Governments across Africa are rushing to reinforce measures to contain the spread of coronavirus, fearing that fragile health systems will be swiftly overwhelmed if the disease spreads beyond a small number of cases on the continent.
World Health Organization (WHO) officials have called for a strong response to a “tremendously fast rise in the number of countries with cases being confirmed”.
“We have to ratchet up what is being done,” said Dr Matshidiso Moeti, WHO’s regional director for Africa.
“It is what is done at this point that will determine the numbers who will become very ill … I still think it is possible that we will prevent large numbers of people dying but it needs coordination, a huge effort and huge resources.”
Most infections involve people who have recently been in Europe or other disease hot spots, but the number of cases of internal transmission are rising every day.
Tedros Ghebreyesus, the director general of the WHO, has warned that official numbers may underestimate the extent of the spread of the disease.
“Probably we have undetected cases or unreported cases,” he said. “In other countries we have seen how the virus actually accelerates after a certain tipping point, so the best advice for Africa is to prepare for the worst and prepare today.”
Health officials across Africa know that hospitals can deal with only a fraction of those needing care if the virus spreads through overcrowded cities, remote villages and among vulnerable populations such as refugees, the malnourished or those suffering from HIV and other chronic conditions.
The WHO is working to establish the exact numbers of ICU beds available across the continent. “We know [the number] is extremely limited … It is a huge challenge,” said Moetse. “It is necessary not to give up on containment .”
South Africa, which has one of Africa’s best public health systems, has fewer than 1,000 intensive care unit (ICU) beds, of which 160 are in the private sector, for a population of 56m. In Malawi, there are about 25 ICU beds in public hospitals, serving 17 million people. The main infectious diseases hospital in Zimbabwe’s capital, Harare, has none, Zimbabwe Association of Doctors for Human Rights said.
Nigeria, Africa’s most populous state, is scrambling to add isolation beds and provide more specialised medical training and equipment at state hospitals.
“Our health system is not as strong as we’d like it to be,” said Chikwe Ihekweazu, the head of Nigeria’s Centre for Disease Control. “It is because we are a bit worried about our capacity to deal with a large outbreak that we are focused so intensively on prevention and early detection.”
Many states have suspended flights and other transport links with badly hit zones in Europe and Asia, or are strictly controlling entry. Restrictions have also been placed on public gatherings, schools and religious services, and mass events have been cancelled across the continent.
Jane Ruth Aceng, Uganda’s minister of health, said the country was on “high alert” as almost all its neighbours have registered cases of Covid-19. “No country can say they are 100% prepared,” Aceng told the Guardian.
Uganda’s new coronavirus tsar, Atel Kagirita, said the virus “will not be a big problem ... if we can effectively stop local transmission.”
“We … don’t envisage having many cases [needing critical care] because we are putting all our efforts on prevention. We are doing a lot of community awareness campaigns and public education,” Kagirita said.
Though Aceng said she was confident Uganda has “enough capacity beds, some ICU units and ventilation to handle a possible outbreak”, some fear this is too optimistic. Uganda – population 44m – is relying primarily on the 1,500-bed Mulago National Referral Hospital. Its ICU can currently accommodate 60 patients.
There are also limited facilities for isolation. In South Sudan, devastated by a five-year civil war, the government has just 24 isolation beds, said Dr. Angok Gordon Kuol, incident manager for the outbreak at the ministry of health.
In Somalia, health minister Dr Fawziya Abikar said the government has established a quarantine facility at Mogadishu airport and was equipping a hospital to deal with Covid-19 cases. “We are still waiting for more equipment for the hospital to arrive,” he said.
Dr Ali Yusuf, one of a team of health officials preventing and controlling the Coronavirus, told the Guardian that facilities were extremely limited. “We only have 15 tents, with one bed each for quarantine and isolation of suspected cases. Our hospital can accommodate only 100 beds,” Dr Yusuf said.
Many African countries have extensive experience in controlling highly infectious and potentially lethal diseases. Preparations for an outbreak of Ebola, which killed more than 11,000 people in west Africa between 2013 and 2016, mean that Uganda has already stockpiled protective equipment, drugs and tents, as well as developing a capacity of moving samples around the country to a central laboratory or using mobile testing laboratories.
Also, the delayed arrival of the virus has allowed governments to work with the WHO to strengthen emergency coordination, improve surveillance, and begin equipping treatment centres.
But few doubt that if the virus starts to take hold the consequences could be very serious, with health systems rapidly overwhelmed.
Prof Pauline Byakika, a specialist in infectious diseases at Uganda’s Makerere University College of Health Sciences, said she was worried that “once its gets here, [coronavirus] was going to spread very fast”. She said the “social environment” of many homes, with poor hygiene and ventilation, posed a very high risk.
“They are about five or six people in a house with one or two windows. Before you know it the whole household is going to be sick,” she said.
There are similar fears in South Africa, where president Cyril Ramaphosa has declared a state of national disaster and imposed stringent restrictions. As elsewhere in the continent, the youthfulness of South Africa’s population may help – only 6% of South Africans are older than 65, which is the higher-risk age group for coronavirus. However, tens of millions live in vast townships and share crowded public transport. Of the 7.7 million South Africans living with HIV, about half are not taking medication that would restore their compromised immune systems.
Q&AHow can I protect myself and others from the coronavirus outbreak?
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The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the coronavirus, for which there is no specific cure or vaccine.
The UN agency advises people to:
- Frequently wash their hands with an alcohol-based hand rub or warm water and soap
- Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
- Avoid close contact with anyone who has a fever or cough
- Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
- Advice about face masks varies. Wearing them while out and about may offer some protection against both spreading and catching the virus via coughs and sneezes, but it is not a cast-iron guarantee of protection
Many countries are now enforcing or recommending curfews or lockdowns. Check with your local authorities for up-to-date information about the situation in your area.
In the UK, NHS advice is that anyone with symptoms should stay at home for at least 7 days.
If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home.
“We are at this very early phase where it is critically important that we contain the virus,” said Richard Friedland, the head of South Africa’s largest private healthcare provider Netcare. “The key issue is with people living in informal settlements, in shacks … that (are) very difficult to self isolate.”
Many countries in Africa already face huge challenges from war or natural disasters or both. “The worst is yet to come on the continent … I fear it will be impossible to stop the spread of the virus in a refugee camp,” said Patrick Youssef, the deputy director for Africa at the International Committee of the Red Cross.
A 2016 analysis by the Rand Corporation, the US think-tank, found that of the 25 countries in the world that were most vulnerable to infectious outbreaks, 22 were in Africa. The others were Afghanistan, Yemen and Haiti.
“Were a communicable disease to emerge within this chain of countries, it could easily spread across borders in all directions, abetted by high overall vulnerability and a string of weak national health systems along the way,” the report warned.
Additional reporting by Abdalle Ahmed Mumin in Mogadishu and Charles Pensulo, Lilongwe