Covid-19

Coronavirus hits Africa: A disaster waiting to happen

Armed with lessons from ebola, Africa is bracing for a coronavirus surge. Officials are worries about transmission in poor neighbourhoods

22 March 2020 - 00:01 By Josiane Kouagheu, Juliette Jabkhiro and Aaron Ross
A woman wears a protective mask as she walks along a street in the Adjame area of Abidjan, Ivory Coast.
A woman wears a protective mask as she walks along a street in the Adjame area of Abidjan, Ivory Coast.
Image: Reuters

When a passenger arriving from Brussels at Cameroon's Yaounde Nsimalen airport on Saturday was found to have a temperature, health officials say he was whisked to a hospital and diagnosed inside four hours as the country's fourth case of coronavirus.

The Central African country was doing more generalised screening for disease long before China revealed the new virus that has killed more than 11,884 people globally.

Along with other countries on the continent, it hopes its experience guarding against ebola and other epidemics will help its health system cope with a pandemic that could quickly overwhelm it.

“We have cases that were not caught by the measures in France and Italy that were caught here,” Georges Alain Etoundi Mballa, who runs the health ministry's epidemic response, told Reuters, describing the screening as a “spying network”.

“Epidemics come and go, but we keep on the surveillance.” The virus now ravaging Europe has appeared in at least 33 out of 49 countries in Sub-Saharan Africa. In most of them the recorded cases are still in single figures and have come in from abroad rather than emerging at home.

If the disease gets into Africa's poorest areas, squalid, cramped conditions could cause it to spread at lightning speed.

Cameroon has decided to close its land, air and sea borders indefinitely — an unusual step on a continent where the World Health Organisation (WHO) fears porous frontiers mean movement could continue unchecked.

Hospitals across Africa are already overburdened with cases of measles, malaria and other deadly infectious diseases, and conflicts have displaced hundreds of thousands of people and destroyed infrastructure.

Asking patients to self-quarantine at home is not practical in areas where families cram into a single room, share a communal tap or latrine, and survive on daily earnings.

“Africa should brace itself for a serious challenge,” John Nkengasong, head of the Africa Centres for Disease Control and Prevention (CDC), said on March 11.

“I still believe containment is possible, but only with extensive testing and surveillance.”

In some places that looks all but impossible. In South Sudan, devastated by a five-year civil war, the government has just 24 isolation beds, said Angok Gordon Kuol, incident manager for the outbreak at the ministry of health.

He said public officials were trying to encourage hand washing, but many in the impoverished East African nation of 12-million people could not afford soap and did not have running water.

The health ministry in Burkina Faso, which is under siege from jihadist groups linked to Islamic State and Al-Qaeda, said in a report last week that the country lacked the resources to deal with the outbreak.

Its border crossings have no sites to isolate suspected cases, and the country does not have enough skilled health workers. “This can result in high mortality rates and an increased risk of spreading the disease.”

Ebola killed more than 11,000 people in West Africa between 2013 and 2016, mainly in Guinea, Liberia and Sierra Leone. It devastated communities but provided lessons.

The Africa CDC, set up by the AU in 2017, has been working with the WHO to strengthen emergency co-ordination, improve testing and surveillance, and equip treatment centres.

A Kenya Railways worker prepares to spray disinfectant against the coronavirus in a train carriage at the central station in Nairobi.
A Kenya Railways worker prepares to spray disinfectant against the coronavirus in a train carriage at the central station in Nairobi.
Image: Luis Tato/AFP

The number of countries with labs able to diagnose Covid-19 in the WHO's Africa region increased from two to 39 in just over a month. But that still leaves eight countries without.

With three confirmed cases, Nigeria, Africa's most populous nation, is scrambling to increase the number of isolation beds and provide more specialised medical training and equipment at state hospitals.

“Our health system is not as strong as we'd like it to be,” said Chikwe Ihekweazu, head of the Nigeria Centre for Disease Control.

“It is because we are a bit worried about our capacity to deal with a large outbreak that we are focused so intensively on prevention and early detection.”

Africa should brace itself for a serious challenge, I still believe containment is possible, but only with extensive testing and surveillance
John Nkengasong, head of the Africa Centres for Disease Control and Prevention (CDC)

Promoting good hygiene is a key part of that effort. But that is easier said than done. Less than half the population in 34 African countries have basic handwashing facilities in their homes, according to a 2017 UN survey.

In Senegal's capital, Dakar, announcements ring out through loudspeakers on passing cars urging people to wash their hands.

“Cleanliness is important, but here it's not easy,” said Marcelle Diatta, a 41-year-old mother of four who lives in a two-bedroom apartment with four other extended family members.

In SA, which has recorded more than 240 cases of the virus, medical services could be “swamped” if it spreads within the country's vast shanty towns, Susan Cleary, a health economist at the University of Cape Town, said.

“Transmission in an informal settlement is a disaster, an absolute disaster.”


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