Africa has a population of more than one billion people and has had about 1.5 million Coronavirus cases until October 2020, only. This is what compiled by the John Hopkins University suggests. These figures are far lower than those in Europe, Asia, or the Americas, with reported cases continuing to decline. Africa has recorded about 37,000 deaths, compared with roughly 580,000 in the Americas, 230,000 in Europe, and 205,000 in Asia.
The case-fatality ratio (CFR) for Covid-19 in Africa is lower than the global CFR, as noted by a recent continental study by Partnership for Evidence-based Response to Covid-19 (PERC), which brings together a number of private and public organizations.
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And while low testing rates continue to undermine the continental response, there is no indication that a large number of Covid-19 deaths have been missed. So what may be the reasons for Africa’s relatively low death rate?
Young population – and few old-age homes
The age of the population in most African countries is also likely to have played a role in containing the spread of Covid-19. Globally, most of those who have died have been aged over 80, while Africa is home to the world’s youngest population with a median age of 19 years, according to UN data. “The pandemic has largely been in younger age groups… about 91% of Covid-19 infection in sub-Saharan Africa is among people below 60 years and over 80% are asymptomatic,” said the World Health Organization (WHO).
“We have [in Africa] about 3% of the population aged over 65 years,” said Dr Matshidiso Moeti, the WHO Africa head. In comparison, Europe, North America, and wealthier Asian countries have the oldest inhabitants. “One of the big drivers in Western countries is that the elderly people were living in specialized homes and these became places where the transmission was very intense,” Dr. Moeti added.
These homes are rare in most African countries, where older people are more likely to be living in rural areas. It is the norm in many African countries for people to return to their rural homes when they retire from employment in urban areas. The population density in rural areas is lower and therefore maintaining social distance much easier. Furthermore, an underdeveloped transport system within and between countries appears to have been a blessing in disguise. It means that Africans do not travel as much as people do in more developed economies, minimizing contact.
The first case on the continent was confirmed in Egypt on 14 February. There were fears that the new virus could quickly overwhelm largely fragile health systems on the continent. So, right from the beginning, most African governments took drastic measures to try and slow the spread of the virus.
Public health measures – including avoiding handshakes, frequent hand-washing, social distancing, and wearing of face masks – were swiftly introduced. Some countries – like Lesotho – acted even before a single case was reported. It declared an emergency and closed schools on 18 March, and went into a three-week lockdown about 10 days later in unison with many other southern African states.
But only days after the lockdown was lifted – in early May – did Lesotho find its first confirmed cases. In a population of more than 2 million, it has so far recorded about 1,700 cases and 40 deaths.
The implementation of the strict Covid-19 restrictions in Africa came at a huge cost. Livelihoods were lost on a large scale. South Africa – which had one of the most stringent lockdowns in the world – lost 2.2 million jobs during the first half of the year. More and more countries have been forced to re-open their economies even though the number of cases is much higher than when they ordered the shutdowns.
Public support and experience with deadly viruses
In a survey conducted in 18 countries in August by PERC, public support for safety measures was high – 85% of respondents said they wore masks in the previous week. “With strict public health and social measures implemented, African Union member states were able to contain the virus between March and May,” the report said. It added that “minor loosening [of restrictions] in June and July coincided with an increase in the reported cases across the continent”.
Since then, there has been a notable drop in the number of confirmed cases and deaths in about half of the continent, possibly linked to the end of the southern hemisphere winter.
A study conducted by researchers in the University of Maryland in the US found a correlation between temperature, humidity and latitude, and the spread of Covid-19. “We looked at the early spread [of the virus] in 50 cities around the world. The virus had an easier time spreading in lower temperatures and humidity,” said Mohammad Sajadi, the lead researcher.
“Not that it doesn’t spread in other conditions – it just spreads better when temperature and humidity drop.” African countries away from the tropics have been worse off. The spread of the virus accelerated in South Africa as the southern hemisphere went into winter.
But as it became warmer, the number of cases dropped significantly, impacting the continental outlook, as South Africa accounts for almost half the total number of cases and deaths on the continent.
Community health systems
The Covid-19 pandemic came at a time when the Democratic Republic of Congo was dealing with its biggest outbreak of Ebola yet. Neighboring states were on high alert, and the health screening of travelers for Ebola was extended to include Covid-19.
Several West African states – which battled the world’s worst-ever outbreak of Ebola from 2013-16 – had also mastered the public health measures that have been used to prevent Covid-19, including isolating the infected, tracing their contacts, and then getting them quarantined while they get tested.
Some of those helping with Nigeria’s polio vaccination program switched to targeting Covid-19. Furthermore, in Africa’s most populous state, Nigeria, teams that had been going into villages to vaccinate children against polio were quickly re-purposed to educate communities about the new pandemic.
So, while hospital infrastructure in much of Africa is less developed than in other parts of the world, the continent’s strength lay in its tried and tested community health systems.
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