The continent is especially sensitive to the pandemic, but it has also learned many lessons from previous emergencies.
The SARS-CoV-2 pandemic is advancing relentlessly and puts the health systems of many countries in the Northern Hemisphere in check. As with the SARS coronavirus [2002-2003] and the H1N1 flu , COVID-19 reaches Africa later. This continent already accumulates almost 6,000 reported cases in 49 countries. The WHO Regional Office for Africa warns that this could be the biggest public health challenge the region has faced in recent times.
Sub-Saharan Africa is the region with the highest risk of mortality from seasonal influenza, followed closely by the Eastern Mediterranean and Southeast Asia. If we take into account that the SARS-CoV-2 infection is showing higher contagion and fatality rates than the flu and that there is a possible association between mortality from COVID-19 and the difficulty of access to health resources, we can consider that the African continent would not be in the best situation to receive the pandemic.
Faced with the uncertainty of the impact that the coronavirus will have on this continent, we know that it joins other emergencies. In Africa, measles outbreaks and humanitarian crises coexist with the three major endemics [malaria, AIDS and tuberculosis], neglected tropical diseases and a locust plague that threatens food security in the Horn of Africa. During the past week, 91 outbreaks of different diseases were reported in this part of the planet, including COVID-19.
With one of the most fragile health systems in the world, Africa bears a quarter of the global burden of disease and accounts for only 3% of health workers. In terms of tangible investments, most of the health budget in African countries is destined to medical products, spending on personnel is 14% and on infrastructure, 7%. These figures are far from those of regions with better performing health systems, where investment is higher in both the workforce [40%] and infrastructure [33%].
Although there is variability among African countries, in global terms only half of the population has access to satisfactory health and welfare services. Their health systems function at 49% of their possibilities, far from reaching their maximum potential, and with a low level of resilience. These are few resources, human and material, to cope with an explosive increase in patients in need of intensive care.
Faced with this scenario, most African countries are making efforts to detect early, close or limit air traffic and at borders, as well as isolation, quarantine and social distancing measures. It is a titanic effort both for the rural area, where 60% of the population lives and the subsistence economy is frequent, and for the cities, where poorly planned urbanism abounds in the periphery, with deficient infrastructures and inadequate access to the supply of electricity. water, sanitation and waste management.
We have heard ad nauseam that hand washing is one of the main measures to curb the transmission of COVID-19. Fortunately, in North Africa 90% of the population has access to clean water, but this is going to be a problem in sub-Saharan Africa, where 40% of the population [approximately 300 million people] do not. They are well aware of the importance of hygiene and sanitation: after respiratory diseases and AIDS, diarrheal diseases are the third leading cause of morbidity and mortality in Africa.
Consequences of COVID-19 in a punished continent
The demographic pyramid in African countries is very different from ours, with a much less aged population. This would lead us to think of a lower mortality from COVID-19, but the proportion of individuals who have a compromised immune system is much higher.
The Director General of the WHO, Tedros Adhanom, highlighted how this pandemic shows how vulnerable people are with lung disease or with a weakened immune system.
Today is #WorldTBDay. As we stand together to confront the # COVID19 pandemic, it highlights just how vulnerable people with lung diseases & weakened immune systems can be. Millions of people around the 🌍 suffer & die from #tuberculosis, a preventable, treatable, curable disease. pic.twitter.com/uCzvPGJdIa
Tedros Adhanom Ghebreyesus [@DrTedros] March 24, 2020
This does not bode well for a region where lower respiratory tract infections and AIDS are the leading causes of morbidity and mortality. Africa is the region with the highest burden of AIDS, almost two thirds of new HIV infections occur on this continent. It also tops the rankings for other epidemics such as malaria, tuberculosis and childhood pneumonia, and it bears the bulk of the global burden of neglected tropical diseases. Without forgetting that the African continent also takes the worst part in terms of malnutrition and food insecurity.
In addition to the direct impact on people, there is also great concern about the effect of COVID-19 on health programs and access to medical care. An example is the previous Ebola epidemic and the negative consequences it had on childhood vaccination campaigns [measles and pentavalent] in Sierra Leone.
The impact of COVID-19 on tuberculosis is especially worrying, since the continent has a high prevalence of HIV and in this condition co-infection with tuberculosis is the main cause of mortality. That is why, recently, the WHO has encouraged countries to maintain the continuity of tuberculosis programs and provided guidelines to minimize the negative effects of the COVID-19 pandemic.
The WHO sends similar guidelines in the case of malaria, another one of the “big three”, which concentrates in Africa 90% of cases and deaths [especially in children under five years]. If efforts to control this disease are not maintained [insecticide spraying, distribution of mosquito nets, early diagnosis and treatment], a rebound in malaria will be observed after the colossal efforts made in recent years. A bad moment, when the malaria vaccine implementation program already takes place in three African countries.
Lessons and good news
The African continent is already a veteran in the fight against high-impact epidemics and in the rapid response in crisis situations. The Ebola outbreak in West Africa highlighted how an epidemic can spread rapidly and pose huge problems in the absence of a strong health system. But the enormous effort that this crisis entailed, of integration and cooperation of international organizations, government entities and, above all, civil society, is now a learning process and an acquired response; your most effective vaccine.
Along with this, the late arrival of COVID-19 to Africa has provided an opportunity for preparedness that has not been missed. This is how the Africa Joint Continental Strategy for COVID-19 OUTBREAK was created, a multilateral action that coordinates efforts of agencies of the African Union and member countries, WHO and other partners, and that focuses on 6 pillars: Laboratory capacity , surveillance, prevention and control in medical centers, case management, communication and logistics.
Since February this year, Africa has prepared and improved its capacity for COVID-19 diagnosis. The Africa CDC and the Pasteur Institute in Dakar have worked in coordination to implement SARS-CoV-2 RNA detection techniques in more than 40 countries on the continent. At the same time, the WHO Africa Regional Office, together with Africa CDC, have launched a campaign for technical guidance, communication and awareness.
There is a United Nations COVID-19 Global Humanitarian Response Plan that has two billion dollars and considers Africa as a priority region, while in the contributions that different countries, multilateral organizations, foundations and corporations make to the global fight against COVID-19, support for low and middle income countries is not forgotten.
One of the things that this pandemic teaches us is that we live in a globalized world, with a flow of people, goods, and pathogens on a global scale. Infectious agents, including this virus, know no borders. COVID-19 started in China and is now reaching Africa. The continent has overcome serious epidemics, has the coalitions and response plans that it inherits from past health emergencies and with international support.
The most important thing is that it has a population that knows the power that the community has in the fight against epidemics. A characteristic of the African people is their resilience and their living in the present. In his novel Ébano, Kapuscinski defined it as follows: “In Africa, you live from day to day, at the moment, each day is a difficult obstacle to overcome, the imagination does not exceed twenty-four hours, no plans are made or dreams are caressed. Much remains for us to learn from it. While waiting to see how the pandemic evolves, our hopes are with Africa.
This article has been published in The Conversation.
WHO World Health Organization, Sierra Leone, China, Vaccines, Coronavirus COVID-19