disease just like the herbal remedy Artemisia annua widely used in Madagascar is limiting the potency of the disease on its population.
In both countries, even with rising cases, recovery rates from Covid-19 are much higher with low deaths, consistent with the observations in most malaria-prone countries.
Interestingly, malaria is not prevalent in Africa’s Covid-19 hotspots of South Africa (except in one province) and North Africa.
The fact that the World Health Organisation is conducting clinical trials on malaria drugs (chloroquine/hydroxychloroquine); HIV drugs (remdesivir, ritonavir/lopinavir and interferon-beta) is quite telling and promising enough to a continent where the use of these drugs is already widespread and therefore opening up possibilities of trained immunity against Sars-Covid-2 for Africans in general. The jury is still out on this one.
A reason for hope
The African story is yet to fully unfold. The case numbers are rising and so are deaths, but not at pace with the rest of the world.
For now, the continent is treading carefully, and should not be taking anything for granted. With the pressure to lift restrictions to avoid the socio-economic fallout already projected to be large, caution has to be taken noting that the world is not going back to normal as we knew it.
Covid-19 may be a coexistental threat that will demand radical changes in the way we do business and interact. More so for a continent that community spreads could easily tip the scales towards worse possible outcomes if the thesis above does not hold. Maintaining some of the measures that have proven effective, ramping up experimentation with existing and herbal remedies combined with an innovation drive will certainly help the African case.
From Senegal’s affordable rapid testing kits and low-cost ventilator substitution; Ghana’s innovation pooling test, Ethiopia’s contactless soap dispensers, mobile tech solutions in Nigeria, Uganda and Rwanda as well as the repurposing of industries in Malawi, South Africa, Uganda and Kenya towards the production of hand sanitisers in response to the pandemic is deeply encouraging.