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SHORT COMMUNICATION
Year : 2020  |  Volume : 9  |  Issue : 4  |  Page : 374-377

What is shaping the coronavirus pandemic in Africa?


1 Division of Health Systems Management and Policy, University of Memphis, Memphis, USA
2 Division of Social and Behavioral Sciences, University of Memphis, Memphis, Tennessee, USA
3 Joint Medical Lifesavers Foundation, Bowling Green, Kentucky, USA

Date of Submission10-Jul-2020
Date of Decision11-Jul-2020
Date of Acceptance07-Aug-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Dr. Aram Dobalian
Health Systems Management and Policy, University of Memphis, Memphis, Tennessee
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_142_20

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  Abstract 


CONTEXT: The low prevalence of the coronavirus (COVID-19) outbreak in Africa has puzzled many experts. Some have attributed the low prevalence to the continent's inadequate testing capacity, whereas others have suggested other less substantiated evidence such as the preponderance of active global tuberculosis vaccination policies in African countries. Regardless of the true prevalence of COVID-19 in Africa, the pandemic is expected to exhibit a different pattern in Africa compared to other parts of the world because of the continent's peculiarities.
AIM: In this article, we discuss the major factors that are currently shaping the pattern and prevalence of the outbreak in Africa.
CONCLUSIONS: Based on this assessment, Africa will face an uphill battle against the COVID-19 pandemic with significant long-term effects.

Keywords: Africa, coronavirus, COVID-19, factors, pandemic


How to cite this article:
Kabir UY, Ward KD, Uju KJ, Dobalian A. What is shaping the coronavirus pandemic in Africa?. Int J Health Allied Sci 2020;9:374-7

How to cite this URL:
Kabir UY, Ward KD, Uju KJ, Dobalian A. What is shaping the coronavirus pandemic in Africa?. Int J Health Allied Sci [serial online] 2020 [cited 2020 Oct 28];9:374-7. Available from: https://www.ijhas.in/text.asp?2020/9/4/374/298110




  Introduction Top


As Africa struggles to contain the coronavirus (COVID-19) outbreak, most experts are puzzled by the low prevalence of this in the continent. The first case of coronavirus in Africa was reported on Valentine's day, the April 14, 2020, in Egypt.[1] Since then, the number of cases has grown exponentially. As of July 21, Africa has >737,867 reported cases of COVID-19 associated with about 15,000 deaths.[2] Although these numbers are worrisome, African countries have some of the lowest per capita cases in the world.[2] The low prevalence has been an anomaly considering the region's poorly developed medical systems and emergency preparedness, and their close relationship and high contact with China, the likely original COVID-19 epicenter where the index case was reported.

One possible explanation for this anomaly has been the lack of testing capacity for most African countries. For example, Nigeria, the most populous and strongest economic power in Africa, only tested 71,000 samples for its over 200 million citizens in the first 3 months of its outbreak, a rate which is very low compared to that of developed countries.[3] South Korea, which has a population that is only a fourth of that of Nigeria, tested >340,000 people within their first 2 months of its COVID-19 outbreak.[4] This raises skepticism about the reported number of cases because there might be numerous untested cases in these countries.

Other reasons for the low prevalence are based on unsubstantiated evidence. One study found an association between countries with active global tuberculosis vaccination (bacillus Calmette–Guerin [BCG]) policy and a low prevalence of COVID-19.[5] This connotes that the BCG vaccine might offer some nonspecific protection against COVID-19 for vaccinated individuals. Most countries that have an active BCG vaccination policy are underdeveloped and have a lower testing capacity, however this relationship might just mirror the association between low testing and low prevalence of COVID-19. Another potential explanation of the relatively lower burden of COVID-19 in Africa is the endemic use of chloroquine, a sister compound to hydroxychloroquine, which is used to treat malaria in the continent. Albeit anecdotal, there was initially some evidence that hydroxychloroquine slows the progression of the virus in humans, which has led to numerous clinical trials all over the world. Nonetheless, new and more rigorous studies have now refuted the claim that hydroxychloroquine is effective in treating COVID-19,[6],[7] and some studies even suggest that use of this compound might be harmful to its users, leading to an abrupt halt of a multicountry trial of the drug by the World Health Organization (WHO).[8]

Regardless of the true prevalence of coronavirus in Africa, preliminary data about this new strain of coronavirus, SARS-COV-2, suggest that some factors will shape the spread and severity of this pandemic in most African countries. Although the impact of each of these factors may vary from country to country, most African nations share these characteristics.

