Corona Virus in Africa: Are we expecting the situation to worsen?

Over the past two decades, three deadly zoonotic coronaviruses have emerged: Severe Acute Respiratory Syndrome (SARS)-coronavirus (CoV), the Middle East Respiratory Syndrome (MER)-Cov, and now the coronavirus disease (Covid-19). Unlike SARS and MER, Covid-19 has reached pandemic levels and has spread globally.

As of 27 March 2020, about 542,530 cases were reported globally including 24,369 deaths, translating to a case fatality ratio of 4.5%. As with SARS, this disease originated in China but quickly spread. Europe, North America, particularly the US, and some parts of Asia have been particularly hard-hit by the virus.

Surprisingly, Africa has recorded just 2,234 cases of Covid-19, accounting for less than 0.4% of the total cases globally. This is despite Africa housing 11% of the global population. This leaves the question of whether the low number of cases is due to lack of diagnostic capacity or simply that the disease hasn’t yet hit Africa? Further, do we expect cases to remain low and, if they do, will Africa survive both the health crisis and the accompanying economic crisis? Using the case of Zambia as an example, I discuss these questions in this short comment.

Experience from previous health crises shows that a lack of diagnostic capacity and low reporting do not sufficiently explain the low number of cases in Africa. If there were a high level of cases of Covid-19, health facilities would have been overwhelmed, however, this has not been reported or observed by the author. While it could be that people are sick but forgoing care, health services are free in Zambia and thus it is not expected that people would choose to stay at home if they are hit by a serious condition. There has been substantial improvement in diagnostic capacity over the past one to two months and the number of African countries with the capacity to test has grown from 2 to 40. Zambia now has testing capacity.

The low number of cases and improved testing capacity should be seen as an opportunity to halt the spread of disease.

A corona virus pandemic in Africa would be truly catastrophic as most countries lack adequate health infrastructure, equipment, financial resources, and health workers to handle a crisis of such magnitude. The previous two coronaviruses did not heavily impact Africa, and the continent could experience fewer effects of the current crisis if the issue is quickly and appropriately addressed. One such measure would be to close borders to prevent importing cases. Once the virus reaches Africa, local transmission may be high due to crowded living conditions, high poverty levels which limit households from purchasing protective items such as sanitizers, and high comorbidities from HIV, TB and other conditions.

In Zambia, schools and universities have been shut indefinitely and guidelines reducing operating hours for places of worship, bars and restaurants have been issued. Zambia has also increased screening at all ports of entry and instituted a mandatory 14-day quarantine for all incoming travelers. As of 27 March, 22 cases have been confirmed and there has been no local transmission reported. However, there is pressure on the government to completely lock down the country and completely close the borders. After initially resisting such calls, the government announced a series of measures to restrict travel.

Zambia is currently experiencing a tough economic situation, with diminished tax revenues, constrained export demand in China, and increased debt servicing costs which have forced government to cut on social spending, including education and health. More than 60% of the Zambian population live in poverty and more than 85% are engaged in the informal sector, depending on daily income for survival. Limited fiscal space also means that there will be no government support for individuals and businesses affected by either the pandemic or shutdown. Complete lock down of the country would worsen the current economic situation and careful response is needed, informed by evidence of the likelihood of a generalized pandemic in the country.

A complete shut down without any social protection means hunger.

It is therefore crucial that any policy options aimed to reduce the spread of Covid-19 are subject to careful and informed cost benefit analysis. It is not necessary to adopt all the measures taken across most of Europe, South Africa and the US and it is possible that just closing the borders may limit the likelihood of importing any more cases.

It is not debatable that the pandemic needs to be stopped. However, Zambia has limited or no local transmission and therefore the best policy option is to avoid imported cases. This could be achieved by closing the borders for a short period with no passenger traffic.

Written by Peter Hangoma, post doc at CMI and the Bergen Centre for Ethics and Priority Setting (BCEPS) at the University of Bergen.