Why and how different countries need a unique response to COVID-19

As of 29 March 2020, there have been more than 680,000 confirmed cases of COVID-19 disease in 203 countries around the world.

On 11 March, the World Health Organization characterized COVID-19 a pandemic. Africa was initially spared, however this is changing rapidly. In the last two weeks, the number of affected African countries increased from 9 to 41. As people continue to travel, it is only a matter of time before COVID-19 spreads to the rest of the 54 countries on the continent. As I write this from Monrovia, Liberia – a country whose health system has suffered enormous challenges due to civil wars and the Ebola epidemic in 2014 – I am compelled to highlight that one size does not fit all, and special considerations need to be taken into account as we develop the COVID-19 response for Africa.

The continent’s population and health systems make it different from other regions that have experienced COVID-19 to date. Three factors are important at the population level.

First, the continent’s demographic structure is different from other regions in the world. The median age of the 1.3 billion population in Africa is 19.7 years. By contrast, the median age in China is: 38.4 years, and the median age in the European Union is: 43.1 years.

Experiences in Asia and Europe showed that people over 60, and those with significant health problems are most vulnerable to severe cases of COVID-19. Although Africa’s youth may be considered a significant protective factor in the pandemic, how the virus will evolve and manifest itself on the continent remains unknown.

The second factor within the population is the high prevalence of malnutrition, anemia, malaria, HIV/AIDs, and tuberculosis. Liberia, for example, has one of the highest rates of stunting in the world: one in three children under five years old are stunted. In recent weeks, we have witnessed an increase in the incidence of malnutrition. Moreover, the rainy season has come early this year, which means that malaria cases will rise rapidly and peak malaria cases in 2020 may coincide with the ongoing COVID-19 pandemic.

We should therefore anticipate that in Africa a higher incidence of severe forms of COVID-19 may occur in younger patients because of the demographics and associated endemic conditions that affect the immune system. Malnutrition, anemia, malaria, HIV/AIDs, and tuberculosis are likely to increase the severity of COVID-19. Africa may not see the same narrative of “most people who get it will be fine” play out.

Therefore, there might be a need for a different response from other parts of the world

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