Demography

By now, it has been well established that advanced age is among the chief risk factor for developing significant symptoms or dying from COVID-19,[9] and Africa has a burgeoning young population.[10] Only 3% of its population are elderly (65 years and older) compared to 16% in North America and 18% in Europe.[10] This youthful population reduces the vulnerability of African countries to the pandemic. Moreover, the majority of Africans reside in less densely populated rural areas as opposed to urban centers,[11] which limits the transmission of this virus. These demographic characteristics suggest that the impact of COVID-19 will be lower in Africa compared to developed nations with older populations in denser, more urban locales.

On the other hand, years of conflicts have left many places in Africa with a large displaced population living in congested camps, which could be a breeding ground for this contagious virus. Similar crowded conditions may have led to a resurgence of cases in Singapore.[12] Furthermore, countries in the sub-Saharan Africa are currently battling the HIV epidemic, a disease that is capable of severely damaging the immune system and leaves countless Africans highly vulnerable to the COVID-19.[13] Likewise, the African continent has one of the highest burdens of malnutrition in the world, which can compromise the health of its people.[13] These demographic characteristics paint a more dire prognosis of this pandemic for the continent.

Environment

In general, coronaviruses cannot survive for long at temperatures of above 30°C,[14] which is much below the current daily temperatures of many African countries. Owing to its location, Africa is the hottest continent on the planet and as luck would have it, the COVID-19 pandemic is only reaching most African countries at the beginning of their hottest months of the year. Furthermore, newer studies have indicated that ultraviolet light, which is commonplace in most African countries, inactivates SARS-CoV-2. These factors reduce the risk of transmission of the virus by decreasing its spread through outdoor surface contact, all of which would be good news for African countries. However, this potential reduction in transmissibility has not been greatly studied in SARS-CoV-2 because it is a new strain; there is not much information about its thermostability, and its seasonality has not been established. Moreover, reduced transmissibility does not mean that the virus cannot be transmitted in hot areas.[15],[16]

Societal characteristics

Some unique societal and attitudinal characteristics of Africans will play a significant role in shaping this pandemic in Africa. Certain common African traditions, like the communal nature of daily life, could strongly hamper even the most effective public health tool for combating this outbreak, namely, social distancing. Unlike many Western countries where individuals and families are more or less independent units, extended families that live in the same vicinity are common in Africa. The complex nature of the family structure and their strong interdependence makes it virtually impossible to reduce contact within the community.

Furthermore, mistrust of Western medicine is rife on this continent. This mistrust has been fueled by horrific headlines of incidents such as the Pfizer experimental drug trial scandal of 1999 and allegations of unethical research practices by several Western scientists in Africa.[17] This mistrust was made evident in April when troops of young Africans took to social media to protest alleged remarks made by two French physicians on the potential of testing the COVID-19 vaccine in Africa.[18] Such mistrust, coupled with misperceptions that they are not susceptible to COVID-19 (as shown in a new poll)[19] and factors such as food insecurity that have been shown to decrease adherence to preventative medical guidelines,[20] could significantly impede Africa's ability to tackle the outbreak.

Health and health-care system

It is no secret that the health systems of many African countries have endured years of neglect and underfunding that has left them fragile. Several of these countries face a chronic shortage of health-care workers, despite demand that is second only to South-East Asia and which is projected to surpass all regions by 2030.[21] Moreover, in countries like Nigeria, the physician specialists who are most critical for the care of COVID-19 cases, registered respiratory physicians are estimated to be about one for every 22 million Nigerians, a prevalence rate that is far below its projected need.[22] Compounding the issue is the scarcity of ventilators that are currently the most important device for treating coronavirus patients with advanced cases. The New York Times recently reported that as many as ten African countries have no ventilators.[23] The article further cited a WHO report that found fewer than 5000 intensive care beds in 43 African countries. This lack of resources suggests an extremely poor prognosis for the continent's outlook in its fight against coronavirus.

