The Coronavirus Disease 2019 (COVID-19) Pandemic in Africa: What Can We Expect?

As of April 27, 2020, 2 973 264 cases and 206 569 deaths due to coronavirus disease 2019 (COVID-19) had been reported worldwide. Africa was initially less affected, but the epidemiological situation has changed rapidly in the past few weeks, and the pandemic has spread almost to the whole continent in a very short time, leaving only Comoros and Lesotho with no reported cases to date. There have been more than 32 000 confirmed cases and 1425 deaths, notably in South Africa, Egypt, Morocco, and Algeria, respectively, countries with more than 3500 cases.

The rapid growth of the outbreak in Africa is a major health threat in the coming weeks and months, considering the weakness of the public health ecosystem and the high prevalence of HIV, malaria, malnutrition, and other comorbidities in many of the affected countries.¹ Experiences learned in Italy, Spain, Iran, and China are extremely valuable; nevertheless, the COVID-19 pandemic would have a different impact on African countries, because the continent’s demographic structure and health system constraints are different from other regions that have experienced COVID-19 earlier. The young age of the African population can be considered as a protective factor, because the median age of the 1.3 billion population is 19.7 years, which would limit the aged population exposed to severe and potentially fatal forms. Nevertheless, this argument is offset by the poor capacity to provide intensive care for a large number of patients.

Although the World Health Organization has been supporting countries by providing thousands of COVID-19 testing kits, we admit a substantial underdiagnosis in most African countries owing to limitations in testing capabilities for the coronavirus. In this context, the preliminary case fatality rate (the percentage of individuals with symptomatic or confirmed disease who die from the disease) reported by some countries (Liberia 21%, Algeria 14.53%, Botswana 17%, Egypt 7.52%)² is much higher compared with the reported case fatality rate in China of 1.38% (1.23-1.53) and from international cases of 1.4% (0.4-3.5).³ Furthermore, the case fatality ratio is strongly influenced by the availability of intensive care unit facilities and beds; nevertheless, health systems in Africa before the COVID-19 outbreak were limited in supplies of intensive care unit equipment and ventilators.

In these circumstances, and based on the model developed by Verity and colleagues,³ we can estimate possible deaths in Africa as between 311 136 and 1 555 680, depending on the infection attack rate (10% and 50%, respectively). This forecast is highly uncertain, and these projections are still in an early phase because it relies in part on many assumptions. Nevertheless, this number could be substantially higher if decisive action and mitigation like distancing policies are not implemented and enforced across all countries.

Keeping the infected population rate as low as possible should be the highest priority for all African countries until an effective treatment or a vaccine is available to immunize the population. Our estimate of deaths in Africa over the next months is alarming, but the scenario could be substantially worse, and the impact could be hardest felt in health as well as socioeconomically, in the case of excess demand for health system resources if not addressed, and if social distancing policies are not vigorously implemented and enforced across all regions. Nevertheless, Africa still has the opportunity to flatten the curve; for this purpose, cooperation and coordination among countries at a regional level to scale up the capacities in critical areas are highly needed, but given the global nature of the problem, international support with essential supplies and equipment for low- and middle-income countries is required.⁴ Also, tailoring and adapting successful measures to local contexts and empowering communities to respond to outbreaks locally is greatly required.

As the ancients used to say: “Nulla tenaci invia est via”—No road is impassable.