It has been seven odd months since the first case of COVID-19 was reported in Africa in February 2020 and subsequent progression to pandemic. To the contrast of conventional expectations, Africa has so far not been hit hard compare to the rest of the world. The reluctant spread of COVID-19 has worked to the advantage of Africa which is known for fragile Public health systems. The slow spread of COVID-19 in Africa has equally slowed down overstretching and overwhelming the health systems.
By 31st August 2020, the number of accumulated confirmed cases in Africa since the onset of COVID-19, is staggering 1,245,440. Out of whom 29,587 cases have been confirmeddead from COVID-19 related ailments and 927,152 cases have recovered from Coronavirus disease.
The top ten Countries in Africa which has reported the most COVID-19 cases includes South Africa, Egypt, Morocco, Nigeria, Ghana, Algeria, Kenya, Cameroon, Cote d’Ivoire. On the other hand, the top ten countries reported most COVID-19 related deaths includes South Africa, Algeria, Nigeria, Morocco, Ethiopia, Kenya, Cameroon, Zambia, Senegal, Ghana and Democratic Republic of Congo. The countries reporting the least infection includes Western Sahara, Seychelles, Eritrea, Mauritius, Comoros. These countries have one thing in common... three of them are islands and two are located on the fringes of Africa with little communication with the rest of Africa. The western part of Africa is leading in confirmed COVID-19 cases followed by the Southern part of Africa. In the third place is the Northern parts of Africa followed by Eastern part of Africa and finally Central parts of Africa.
COVID-19 Risk Profiles for African Countries
At the onset of COVID-19 outbreaks many pundits including the medical journal,The Lancet had projected the risk factors that would make African countries vulnerable to COVID-19 outbreaks. The African Centre for Strategic studies unveiled nine key risk factors for COVID-19 in Africa.The set of risk factors comprised of International exposure, population demography, strength of the Public Health Systems, the population age stratification, the size of Urban population, governance, press freedom, and fragility of States.
A risk factor is any attribute, characteristic or exposure of an individual or population of a country, that increases the likelihood of populationdeveloping a disease or injury (WHO 2017b).
At the beginning of the outbreak three of the nine risk factors played out glaringly. It became clear that the Coronavirus got into Africa through the people who had contacts with International Community. It also became clear that once the virus settled in Africa, it started spreading undetected within densely populated areas of the cities and the weak Public health systems could not cope with identifying, testing and isolating the people with Coronavirus.
Long after the COVID-19 penetrated Africa and transmission sipped into the inner core communities, the international exposure risk factors waned out. Currently, the determinant risk factors for COVID-19 in Africa includes the size of urban population, relative age of total population, and level of press freedom. The analysis for each is expounded here below.
International exposure as a Risk Factor
It is a common knowledge now that the first cases of the coronavirus in Africa came from exposure to international contacts via the people who travelled (travel, trade, tourism, or business) to Egypt, Algeria, Morocco, Nigeria and South Africa. The disease began to spread into the local population and with time the trajectory of virus transmission changesfrom international exposure to intra-continental and intra-state transmission vulnerabilities.
Weak Public Health Systems as Risk Factor
The Public Health Systems plays a critical role in identifying, testing, isolating, and treating the COVID-19 infected individuals. Whereas the public health systems of countries that had international exposure are strong, other countries in Africa have weak Public Health Systems with no capability to FastTrack virus testing of the population. Consequently, the virus got passed insidiously among unsuspecting individuals. Weak Public Health System thus exacerbated the spread of virus into the community.
Population Density in Urban areas as a Risk Factor
Population density is measured by the number of people living in a radius of one square kilometer. The denser the populationthe higher the chance of the virus spreading undetected and rapidly. There is a high density of population in most informal settlement of cities in Africa. Just by the nature of social structure, there is increase body-to-body contact, face-to-face interaction, and frequent movement of the people within an area and thus likelihood of transmission of COVID-19.
Population Age as a Risk Factor
Covid-19 is known to have a higher mortality rate for the elderly population.More than 70% of Africa’s population is under the age of 35 years while about 2% of the population are over the age of 70 years. There has been increased mortality in African countries within elderly population. Amongst them includes South Africa, Algeria, Morocco, Tunisia, and Mauritius. More than 70% of Africa’s population is under the age of 35 years. According to WHO, one of the reasons why the reported deaths has been low in Africa compared to the rest of the world, is partly due to the relative young population in Africa.
Key Risk Factors analysis for COVID-19 in African Countries
As community transmission becomes more prominent, each country’s unique risk profile will become more relevant especially with regards to adopting mitigation measures for COVID-19. It is for this reason that African Centre for Strategic studies (ACSS), compiled and analysed the risk profiles for each country in Africa as shown on the table below.
The ACSS created nine COVID-19 profiles for African countries on the basis of varied risk factors: International exposure, strength of the Public health systems, size of population, dimensions of urban landscapes, magnitude of conflict and displacement, demography, and governance. Each country was analysed for each profile to determine the COVID-19 threat and how best to mitigate its effects.
Note: Countries are categorized by relative risk for each factor on a 1 to 5 scale, with 1 representing less risk and 5 most risk.
Community Transmissions Phase of COVID-19 Pandemic
The COVID-19 trajectory in Africa is rapidly evolving and the focus has changed from COVID-19 preparedness to community transmission. Surveillance has been enhanced to provide a clear understanding of transmission pattern of COVID-19 into the community particularly the rural settings where senior citizens dwells. According to WHO, Community Transmission is “evidenced by the inability to relate confirmed cases or by increasing positive test through sentinel samples (routine systematic testing of respiratory samples from established laboratories)”.
Community transmission is an integral part of 6thPhase of the WHO Pandemic phases that were developed in 1999 and revised in 2005 and 2020. Other phases includes; Phases 1-3 which is predominantly animal infections with few human infections. Phase 4 is a sustained human-to-human transmission while Phases 5-6 is human-to-human infection with spread of viruses into at least two countries characterized by community level outbreaks in a least one country in another region.
By end of June 2020, over a half of the 54 African Countries had reported Community transmission. In West Africa, twelve out of fifteen countries reported community transmission with Nigeriaand Ghana leading the pack. In Central Africa, Community transmission has been observed in at least five out of seven countries including Cameroon, DRC, Gabon, Equatorial Guinea, and Chad. In East Africa, community transmission has been reported in Kenya, South Sudan, Ethiopia, and Tanzania. In North Africa, Community transmission has been reported in Algeria and Tunisia while in Southern part of Africa, the community transmission was noted in South Africa and Zambia.
The community transmission has deep and wide implications as well as complications. The potential effect of community transmission includes increasing number of cases and deaths in the communities where the elderly lived.
As African countries opens from lockdowns and skies are getting open, the countries should brace up for the second wave of COVID-19. The identified risk factors are still valid. Nevertheless, more focus should be on community transmission.