Why Has Africa Been Somewhat Spared by the Pandemic?

On the 14th of February 2020, the first case was reported in Egypt. To date, the ‘wave’ has still not arrived. How can this relative protection be explained?

Coronavirus Risk Africa

Coronavirus Risk Africa Courtesy of INSERM

Experts have been predicting a frightening scenario since the first case of coronavirus in Egypt. They predicted that Africa would quickly be hit by the COVID-19 pandemic, which would lead to a health disaster on a poor continent with a failing health system. The World Health Organization (WHO) calls on the continent almost daily to “prepare for the worst”. Weeks later, the tsunami has still not happened. This, notwithstanding the devastation in Europe, the United States, and the rest of the world.

Africa: The Continent Least Affected by the COVID-19 Pandemic

With 40,575 cases and 1,692 deaths as of May 2nd,  Africa is the continent least affected by the pandemic. Egypt is the country with the most deaths (406), ahead of Algeria, Morocco, and South Africa. In comparison, the US with a population of 365 million inhabitants has more than 65,000 Covid-19 deaths. So why does Africa, with a population of 1.2 billion, seem to be relatively spared?

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Of course, the number of cases may undoubtedly largely be underestimated. The head of the African Center for Disease Control and Prevention, John Nkengasong, admits that the statistics are not perfect due to a lack of testing. He, however, rejects the idea that cases are purposefully unreported. “Hospitals would be flooded with sick people, which is not true,” the doctor confirms. But other factors can also provide an explanation.

One Step Ahead

The epidemic reached Africa a few weeks after Europe and enabled its leaders to take preventive measures well in advance. “Even before the first cases of coronavirus were detected on Rwandan soil, we took very early hygienic measures that were applied throughout the country,” said Dr. Sabin Nsanzimana, Director General of the Rwandan Biomedical Center. South Africa, Tunisia, Morocco, and Algeria introduced restrictions and curfews before the epidemic spread.

Low Population Density

With 43 inhabitants per square km, compared with 181 in Western Europe and 154 in South East Asia, Africa remains a sparsely populated continent in most regions. The population is concentrated in the capitals and most were closed very early. In Ivory Coast, Abidjan has been officially isolated from the rest of the country since 30 March. The same applies to Nigeria, where the inhabitants of the two mega-cities Abuja and Lagos were not allowed to leave the city. This low density considerably reduces contact and thus the transmission of the virus is halted.

A Lower Influx of People

In contrast to most Western countries, many parts of Africa are still somewhat isolated and live in virtual self-sufficiency. As a result, the virus circulates only very rarely in the population. In comparison to Europe and the USA, most regions of Africa have less tourist movement. Of the 50 busiest airports in the world, only one is in Africa (Johannesburg). Furthermore, the number of Africans in the diaspora returning home during the Pandemic was less compared to places like China or India, who had to contend with the return of many foreign students. Also, there are fewer major population movements in sub-Saharan Africa.

A Younger Age Distribution

About 60 percent of the African population is under the age of 25. However, the coronavirus mainly affects older people: More than 72% of people who die from Covid-19 are over 65 years old. Northern Italy, the most affected region in the world, also has a very large population of older people. “On the African continent, there are no more elderly people to kill,” the Ivorian writer Gauz sarcastically said in an op-ed on the Jeune Afrique website. Africa also has a low obesity rate in comparison to the rest of the world, which is a major mortality risk factor for Covid-19.

Existing Immunity?

A preliminary study by the NHS (National Health Service) and King’s College shows a negative correlation between countries affected by malaria and countries affected by Covid-19, which can be explained by the possible protective effect of preventive malaria treatments such as chloroquine. According to another study, it is the systematic BCG vaccination used in Africa that could explain the immunization of the population. Countries without a universal BCG vaccination policy, such as Italy and the United States, are most affected by Covid-19, the authors note. However, these correlations do not provide any evidence of cause and effect.

Not So fast! Hunger, Locusts and Economic Collapse

Despite these advantages, Africa will probably have to pay the price for the Covid-19 epidemic. As a result of border closures, deterrence measures, and rising food prices, “the number of people at risk of starvation in West Africa could almost triple within three months,” warned the NGO Oxfam on 21 April. The locust invasion is now wreaking havoc in East Africa as well. 200,000 hectares of Ethiopian farmland have been devastated. As a result, one million people in need of emergency food aid. The coronavirus pandemic has also brought most vaccination campaigns against polio, measles, and diphtheria to a halt. In Africa, coronavirus is far from being a priority for the locals.

An Inserm study published in The Lancet looked at the vulnerability of African countries to the pandemic. The study factored in the health infrastructure, demographics, and the number of connections to China. Doing so allowed the researchers to identify African countries most at risk of a severe pandemic.

Algeria, Egypt and South Africa are the Most Vulnerable

Scientists have identified the three countries that are most susceptible to virus imports: Algeria, Egypt, and South Africa, as they all maintain a constant air connection with the infected provinces in China. Nevertheless, their health infrastructures suggest that they are capable of effectively detecting and stopping the pandemic.

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Countries like Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya are much less likely to have a high number of imported infections into their territory. However, they may not be able to contain the spread because their medical infrastructures are not as highly equipped.

Impact of Chinese Airports

The import of Covid-19 is not only taking place in Africa. In fact, the development of the pandemic could change the situation in some important Chinese provinces. This is the case, for example, in Beijing, where many planes fly to Africa. Ethiopian Airlines continues to operate half of its flights to China.

Scientists have divided the countries into three groups according to their flight connections to China. So if the epidemic in the Beijing area increases, 18 countries on the African continent will become more vulnerable. If COVID-19 numbers were to increase in Guangdong province, there are 7 more countries where the risk of virus introduction could increase.

“This work allows us to adapt to the development of the situation in China. It also warns the most vulnerable countries of the need to prepare for the possible introduction of the virus. The difficulty of quickly detecting imported cases from abroad is obvious. In several African countries, which have few resources to cope with the pandemic, there is a significant risk of a lack of organization and infrastructure to detect, deter and care for the sick, raising concerns about the risk of an epidemic on the continent,” concludes Vittoria Colizza, Research Director at Inserm.

References

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930411-6

https://presse.inserm.fr/en/egypt-algeria-and-republic-of-south-africa-main-gates-for-coronavirus-importation-in-africa/38322/

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