The snakes have started dancing: Africa and rising covid-19 cases

Like dancing snakes enchanted by their piper’s music, covid-19 infection curves in Africa are steepening and the continent’s response in coming months will be definitive…

The number of confirmed covid-19 cases in Africa is rising at a worrying rate. While only South Africa had more than 900 confirmed cases as of the end of March, at least 10 African countries had over 900 cases by the 23rd of April, barely 4 weeks later (See chart below). According the Boston Globe, coronavirus cases in Africa rose 43 percent in the week ending 24 April alone.

Africa’s healthcare system is already severely compromised by pre-existing conditions. With average per capita public spending that is half the global average and at least 24 countries on the continent spending less than US$200 per capita on health annually, the sector is plagued by decades of underinvesting. The low investments are reflected in the health personnel ratios. For instance, there is only one medical doctor for every 5,000 Africans compared to, for example, the Caribbean where there are 4 times the number of doctors for every 5,000 inhabitants.

The results of this have almost been daunting on women and children. In 2015, all 20 nations with over 500 mothers dying for every 100,000 live births were from Africa. Additionally, almost half of all children under the age of 5 years dying globally are from Africa. The fact that over two-thirds of people living with HIV/AIDS are in Africa also provides a cause of concern as global evidence suggests these are the people most vulnerable to the virus.

It’s within this context that the relatively low number of cases are proving to be a mystery. Because of the fast changing covid-19 environment, it is worth explaining that any statistic mentioned in the proceeding sections will be, unless explicitly stated, referring to the situation as of 23 April 2020. As of that day, Africa was registering 1 new case per million people while Europe was registering, on average, 27 new cases per million people per day.

One possible explanation for this is the low testing rates on the continent. The continent is testing six times less the number of people Europe is testing per thousand people. The argument therefore is that the low numbers are simply due to ‘undercounting’. It is an argument that has some merits but is frustratingly incomplete.

The UN health agency, the World Health Organisation (WHO) estimates that it can take up to 14 days between exposure to the virus and when its symptoms start showing. Cognizance has to be paid to the fact that a case was reported with a 27-day incubation period in Hubei province in China. The virus therefore has the proven capability to take 27 days to incubate.

As of the final week of April, the majority of African countries will have had over 30 days of confirmed cases. This is well over the 27 day longest recorded incubation period. Significantly, it argues that the low number of cases are not merely due to low testing rates. This is because, even with low testing rates there would be a bulging number of people showing symptoms. At this point, it is important not to concoct facts by making it clear that the number of confirmed cases has been steadily rising on the continent, albeit at a much more constrained rate than expected.

The response of African countries to the virus also offers propositions that might partially explain the relatively low numbers of confirmed cases. The World Health Organisation declared the virus a pandemic on 11 March 2020. The Oxford University covid-19 government response index, an index measuring the stringency with which governments have responded to the virus, contends that within two weeks, at least 12 countries had implemented stringent non-pharmaceutical interventions (NPIs) to slow the spread of the virus.

By 24 March, 52 countries on the continent had imposed movement restrictions and public health measures such as screening travelers at airports, conducting awareness campaigns and introducing isolation and quarantine policies. Similarly, at least 50 African countries had put in place social distancing measures such as limiting public gatherings and closing schools and 7 were in covid-19 induced lockdowns.

The importance of this must not be overlooked. Evidence from the experiences of countries such as South Korea strongly supports implementation of NPIs to slow the spread of the virus. Additionally, the Imperial College covid-19 response team asserts this. According to them, NPIs have the potential to halve the expected mortality burden of the virus in developed country settings. They also note that the impact in low income country settings is likely to be “substantially higher”.

One thing is clear- these interventions are not without costs! Despite the relieving news above, the effects on Africa’s social fabric and economies has already started and will be long lasting. The UN Secretar General, for example, has noted a ‘horrifying surge’ in gender-based violence during lockdowns. Cases of police clashing with hungry protesters have been recorded in South Africa. In Somalia violent protests erupted after police allegedly killed a person while in The Gambia, steep increases in public transport prices have ignited an acrimonious relationship between commuters and transport operators.

At the end of it all, the United Nations Economic Commission for Africa (UNECA) estimates that, even at best case, the pandemic with take over 300,00 lives across the continent and halve GDP growth pushing 27 million people to extreme poverty. The snakes have started dancing…