With 6 681 confirmed coronavirus cases in 50 of 54 African countries as at 2 April 2020, concerns are growing about the virus’s potential spread with various unique drivers and challenges set to fuel the contagion. With only four countries yet to confirm a Covid-19 case (Comoros, Lesotho, São Tomé and Principe, and South Sudan), South Africa is leading the pack with 1 462 cases, followed by Algeria (847), Egypt (779), Morocco (691) and Tunisia (455).
There is little doubt, however, that these numbers could climb soon and rapidly, although experts note that the delay in catching up with the rest of world may have given Africa a reprieve period to get ready. In mid-March, World Health Organisation (WHO) response expert, Michel Yao, said that while only South Africa and Senegal initially had laboratories that could test for the virus, more than half of sub-Saharan countries were now suitably equipped. Nonetheless, overall health infrastructure remains wholly inadequate, with a recent Lancet study finding that only Egypt, Algeria and South Africa had health systems that were prepared to handle the virus.
That most of Africa is underprepared for a Covid-19 onslaught is clear. It is also vulnerable.
The United States (US) based think-tank, the Rand Corporation’s Infectious Disease Vulnerability Index, notes that of the 25 countries in the world most vulnerable to infectious outbreaks, 22 are in Africa. Factors driving risk include numerous conflict zones, poor health infrastructure and porous borders. It adds that targeted and timely interventions in crisis management, public health, and governance (with global aid and support) can help mitigate outbreaks, as seen with Ebola in Nigeria, Senegal, and Mali during the 2014 Ebola outbreak.
Facing these limitations, many states have imposed some kind of lockdown and coronavirus management plan to try and contain the pandemic.
South Africa, regarded as the epicentre of the virus on the continent (with relatively high exposure to foreign travellers both business and tourists) instituted a total lockdown on 27 March. With the country’s 1 462 cases now way behind initial estimates that infections would hit 4 000 by 1 April, there is cautious optimism that the lockdown may have helped slow the spread of the virus to and within the country’s highly densely populated townships that present the greatest risk of an uncontrollable infection rate. On the flipside, testing has to date been largely confined to private sector institutions that largely serve the suburban middle class. This means the numbers could soon change dramatically as cases in the townships have reached double digits and could soar as the state rolls out a massive screening and testing programme. Severe limitations remain, however, with the National Health Laboratory Service (NHLS) currently able to manage only 5 000 tests a day.
The WHO has been quick to praise South Africa’s speedy response, and with confirmed cases climbing from 17 to 82 in two weeks, Rwanda’s reaction has been equally intense. On 2 April it extended a strict lockdown that was announced on 21 March and due to end on 19 April. As in South Africa, the Rwandan lockdown compels people in the East African nation to stay at home unless necessary for food, medical care or the provision of essential services with security forces deployed to enforce the measures.
Among South Africa’s neighbours, Botswana (now with 4 cases but then one of the few countries in Africa without a confirmed case) closed its borders on 24 March after neighbouring Zimbabwe (8 cases) recorded its first coronavirus death the day before. This comes as Botswana’s own President, Mokgweetsi Masisi, warned of an imminent lockdown after being in precautionary self-quarantine after a visit to neighbouring Namibia (13 cases) which, along with Zimbabwe, declared a national emergency on 17 March. Cross-border impacts have already manifest as thousands of Mozambicans (10 cases) returned from South Africa after it closed the main border post between the two countries, at Ressano Garcia, at 12pm on 26 March. Far less prepared is Malawi (3 cases), with about 20 ICU beds for about 18 million people, as opposition parties complain that people from affected countries continue to cross the country’s borders without being tested.
With Zambia (39 cases) proposing a lockdown of borders to non-essential cargo, further to the east, Kenya (110), like South Africa and others, has drawn bad press for the way security forces are cracking down to enforce curfews and other restrictions. Uganda (44 cases), meanwhile, closed its borders and banned international flights on 21 March before ordering a 14-day lockdown on 30 March. Tanzania (20 cases), contrarily, is taking heat for its wait and see approach, with church services and funerals carrying on as usual as government seems focused on making sure the pandemic doesn’t paralyse the country. At the other end of the scale, prosperous island nation Mauritius (161) is still on full alert after extending possibly the most severe lockdown on the continent (including all supermarkets, shops and bakeries) from 31 March 2020 to 15 April.
In West Africa, traditional powerhouse Nigeria (174 cases) closed its airports to all incoming international flights for a month on 21 March and imposed a partial lockdown on 26 March to counter the spread among its 200 million strong population. Ghana (204 cases) closed its borders on 22 March and on 30 March imposed a lockdown on its two biggest cities of Accra and Kumasi (a combined population of about 7 million). The Ivory Coast (190) has had its borders closed since 25 March and has declared a state of emergency and curfews, as has Senegal (195 cases). Burkina Faso (282) and Mali (28) have imposed night-time curfews, while 6 Burkinabé ministers have tested positive for Covid-19, affirming perceptions that the virus is spreading from the top down in Africa.
The worst hit country in Central Africa, Cameroon (284), shut all borders indefinitely from 17 March, and from 18 March suspended all international flights, except for cargo planes, until 17 April. It has yet to enforce a lockdown. Exemplifying the complexities at play, while the Democratic Republic of Congo (DRC – 123 cases) declared a state of emergency on 24 March, it has yet to enforce severe measures with a proposed lockdown on Kinshasa postponed on 27 March amid insecurity and price speculation on basic goods. With the Central African Republic (CAR – 8 cases) population of five million people said to have only three ventilators, the country is a striking example of how ill-prepared the continent might be.
With better infrastructure, but the highest numbers outside South Africa all in the north of the continent, Morocco instituted flight restrictions from 15 March; Algeria closed mosques, cafes and markets, land borders and suspended international flights on 16 March; Tunisia imposed a curfew from 18 March and suspended air and sea travel with Europe from 19 March; and Egypt implemented a lockdown, followed by 24 March national curfew.
All these numbers, however, are in their very early days and exactly how and how quickly the virus will spread in Africa compared to the rest of the world remains unknown. What is clear is that Africa faces its own set of challenges in containing, quantifying and recovering from the virus, with some even questioning whether the numbers are being manipulated or “covered up”. The WHO says this would be difficult in the longer term as detecting and hiding cases would require an “exceptionally managed” response and likely result in a bigger and faster-spreading outbreak. The possibility of severe under-reporting due to capacity constraints is more real and, with most of the continent already battling malnutrition, disease and a lack of healthcare facilities, the Covid-19 pandemic could be disastrous for developing countries.
Hence, Africa is racing to curb the spread of the illness as fears grow about under-reporting and the lack of medical and other infrastructure with early rainy seasons threatening concomitant peaks in malaria cases while measles continues to move through the Congo unabated. Combined with extreme limitations on water and sanitation across the continent, current counter measures such as social distancing are far harder to apply in Africa. Population pressures mean slum like conditions for many, and dense queues for food, water, and social security assistance are proliferate. Should the numbers grow in the coming weeks new and more Africa-specific responses will need to be considered and considerable aid will be required.
As things stand, the strength and speed of measures applied by most African governments underscores deep common concern about what will happen if the virus penetrates high-density urban areas. Socio-economic conditions will make it more difficult for South Africa and other impacted African nations to implement the shutdowns being deployed elsewhere. This, in itself, could affect containment and the fallout remains a volatile unknown in the short to medium term, with mismanagement potentially leading to human and stability costs far exceeding economic losses.