Africa has so far escaped the worst from Covid-19. Are we being lulled into a false sense of security or has the continent dealt with the threat better than others? Anver Versi weighs up the facts.
When Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organisation, made the assessment that Covid-19 could be officially described as a pandemic due to the rapid increase in the number of cases outside China on 11 March, most of us feared the worst for Africa.
While various countries across the world scrambled around to deal with (or not deal with it in some cases) the pandemic, the outlook for Africa, according to experts, was dire.
Not long after the announcement of the onset of the pandemic, according to a regional WTO official, coronavirus cases in Africa could surge from just thousands then to 10m within three to six months.
According to modelling by Imperial College, London. Africa could see 300,000 deaths from the coronavirus even under the best-case scenario. Under the worst-case scenario with no interventions against the virus, said the UN Economic Commission for Africa, the continent could see 3.3m deaths and 1.2bn infections.
Relatively few deaths so far
As Covid-19 continued to ravage the advanced countries of Europe and the US, we waited for the hammer to fall – as did the rest of the world. Melinda Gates, speaking on CNN, predicted that the pandemic would devastate the developing world and that she would imagine bodies lying on the streets of African countries.
This was when refrigerated trucks were carrying off the corpses of Covid-19 victims from US hospitals, and sports arenas were being repurposed as intensive care units in the US.
It seemed inevitable that Africa, which has felt the brunt of virtually all epidemics to hit the world over the last 50 years, would become the epicentre of the coronavirus outbreak. If even the highly advanced medical teams and state-of-the-art equipment in Europe and the US could not halt its relentless march, what hope had Africa?
Well, the hammer did not fall – or rather, it fell rather lightly, causing very little damage, relatively speaking. Let’s look at some comparative figures as at 20 May:
Africa: 91,365 cases – the five countries reporting most cases are South Africa (17,200), Egypt (13,484), Algeria (7,377), Morocco (7,023) and Nigeria (6,401). Deaths: 2,903 – the five countries reporting most deaths are Egypt (659), Algeria (561), South Africa (312), Morocco (193) and Nigeria (192).
Asia: 833,437 cases – the five countries reporting most cases are Turkey (151,615), Iran (124,603), India (106,750), China (84,065) and Saudi Arabia (59.854). Deaths: 25,417 – the five countries reporting most deaths are Iran (7,119), China (4,638), Turkey (4,199), India (3,303) and Indonesia (1,221).
America: 2,186,907 cases – the five countries reporting most cases are the United States (1,528,568), Brazil (271,628), Peru (99,483), Canada (79,101) and Mexico (54,346). Deaths: 129,680 – the five countries reporting most deaths are the United States (91,921), Brazil (17,408), Canada (5,912), Mexico (5,666) and Peru (2,914).
Europe: 1,740,551 cases – the five countries reporting most cases are Russia (299,941), the United Kingdom (248,818), Spain (232,037), Italy (226,699) and Germany (176,007). Deaths: 164,349 – the five countries reporting most deaths are the United Kingdom (35,341), Italy (32,169), France (28,022), Spain (27,778) and Belgium (9,108).
Oceania: 8,500 cases – the five countries reporting most cases are Australia (7,068), New Zealand (1,153), Guam (154), French Polynesia (60) and Northern Mariana Islands (21). Deaths: 127 – the four countries reporting most deaths are Australia (99), New Zealand (21), Guam (5) and Northern Mariana Islands (2).
Worldwide, the figures were: 5,035,898 confirmed cases, 326,228 deaths and 1,988,535 recoveries.
Taking its population into account, Africa’s infection and death rates are astonishing. The only other region with remarkably low infection rates is Oceania, with only 8,500 so far, but its entire population is only 42,156,769 people compared to Africa’s 1.2bn.
What is more, Australians comprise roughly 60% of the population of Oceania, with New Zealanders making up 11.5%. Both these countries were very quick to shut out the rest of the world by closing their airspaces and borders and by imposing strict lockdowns. They also have some of the most advanced medical facilities in the world. Sub-Saharan Africa on the other hand, as we know, has on average, the most basic public health facilities. Only South Africa can be said to have some facilities that come up to world standards, but even these are not easily accessible to the average citizen.
Before the virus arrived, South Africa had the highest number of ventilators at 1,500, but 10 countries in Africa had none. Egypt has the highest number of intensive care beds, at 10,300 (and more were made available through repurposing when the virus struck) but six countries have none.
Again, as we know to our cost, Africa has more than its fair share of other epidemic diseases: roughly 24m Africans live with HIV and a million die each year from the condition; malaria kills an estimated 430,000 Africans a year and 2.5m are infected with TB. Malnutrition is endemic in many part of Africa.
Therefore, all the so-called underlying causes that leads to serious Covid-19 illness and death are plentiful in Africa yet infection numbers remain low.
The question is, why?
Explanations that fall down
There have been all sorts of theories. There has not been enough testing and when tests are carried out fully, the picture will change dramatically. Not quite. Many African countries have been carrying out testing successfully and identifying and isolating those who are carriers.
True enough, there are not enough test kits or diagnostics, as Dr John Nkengasong, the director of the Africa Centres for Disease Control and Prevention readily admits, but organisations such as the Jack Ma Foundation and even the government of Ethiopia have donated a considerable amount of equipment to carry out tests.
