Why sub-sahara Africa need a unique response to COVID19 outbreak

Malnutrition and disease means COVID-19 could be more deadly in Africa than elsewhere in the world.
Health systems in Africa have limited capacity to absorb the pandemic.
The strategic approach should focus on containment and aggressive preventive measures.
As of 18 April 2020, there have been more than 2,094,884 confirmed cases of COVID-19 disease in 210 countries around the world. On 11 March 2020, the World Health Organization declared COVID-19 a pandemic. Africa was initially spared, however this is changing rapidly, and the virus is spreading like a wildfire across the continent. North African countries alone has close to 9000 reported cases, South African countries has close to 4000 confirm reported cases with south-Africa (johannesburg) having close to 3000 reported cases. In recent weeks, sub-saharan countries has close 5000 confirmed cases.

Major African stats as of April 18 as of 5:00 GMT:
Confirmed cases = 19,827
Number of deaths = 1,020
Recoveries = 4,619
Infected countries = 52
Virus-free countries = 2 (Lesotho, Comoros)

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, but the virus is evolving and manifesting itself in the continent as I write.

The second factor within the population is the high prevalence of malnutrition, anemia, malaria, HIV/AIDs, and tuberculosis. Most sub-saharan Countries like Liberia, Niger, Chad, 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. We are currently experiencing and anticipating a higher incidence of severe forms of COVID-19 in younger patients because of the demographics and associated endemic conditions that affect the immune system in Africa. Malnutrition, anemia, malaria, HIV/AIDs, and tuberculosis are likely to increase the severity of COVID-19.

Third, social cohesion and social gatherings are of great importance in Africa. For example, weekly attendance of a religious service is highest in Africa with rates as high as 82% in Uganda and Ethiopia. Many have been forced, restrained by the military men but still many are still out there who turn deaf ear to social and religious gathering.

There are two major health system factors that is making the COVID-19 response in Africa more challenging. First, the continent is experiencing the double burden of diseases: in addition to dealing with these pandemic infectious diseases, health systems in Africa are facing non-communicable diseases, including malaria, cholera, injury, and cancer. As a result, the health systems are stretched thin to begin with, and there is very little room to absorb the COVID-19 pandemic. Second, the capacity to provide critical care is the lowest in the world. Severe forms of COVID-19 lead to respiratory failure requiring ventilation support. The ability to treat severe forms of COVID-19 will depend on the availability of ventilators, electricity, and oxygen. As a result, make shift hospitals are been use like stadium.

Lessons learnt in Italy and China are extremely valuable. However, they cannot be extrapolated directly to Africa because of these differences in demographics and health system constraints.
Because health systems in Africa are strained to begin with and have very limited capacity to absorb the pandemic, the overall strategic approach should focus on containment and aggressive preventive measures.

Early and aggressive physical distancing and frequent hand-washing with sanitizer will prevail as the most effective and affordable interventions for the continent, with parallel testing, contact tracing, and isolation of cases. For aggressive preventive measures to work, we will need the full support of populations. Full support of populations can only be achieved with community engagement and strong health leadership.

Furthermore, given the youth of the continent, youth leadership and engagement will be critical for prevention and containment activities. And lastly, given the priority given to religious services, religious leaders will need to participate actively in the COVID-19 response. At the health system level, operating rooms and teams could be reorganized and repurposed to build critical care capacity in district hospitals.

The African context is unique. There are population structure differences, high prevalence of this pandemic disease and the double burden of diseases, with health systems that are stretched thin with minimal critical care capacity.

A robust COVID-19 response for the continent will need to take these factors into account and include community engagement, health leadership, and involvement of youth and religious leaders to drive containment. At the health system level, temporary repurposing and reorganizing of the surgical system will be key to increasing critical care capacity during the response, focusing on what we have as we move forward.

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