By STEVEN VANDEN BUSSCHE
This article was published in Dutch on the Belgian Investigative Journalism website “Apache”.
Date: 23 March 2020
Official figures show that virtually no people on the African continent are infected with the coronavirus. But experts fear that the virus is slowly spreading through the population. Unlike in Western countries, health information systems are often inadequate to generate reliable data.
Sub-Saharan Africa in particular seems to be more or less spared by the coronavirus, with the exception of South Africa. This can be seen from the continuously updated distribution map on the Johns Hopkins University’s numerical dashboard. The African branch of the World Health Organization (WHO) has also launched its interactive map and dashboard, where more details on the number of known infections, people reported cured, and deaths can be found, specifically for the continent, but also for each country.
World Health Organization: “We can still change the course of this pandemic in Africa. Governments must use all their capacities and act faster”.
Most infections are currently reported in Egypt, where the virus was first detected on the continent. The majority of reports come from South Africa, followed by Algeria and Morocco.
Figures from last Sunday (22 March) show that the number of confirmed infections has almost doubled in five days to 1,321. “The rapid spread of COVID-19 in Africa is very worrying and is a clear signal for action,” said World Health Organization Regional Director Dr Matshidiso Moeti last Thursday. “But we can still change the course of this pandemic. Governments must use all their capacities and act more effectively and quickly. It is mainly the locally transmitted infections in the countries that are of concern, and they are increasing.”
Last Thursday, the virus was confirmed in 34 African countries, Sunday this figure rose to 43 states. Ethiopia, where daily flights from China land at Addis Ababa airport, had 11 confirmed victims on Sunday. With the exception of South Africa, only a handful of patients are known in almost all sub-Saharan countries. The total number of confirmed infections on a continent of 1.3 billion people contrasts sharply with the spread of the virus worldwide. Experts therefore fear that the virus is spreading under the radar and underreporting is a major initial problem.
Health information systems
Theo Lippeveld: “If nobody reports cases of persons infected with coronavirus, it is obvious that the figures also indicate “no contamination”.
“First and foremost, I think there is a problem with health information systems, with the way information on the health status of the population is collected from the health services,” says Dr. Theo Lippeveld. The Belgian doctor has dedicated his career to building health information systems in Africa, professionally with Harvard University and the JSI Research & Training Institute, and currently as a volunteer with the NGO called RHINO (Routine Health Information Network – www.rhinonet.org).
“These health information systems get most of their information from local health services,” Lippeveld explains. “Of course they are supposed to report data, and I’m afraid there’s a big problem of non-reporting in many sub-Saharan African countries. If nobody reports a case of a person infected with coronavirus, then of course there is “no infection” in the figures”.
Theo Lippeveld: “We need information systems that work every day. Developing them is a long-term process.
The lack of this basic information makes it difficult to implement a health policies and plans. “For health information systems to work, they must be in place before an epidemic occurs. During an epidemic, it is too late,” says Lippeveld.
When the Ebola virus broke out in Guinea, no one had a standardized method for reporting it. When the virus swept through Sierra Leone and Liberia, hundreds of experts came to set up measures to control the epidemic. This is not the way it should be done. You have to have information systems that work every day. This is a long-term job, although there are now countries in Africa that have better health information systems, such as Ethiopia, Kenya and Tanzania in East Africa, but also South Africa, and Senegal and Ghana in West Africa.
African Union Reports
In Africa itself, the African Center for Disease Control and Prevention (Africa CDC) reports on the spread of the virus. By analogy with the World Health Organization, this specialized technical body of the African Union provides regular updates on the situation on the ground.
The CDC Africa was not established until 2016. Its headquarters are located in Addis Ababa, Ethiopia. The institution supports African countries in the prevention, surveillance and treatment of infectious diseases. This coordinated approach is important for the future.
Bruce Basset (University of Cape Town): “I’m afraid it’s a ticking time bomb”.
