Covid-19 pandemic not yet under control in Africa
Despite the lower than expected covid-19 cases and deaths, trends in different African countries suggest the pandemic is not yet under control on the continent
Africa seems to be weathering the pandemic far much better than was expected or forecast. As of the 12th of September 2020, eighty-one percent (1,070,604 people) of the total confirmed covid-19 cases had recovered. Importantly, the total number of confirmed active covid-19 cases has been steadily declining over the last 30 days (See Figure 1 below).
This may inadvertently suggest that the continent has the pandemic under control. However, a closer look at the trend in confirmed cases as well as the trend in mortality rates suggests otherwise. Starting with the trend in confirmed active cases. The decline in the number of active cases on the continent is largely attributable to what is happening in one country — South Africa. South Africa currently accounts for nearly half (49 percent) of all the continent’s confirmed cases (See Figure 2 below).
Removing South Africa divulges just how different to South Africa, the rest of the continent’s trajectory is. As Figure 3 below illustrates, confirmed active coronavirus cases on the continent (excluding South Africa) have actually been gradually increasing (and not declining) over the last 30 days.
Additionally with 32,010 deaths recorded (as of 12 September) and an average case mortality rate of 2.5 percent, deaths from the disease have been much lower than predicted. The continent’s mortality rates are also substantially lower than those in other regions globally.
The reality is that not all countries have registered low case mortality rates. Chad (7.4 percent), Sudan (6.2 percent), Liberia (6.2 percent), Niger (5.8) percent and Egypt (5.6 percent) are among the countries with the 20 highest case mortality rates globally. Moreover, Angola, Algeria, Burkina Faso, The Gambia, Malawi, Mali and Sierra Leone all have case mortality rates that are significantly higher than the continent’s average (between 3 and 5 percent).
Among the explanations to this could be the the quality of healthcare in the countries. For example, half of the countries with above average case mortality rates (Chad, Liberia, Sierra Leone, Burkina Faso, Malawi and Niger) in Africa are also among the countries with the least density of healthcare workers on the continent.
Egypt on the other hand has one of the highest density of healthcare workers. It is also among the countries on the continent with high per capita healthcare expenditure. That said, Egyptians lose up to 7 times more years of good health due to diabetes than the average African. This, considered with the suggestion from at least one study that, mortality rates among people with diabetes could be more than 3 times higher than those without diabetes, may have possibly contributed to the country’s high case mortality rate.
Another thing worth considering is the plight of small economies. Focusing on the magnitude of confirmed numbers carries the risk of missing the trends in countries with small populations and relatively small numbers of confirmed covid-19 cases and deaths. Figure 4 below attempts to illustrate this using the case of 6 African countries with (a) a total population below 3.5 million, (b) less than 100 covid-19 confirmed deaths as of 11 September and, (c) less than 10,000 covid-19 confirmed cases as of 11 September. From Figure 4 (above), it can be seen that while Gabon has nearly three times more confirmed cases than The Gambia, it has almost half the number of deaths.
Admittedly, understanding what is happening in Africa is challenging because of the low number of tests that are being conducted across the continent. As Figure 5 below demonstrates, most countries, have tested less than 10 people out of every thousand people regardless of the size of the economy (measured by GDP per capita). Only in South Africa and Morocco are more than 50 people per thousand being tested.
The low testing rates do not however prevent the broad estimation of whether the pandemic is under control in a country. The share of positive results for every test — the positive rate — is a one of the measures that can be used to estimate the extent the epidemic is under control in a country. According to criteria published by the WHO in May, a positive rate of less than 5 percent is one of the indicators that the epidemic is under control. There are 17 African countries for which data on positive rates is publicly available.
Probably hinting at how far the continent still has to go to controlling the pandemic, only 3 out of the 17 countries (Malawi, Uganda and Rwanda) have a positive rate below 5 percent. Senegal, Ethiopia, Nigeria, Tunisia, Kenya and Zimbabwe have positive rates between 5.4 percent and 6.9 percent. South Africa, Morocco and Ivory Coast have positive rates between 7 percent and 11 percent while Zambia, DRC and Ghana have even higher positive rates (between 12.1 percent and 14.3 percent). At 25.5 percent, the positive rate in The Gambia is the highest among the 17 countries, reiterating the plight of small economies alluded to earlier.
In conclusion, while the lower than expected covid-19 cases and deaths on the continent provides reasons to be optimistic, the continent still has a low way to go before the pandemic is under control. As shown above, several reasons support this conclusion.
First, outside of South Africa, the total covid-19 confirmed cases on the continent are increasing. Second, most countries continue to register positive rates above 5 percent. Lastly, above average case mortality rates especially in small economies with low densities of healthcare workers as well as per capita expenditure on health emphasizes the centrality of upgrading healthcare systems if the continent is to be able to handle the pandemic.
