By Elizabeth Merab

More by this Author

The World Health Organisation has warned that the coronavirus pandemic could overwhelm already strained public health systems in Africa. Despite considerable investments in the past five months, Africa’s healthcare infrastructure remains gravely inadequate. The average doctor to patient ratio of 1:5,000 is still far short of the World Health Organisation (WHO) recommended proportion of 1:1,000.

Ironically it is South Africa, with one of the relatively better healthcare infrastructures on the continent, that has recorded the highest infections and death toll. Countries with high infections relative to the size of their populations include South Africa, Djibouti, Gabon, Cape Verde and Sao Tome and Principe.

Here is an overview of countries with highest infection numbers:

South Africa

South Africa imposed a strict lockdown early in its infections curve, on March 27, closing borders and requiring people to stay at home except for essential service providers. The continent’s most industrialised economy also banned the sale of alcohol and cigarettes, earning a reputation of one of the countries with one of the world's toughest lockdowns.

Despite a sharp increase in infections, the government in May allowed the re-opening of schools and many sectors of the economy to forestall mass hunger and a total meltdown. The move was followed by an even sharper increase in confirmed cases, with infections rising at one of the fastest rates in the world.

President Cyril Ramaphosa in July re-imposed a curfew and ban on alcohol sales, both of which are still in effect. He also announced that public schools would close again, this time for four weeks. Classes resume on August 24. The country has also been rocked by corruption scandals involving supply contracts for Covid-19 response equipment. This week the WHO also sent a team of 43 health experts to advise on measures to help contain the coronavirus pandemic.

Egypt

Egypt became the first African country to report a coronavirus case on February 14. So far, it has officially recorded the continent's second-highest number of infections, with 95,000 cases and 4,630 deaths. A curfew imposed in March was lifted at the end of June. Regular domestic and international air traffic resumed on July 1 and tourism, a key income generator, is slowly picking up.

For the first time since April, Egypt’s daily toll of coronavirus cases dropped below 200 this week, with the number of new infections per day ranging between 110-170 cases since Sunday.

At the weekend Jihane al-Assal, who heads the anti-coronavirus scientific panel, announced the gradual closure of isolation hospitals, while assuring that the government was “preparing” for a potential second wave of the pandemic.

“Egypt has passed the peak of the pandemic,” she told a TV talk show.

However, the country's health system has been severely strained and came close to “collapsing”, according to the doctors' union, which recorded at least 134 deaths among its members related to Covid-19.

Nigeria

Africa’s most populous country imposed lockdowns lasting about five weeks in its main cities of Lagos and Abuja, before easing movement restrictions in early May. A lockdown lasting a few weeks was later imposed in the northern commercial hub of Kano State after a suspected outbreak.

In July, a ban on inter-state travel was lifted and domestic flights resumed. A date has yet to be announced for the resumption of international flights. Schools were shut in March but were set to re-open for students sitting graduation exams from August 4.

Wearing of masks in public is mandatory. About 45,000 cases have been recorded in Nigeria, Africa's most populous nation, and more than 900 deaths. In June, the daily caseload rose by between 500 and 800 but has lately dropped to between 300 and 400.

Lockdown restrictions are easing in the commercial hub of Lagos allowing churches and mosques to re-open, with authorities gearing up for a likely second wave of infections.

“New rise in cases is to be expected,” said the chief of the presidential task force on Covid-19, Boss Mustapha.

Nigeria carries out only about 3,000 tests per day, about a tenth of the number in South Africa, which has a much smaller population of 58 million.

Ghana

Ghana now has the fourth-highest number of cases in sub-Saharan Africa, despite having imposed strict movement restrictions at the onset of the pandemic in the country.

The country’s total case count has exceeded 40,000, according to the latest update by the Ghana Health Service (GHS).

Hundreds of health workers have contracted the virus, with medics’ associations warning of potential disaster if supply of personal protective equipment did not improve.

Algeria

Algeria has the continent's third-highest number of fatalities, at 1,273, after South Africa and Egypt. The nation is the fifth worst-hit in Africa in terms of infections after recording a surge in the past few weeks that raised the total to over 33,000. The pandemic has taken a huge toll on the country's economy, which is also taking a hit from the collapse of fossil-fuel prices.

Morocco

Morocco registered 1,144 new Covid-19 cases on Thursday, raising the tally of infections in the country to 29,644, the health ministry said. The government extended a state of medical emergency another one month September 10, in an attempt to curb the surge in new cases.

Kenya

Kenyan President Uhuru Kenyatta on July 6 eased restrictions put in place in early March to contain spread of the coronavirus. Despite announcing a phased re-opening that saw a 9pm to 5am curfew remain in place while international passenger flights were reinstated on Aug 1, the country has gone back to near-normal routine.

Nairobi’s initial response to the pandemic was widely applauded as being strong, but there are emerging issues that need urgent and intensified response measures throughout the country, the WHO Kenya office has said. Cases now stand at 24,411, with 399 deaths.

In recent weeks, WHO said it has observed with concern the rising numbers of Covid-19 cases and scaling up of community transmission in Kenya. The WHO Kenya representative, Dr Rudi Eggers, pointed out that there has been a reversal in people’s behaviour, from wide-spread compliance before opening up locked-down sectors of the economy to people now not wearing masks, keeping distance or sustaining hygiene and protective measures.

“We believe that the rising numbers of transmission are in part a reflection of this general apathy and non-compliance,” said Dr Eggers during a virtual press briefing last week.

Ethiopia

Africa’s second most populous country has seen a sharp rise in new cases, with infections doubling in less than three weeks in July to hit more than 20,000 and over 365 deaths. Around three-quarters of all Covid-19 cases in Ethiopia are in the capital, Addis Ababa.

The upward spiral is coinciding with signs of virus fatigue. Once-ubiquitous hand-washing stations are becoming scarcer. Hitherto-empty restaurants are filling up, and even some health workers say they are struggling to maintain the same vigilance they had in March.

The WHO warns that unrest sparked by the killing of a pop star from the Oromo ethnic group could further accelerate transmissions.

Cameroon

The country deployed its military to handle health and safety communication, after sealing a church that claimed Covid-19 does not exist. confirmed cases are taken care of in military hospitals in the regions and different military health facilities. According to figures published on July 29 by the public health minister, Cameroon has nearly 18,000 confirmed cases, including 15,320 recovered, 391 fatalities, 1,548 active infections, and 155 hospitalised — including nine in ICUs.

Côte d'Ivoire

Côte d'Ivoire is one the worst affected countries in West Africa. Since the first infection was discovered in mid-March, Covid-19 cases have quadrupled, and deaths have nearly tripled to stand at 16,447 and 103 respectively.

A brewing political crisis, following President Alassane Ouattara’s decision to run for a third term in office which some say violates the constitution, could destabilise the country and affect its Covid-19 response.