Puzzle of Africa’s Low COVID-19 Cases

While the Coronavirus (COVID-19) started in China, its wings have spread globally with little trace of the virus left in China. The continent of Asia in which China is located, has also been hit hard. But China seems to be out of the pandemic box in escaping the wrath of the virus. While that makes one wonder what the mystery behind it is, a puzzle remains to be solved why are the African and Oceania Continents slow in catching the pandemic? Till 11th July 2020, Oceania recorded 11,010 cases while Africa had 559,432 cases. This is in contrast to what Asia has – 2,796,583 cases; America – 6,549,560 cases and Europe – 2,558,747 cases.

Medical experts are very curious to know the secret of Africa’s slow COVID-19 spread. Some medics feel that there could be high chances of under-reporting in the continent. Others have speculated with headlines that

‘Africa would be the next epi-centre of the virus after Europe’.

Other scientists and journalists speculate that Africa’s health systems may not be able to detect cases. Other interesting hypothesis includes genetics in the blood of Africans that may resist the virus! This however is not true as Africa is not made up of Africans only but Afrikaners, Europeans, Arabs and Asians.

The answer to this puzzle may be Africa’s linkage with the world. It is important to note that on February 14th, Egypt which was the first African country to report its first case and it ranked the country Number 25 globally after the first case was reported by China on 31st December 2019 (Gilbert et. al., 2020).

History has also shown that past epidemics have also affected Africa almost last and taking its toll on a few casualties compared to other continents. One example is the SARS of 2002-2003 which was first reported by South Africa five months from the initial reports by China. South Africa was also the only country in the continent to have this outbreak. The same was the case for H1N1 in 2009 when the virus hit 41 African countries with over 800 cases and 160 deaths representing only 1% of total global deaths.

The same trend is being seen for COVID-19. This has a lot to do with people’s travelling patterns. Globally Africa gets only 5% of global tourist flows and 4% of tourists from China (Signe, 2018). One may argue that today there are many Chinese workers in the continent as China is Africa’s leading commercial partner. That justifies the argument to the extent that from all Chinese-related projects globally, in 2017 only 16% of the Chinese workers went to Africa and of these 23% were in Algeria.

This explains why the cases in Algeria are high. Records to July 11th, 2020, indicate that the country is the fifth highest in the continent (17,808), with South Africa (250,687), Egypt (80,235), Nigeria (31,323), Ghana (23,834) in the first four positions. This explains the importation risk which is determined by the volume of air traffic connections (Pullano et. al., 2020; Wu et. al., 2020).

Africa’s cases are based on the risk of importation of COVID-19 cases from China based on air travel flows from January 2019 in relation to the number of cases in Chinese provinces and population with cases in these Chinese provinces (Chinazzi et. al., 2020). The results indicated Egypt, Algeria and South Africa with the highest importation risk from China due to high heterogenous population; followed by Nigeria and Ethiopia while Sudan, Angola, Ghana, Kenya, Tanzania and Morocco have moderate importation risks but high vulnerability. This risk is reduced with the African countries stopping flights to and from China’s high-risk provinces and would also reduce future risk from the travel flow. Ethiopia is still known to have a very high risk due to the Ethiopian Airlines, the largest carrier in Africa still continuing flights to China with stopovers in many countries.

While the rest of the continents were struggling to contain COVID-19 numbers from January to June, African countries have been strengthening their preparedness against COVID-19 imports by improving airport surveillance (Nkengasong, 2020), carrying out COVID-19 test at ports of entry, having personal protective equipment, and even recommending not to go to China until red alert is over (Ministry of Health of Nigeria).

Also, the continent’s poorly developed transport infrastructure, especially rail, may be a blessing in disguise. All other continents have very good inter-rail networks that in turn aided in the spread of COVID-19. According to Dr. Githinji Gitahi the CEO of AMREF, on the July 8th, 2020, he stated on the Citizen TV,

“when you slow down movement, you slow down the virus”.

Overall if the numbers spike up on the continent, the shortage of personnel, laboratory capacities and scarcity of resources would put individual countries into stress if they have not learnt lessons from the East and the West or if they believe that their climate is favourable or if indigenous drinks would cure the virus!

According to the WHO special envoy on COVID-19.

“[COVID-19] shows that the health care systems even in places like Europe and Asia and the U.S. are very, very limited. The health care systems in Africa are weak. There are not many African countries with adequate laboratories or trained personnel to detect and diagnose the problem.” – Dr. Samba Sow

For now, the only solution is to make the African continent citizens take the COVID-19 seriously. This was also put very clearly by Dr. Sow, who stated,

“If you want to win a situation, you have to quickly be willing to worry your population. Once you start to worry you will take it seriously. It happened in Europe. People were not taking this seriously… In general, in Africa the population is still not worried about this.” – Dr. Samba Sow

Chinazzi. M., Davis. J. T. and Ajelli. M., (2020). The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. medRxiv published online Feb 11 (preprint). DOI:10.1101/2020.02.09.20021261.

Gilbert. M.,, Pullano. G., Pinotti. F., Valdano. E., Poletto. C., Boëlle. P., D’Ortenzio. E., Yazdanpanah. Y., Eholie. S., Altmann. M., Gutierrez. B., Kraemer. M. and Colizza. V., (2020).Preparedness and vulnerability of African countries against importations of COVID-19: a modelling study. Lancet 395: 871–77.

Pullano. G., Pinotti. F., Valdano. E., Boëlle. P-Y., Poletto. C. and Colizza. V., (2020). Novel coronavirus (COVID-19) early-stage importation risk to Europe. Eurosurveillance 25: 000057.

Signe. L., (2018). Africa’s tourism potential: Trends, drivers, opportunities and strategies. Africa Growth Initiative. Brookings Institution.

Wu. J. T., Leung. K. and Leung. G. M., (2020). Nowcasting and forecasting the potential domestic and international spread of the COVID-19 outbreak originating in Wuhan, China: A. modelling study. Lancet published online Jan 31.

Dr. Parita Shah is a Lecturer in the Department of Geography and Environmental Studies, University of Nairobi

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