Africa, like the rest of the world, is faced with an unprecedented public health emergency, a pandemic by global scale; the outbreak of SARS-CoV2 virus that is responsible for the Coronavirus Disease (COVID-19).
Africa’s COVID 19 story is special, the continent is already dealing with multiple epidemics that may potentially complicate the COVID-19 pandemic. It is no secret that our continent is home to infectious disease epidemics like HIV/AIDS, tuberculosis, malaria with pockets of endemicity and a growing burden of Noncommunicable Diseases (NCDs) such as cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.
The COVID-19 pandemic has dug its claws on the fabric of our health systems. Even the hitherto strong health systems in the west have been shaken by the virus. In Africa, the scare is more about the rundown of the already weak health systems. It is common knowledge that the health system does not exist in a vacuum, it exists within a wider socio-economic milieu. Therefore, the effect of COVID-19 pandemic transcends the narrow bounds of health care and health systems – it has potentially serious socio-economic and political ramifications.
We have seen and read a lot about the evolution of the pandemic in Asia, Europe and America, however, little effort has been put in documenting the evolution of the pandemic in Africa. We must strive to tell the African COVID-19 story, as it evolves and hope to stimulate research and policy directives that are relevant to the African context.
While many countries in the west can institute a complete lockdown as a containment measure, Mother Africa should customise and contextualise interventions. We can’t possibly afford most of the western interventions, however effective they seem in the interim. We must think of our social fabric, our economic fibre, and most importantly, the reality of our existence.
Summary of Infectious Disease Control Measures
COVID-19 is classified as a zoonotic disease (transmitted from animals) affecting humans but the mode of transmission is largely human-to-human through exposure to droplets, direct contact with infected persons or through contaminated inanimate surfaces.
From the time an infectious person gets into a country, the spread of the disease will be influenced by the following characteristics ordinarily used in infectious disease modelling dubbed SEIR
- The number of susceptible persons.
- The number of susceptible persons exposed to the disease (through the infected person).
- The number of Infected persons (sources of transmitted disease).
- The number removed from the transmission cycle. Removal from the cycle happens when infected people recover from the disease and such recovery is associated with the development of immunity or, unfortunately, through death.
Infection prevention measures seek to interfere with the stages listed above. Social distancing and limitation of unnecessary movements, for instance, helps to decrease potential exposure because it is difficult to tell who is infected or infectious in the community. Quarantine is a strategy used to separate people with a high probability of infection following known or suspected exposure to allow them to be tested and also cut the potential transmission during the asymptomatic but infectious phase of the disease. Isolation, on the other hand, is a strategy used to remove confirmed cases (infected persons) from interacting with uninfected people until the time they become non-infectious. The isolation period also allows them to receive clinical management – in the case of COVID-19, conservative treatment.
Given that COVID-19 is caused by a novel virus, it is reasonable to assume that all community members are susceptible as there is no pre-existing immunity. Immunity can therefore only be conferred by vaccination or development of protective antibodies after a person is infected.
The mainstay of cutting the infectious cycle is, therefore, preventing interaction between the infected and uninfected persons and preventing people from touching contaminated surfaces. It goes without saying that the identification of the infected (through strategic, targeted testing) is a key driver of infection control.
Africa’s story can be premised on our socio-economic/political systems that inform our health systems. We have poor health infrastructure/systems that may have been essential were we to adopt the ways of the west in dealing with this pandemic. An example is the high health care worker-patient ratio. On average one health care worker in Africa takes care of more than seven times the number of persons an equivalent in Europe takes care of. In 2014, for instance, the physician density (number of doctors per 100,000 population) in Kenya was 19.37 while in Italy, the UK and Germany it was 395.88, 277.59, and 408.27 respectively. The metrics in Kenya and Africa haven’t changed much and as such COVID 19, interventions must be developed and implemented with these factors in mind.
A view of Africa’s Response
Egypt was the first African country to report a case of COVID-19 disease. In the subsequent days, it was followed by Algeria, Nigeria, Morocco, Senegal, Tunisia, and South Africa. Given the nature of transmission of SARS-CoV2, and the fact that global spread is associated with air travel, the delay in reporting cases in Africa may be attributed to the nature of Africa’s connectedness with the rest of the world, and of course, the strength of our disease surveillance systems. The spread and growth of the African epidemic is, however, a function of a number of things; the diseases surveillance and diagnostics system, the agility of individual countries to mobilise resources for testing, and its political demeanour which affects the latter to a big extent.
Political demeanour influences the policy direction a country would take especially when faced with a global public health threat, and its ability to quickly mobilise a response mechanism. Following this complex relationship between pandemic/epidemic, epidemic response, and political demeanour, the ensuing epidemic is likely to show epidemiologic clustering as well as ‘policy clustering’. Countries with similar leadership demeanour are likely to cluster together holding other factors constant.
Through leadership and policy decisions, we can examine three main categories; early responders, intermediate responders, and late responders. I posit that the early responders are likely to call in a raft of epidemic containment measures early and adopt a structured approach informed by the relevant multi-stakeholder consultations. In those countries, the leadership demeanour is a consultative and listening one. It is likely to assemble a team of experts led by epidemiologists, infectious disease specialists, and comprised of health economists/economists, policy experts, psychological experts, religious leaders, universities, and the general academia.
Intermediate responders are likely to delay interventions, probably seeking religious interventions first. Late responders are likely to assume a lacklustre approach, akin to awaiting fate. In all the approaches, the strength of the economy and the existing health systems factors play a key role. Whereas some late responders may have the will of the early responders, they may lack the wherewithal. They naturally become late responders, but not without consequences.
Written by Dr Mutugi M Muriithi – Program Director, NAISHI