The question remains, of course, whether all infections are currently being effectively recorded and reported. In the journal Science, scientists expressed concern in mid-March about the spread of the virus in Africa. They too fear that COVID-19 will spread silently.
“I’m afraid it’s a ticking time bomb,” says Bruce Basset, a data specialist at the University of Cape Town, in the journal Science. Dr. Lippeveld also fears it is only a matter of time before the pandemic breaks out in Africa as well. “It has also taken time for the epidemic to spread from China to Europe and the United States. There is much more traveling between these continents than between Asia, Europe and Africa”.
Since the emergence of the virus, screening has focused on fever at airports in most African countries. Most countries first screened Asian-looking travelers for fever, then gradually screened all foreign travelers and required hand disinfection on arrival.
Ben Cowling (University of Hong Kong): “Measures to detect infection in travelers will only delay, not prevent, a local epidemic”.
This focus is not effective, say other scientists, because it does not detect infected people during the incubation period. In addition, measuring devices do not always provide reliable information and sick travelers can mislead health professionals by taking antipyretics.
“Measures to detect infections in travelers will only delay, not prevent, a local epidemic,” – epidemiologist Ben Cowling of the University of Hong Kong said in the scientific journal.
Some African countries, such as Mali or Kenya, have moved a step ahead fairly quickly. There, travelers from high-risk areas have been forced into isolation. Other countries, such as Morocco or Egypt, have been forced to cancel flights or international bus lines.
Some leaders are very concerned about the virus. South African President Cyril Ramaphosa has already spoken of a “national disaster” in a televised speech in mid-March. He immediately announced measures to contain the spread, including the closure of schools, a ban on gatherings and travel restrictions. A series of other countries have taken similar decisions, as well as other measures of social distancing.
Poor Health (Care)
Once the disease has arrived, an additional problem arises: lack of testing capacity. According to CDC Africa, 43 African countries have testing capacity, although only 10,000 test kits are distributed across the continent. “So often there are no diagnostic tests available or they can’t be used,” says Theo Lippeveld. “For a virus that has never been seen in Africa, because SARS and MERS were almost non-existent in Africa.”
Most African countries suffer from weak health systems, poor or limited infrastructure, and shortages of personnel and equipment.
In addition, most African countries have weak health care systems, poor or limited infrastructure, and shortages of personnel and equipment. In MO*, Congolese doctors and Médecins du Monde testified on the ground that health systems cannot cope with a pandemic. Except in places where infrastructure and know-how have been put in place to suppress other infectious diseases, such as the Ebola virus in eastern Congo.
Humanitarian surgeon and former Secretary of State Reginald Moreels, who recently returned from a region where the Ebola virus struck hard, also explained why the public health systems of African countries do not have the capacity to fight the virus.
Theo Lippeveld: “In many countries in sub-Saharan Africa, children under the age of five suffer from malnutrition. This makes them more vulnerable to infectious diseases”.
In addition, the general health status of patients infected with the corona virus also plays a role in the success or failure of treatment of their lung disease. “When we see higher mortality, it is often linked to the health status of those who become infected,” says Theo Lippeveld.
For example, in many countries in sub-Saharan Africa, children under the age of five are malnourished. This makes them more vulnerable to infectious diseases. In addition, of course, the presence and quality of health services, as well as the lack of knowledge, staff and sophisticated equipment, also play an important role in the mortality of those in poor condition.
At the same time, the World Health Organization is investing heavily in the detection and training of local medical personnel. An online training course and a manual for health professionals on Covid-19 has been consulted more than 320,000 times, WHO Director Tedros Adhanom Ghebreyesus, himself from Ethiopia, said last week.
AUTHOR: STEVEN VANDEN BUSSCHE
Steven Vanden Bussche studied history at the University of Gent. Steven has been working as a journalist since 2005. First as a regional correspondent for Het Laatste Nieuws and the VRT, then seven years for the press agency Belga. Since August 2017, Steven writes full time for Apache.