Leadership

Perhaps, the most important factor that will determine the progression of this pandemic in Africa is leadership. While the totalitarian and semi-authoritarian governance style that predominates many African nations makes enforcement of stay home orders stricter, the price that comes with such actions is an increase in the incidents of human rights abuse, as has been reported in the media.[24] This further weakens public trust and puts the response to the outbreak in jeopardy. The ubiquity of corruption among African leaders can drastically diminish successful efforts to fight this scourge. Transparency International recently warned that this outbreak could provide an avenue for corrupt practices, which may further undermine the response to the pandemic.[25]


  Conclusion Top


These five factors will continue to shape how this pandemic spreads across Africa. While some of the factors will benefit countries in Africa, most suggest an uphill battle against COVID-19. Ultimately, the outcome of Africa's campaign against this pandemic will largely depend on which among these factors predominates. One thing for sure is that this outbreak will leave African countries with a bill they are nowhere close to footing in an economy that is in its worst shape in at least 25 years. The potential silver lining is that the pandemic might serve as a wakeup call for African nations to rise to their responsibilities of strengthening their health-care systems and the overall emergency preparedness of the continent. Hopefully, this virus will not find a home in Africa and become endemic like HIV and other life-threatening infectious diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Al Jazeera. Breaking News: Egypt Confirms Coronavirus Case, TheFirst in Africa. Available from: https://www.aljazeera.com/news/2020/02/egypt-confirms-coronavirus-case-africa-200214190840134.html. [Last accessed on 2020 Jun 08].  Back to cited text no. 1
    
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3.
African Center for Disease Control: COVID-19 Daily Updates. Available from: https://africacdc.org/covid-19/. [Last accessed on 2020 Jun 08].  Back to cited text no. 3
    
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Shefali L. Kaiser Health News: Trump's Boast About U.S., South Korea Coronavirus Testing. Available from: https://khn.org/news/fact-check-trumps-boast-about-u-s-south-korea-coronavirus-testing-misses-the-mark/. [Last accessed on 2020 Jun 08].  Back to cited text no. 5
    
6.
Sala G, Chakraborti R, Ota A, Miyakawa T. Association of BCG vaccination policy and tuberculosis burden with incidence and mortality of COVID-19. Chan Zukerberg foundation. Available from: https://www.medrxiv.org/content/10.1101/2020.03.30.20048165v3. [Last accessed on 2020 Jun 08].  Back to cited text no. 6
    
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8.
Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med 2020;383:517-25.  Back to cited text no. 8
    
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13.
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Newman T. Medical News Today: How Long can Coronaviruses Survive on Surfaces? Available from: https://www.medicalnewstoday.com/articles/coronaviruses-how-long-can-they-survive-on-surfaces# How-long-do-coronaviruses-persist?. [Last accessed on 2020 Jun 14].  Back to cited text no. 14
    
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18.
Al Jazeera RR. Racism Row as French Doctors Suggest Virus Vaccine Test in Africa. https://www.aljazeera.com/news/2020/04/racism-row-french-doctors-suggest-virus-vaccine-test-africa-200404054304466.html [Last accessed on 2020 Jun 13].  Back to cited text no. 18
    
19.
BBC News Pidgin, Coronavirus: 26% of Nigerians Believe Say COVID-19 no fit Catch Children of God. Available from: https://www.bbc.com/pidgin/5195939. [Last accessed on 2020 Jun 08].  Back to cited text no. 19
    
20.
Mahmood A, Kim H, Kabir U, Kedia S, Ray M. Food insecurity and influenza and pneumonia vaccines uptake among community-dwelling older adults in the United States. J Community Health 2020:1-1  Back to cited text no. 20
    
21.
World Health Organization. Global strategy on human resources for health: Workforce 2030. Available from: http://apps.who.int/iris/bitstream/handle/10665/250368/9789241511131-eng.pdf?sequence=1. [Last accessed on 2020 Jun 08].  Back to cited text no. 21
    
22.
Obaseki D, Adeniyi B, Kolawole T, Onyedum C, Erhabor G. Gaps in capacity for respiratory care in developing countries. Nigeria as a case study. Ann Am Thorac Soc 2015;12:591-8.  Back to cited text no. 22
    
23.
Maclean R. Marks S. 10 African Countries Have No Ventilators. Thatfs Only Part of the Problem.Available from:https://www.nytimes.com/2020/04/18/world/africa/africa.coronavirus.ventilators.html. [Last accessed on 2020 Jun 08].  Back to cited text no. 23
    
24.
Eboh C. Nigerian Security Forces Killed 18 People During Lockdowns: Rights Panel. Available from: https://www.reuters.com/article/us-health-coronavirus-nigeria-security/nigerian-security-forces-killed-18-people-during-lockdowns-rights-panel-idUSKCN21Y272. [Last accessed on 2020 Jun 08].  Back to cited text no. 24
    
25.
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