In any case, we do not see the overwhelming demand for hospital treatment or deaths that accompany the virus elsewhere, so even if a large number of the population are carriers, or have been exposed to the virus, it has remained largely benign.
Then there is the theory that the virus does not like heat and humidity and Africa is hot and humid. But not all of Africa is hot or humid and these climate factors have not helped Brazilians or other Latin Americans to escape Covid-19.
Perhaps, someone suggested, it has to do with the African’s dark pigment. But if that were the case, then all people of a dark hue everywhere in the world would be protected. In fact, the opposite is true – the largest burden of deaths from the disease in the UK and US has fallen on Black and Asian people.
Then there is the theory that Africans have special immunology acquired from diseases such as malaria, or that the treatment of such illness acts as a barrier to the coronavirus. This has led to speculations that anti-malarial treatments such as hydroxychloroquine would work against coronavirus. Donald Trump seems to be a firm believer in this remedy despite warnings from medical experts that it does not cure the illness but can have serious side-effects.
But the fact is that the majority of Africans do not have access to anti-malarial drugs and in any case, many of the infections were acquired by Africans while they were abroad, so the theory of their special immunity does not stand up.
Better at managing crisis
So, why is Africa so far holding out against the dreaded pandemic?
“A rather obvious possibility stares us in the face,” writes journalist Jina Moore in the New Yorker. “What if some African governments are doing a better job than our own of managing the coronavirus?”
She recounts that when Dutch anthropologist Ingrid Gercama landed in South Sudan, she was taken to a separate screening area, where her temperature was recorded along with her hotel address and telephone number by local health officials. She was questioned about her travel and contacts and she saw a good amount of posters on the disease in the area. She had to wash her hands before and after the testing.
She left Juba on 19 March and flew first to Stockholm and thence to Amsterdam. In neither airport was her temperature recorded or was she asked about her travel history. “When she passed through passport control,” writes Moore, “she found no leaflets, no Covid-19 awareness banners, no hotline. ‘They didn’t even tell me to self-isolate,’ Gercama told me. ‘I did so because I have common sense’.”
“One reason why we may be seeing what we are seeing is that the continent of Africa reacted aggressively,” Dr Nkengasong, the director of the Africa Centres for Disease Control and Prevention, told Moore. “Countries were shutting down and declaring states of emergency when no or single cases were reported. We have evidence to show that that helped a lot.”
Caleb Okereke, a Nigerian journalist and filmmaker based in Kampala, Uganda writing for Al Jazeera, says: “Predictions of mass deaths in Africa are problematic for reasons beyond inaccuracy. They assume that nothing that African countries do can mitigate the spread of the disease and prevent high death tolls. They presuppose that Africans will be just passive victims of yet another viral outbreak.”
But, he argues, “many African countries have long experience in dealing with infectious diseases and by now have developed know-how that many Western countries might not have. And many African leaders are also not unaware of their fragile healthcare systems – unlike some of their Western counterparts.”
He says that just as someone who is diabetic knows to avoid sugar, “African governments understand that their most effective strategy in the battle against Covid-19 is prevention and applying lessons learned from previous and/or ongoing outbreaks.”
Another reason why Africa has so far fared better than many other regions is because 70% of its population is under 30 years of age. It seems that the majority of Covid-19 victims are the elderly and infirm. In the UK, 40% of the deaths have been in care homes (residences designed for the elderly).
Such institutions are virtually unknown in sub-Saharan Africa. If the elderly can no longer live with their children in urban centres, they move to their villages where they are respected as senior citizens.
A new age for Africa and the world
One should not tempt fate by believing that Africa has indeed coped with the coronavirus better than other regions; there is still a long way to go and the situation may have changed dramatically by the time you are reading this, but if the status quo more or less holds with new cases increasingly only gradually, then Africa can salute the timely and tough action taken by its leaders.
But of course there are exceptions. Some leaders have tried to use the lockdown to clamp down on opposition or entrench themselves in power; some have used heavy-handed intimidation to enforce curfews; some have allowed bribery and corruption to run riot and some, like Tanzania’s John Magufuli, have played reckless, ego-led games with the lives of their citizens.
Nevertheless, we can say with confidence that most African governments have risen to the challenge and acted swiftly to lock down their countries, but many have done so with the clear knowledge that the majority of their citizens have to work in order to eat and pay their rents.
At their best, the lockdowns have been sensible – reducing the opportunities of transmission by social distancing and the wearing of face masks but making them flexible enough to allow people to continue to earn their living.
The knowledge that African governments, with the support of their people, can survive such global catastrophes, will no doubt inspire new confidence in the ability of Africans to solve their problems in their own ways.
Africa, like the rest of the world, will need considerable support – according to President Paul Kagame of Rwanda, to the tune of £100bn – as well as debt forgiveness to fire up its economic engines again after this crisis has ended (as end it surely must). But this will be a changed Africa and my bet is that it will take the lead in many ways, in giving new life, shape and purpose to the global economy.
It will also be the time to spread Africa’s unique philosophy of Ubuntu to the rest of the world.