Concerns over Africa’s capacity to handle Covid-19 burden

Monday August 10 2020
sa graveyard

Aerial picture showing funerals taking place next to a row of freshly dug graves at a section of the Westpark cemetery in Johannesburg, on July 22, 2020. South Africa has recorded the highest Covid-19 infections and deaths in the continent.

By Elizabeth Merab

Five months on and just five per cent of coronavirus global burden, Africa stills lacks capacity to roll out mass testing of population

Ten countries account for three-quarters of all Covid-19 infections in Africa, making them hotspots of the pandemic on the continent.

The ten, spread across South, North, East and West Africa, have a cumulated total of more than 748,000 Covid-19 positive cases out of the continent’s tally of just over one million as per Friday afternoon data.

South Africa (538,184 cases) is the most afflicted, accounting for more than half of the continent’s total while Nigeria (45,244), Ghana (39,642), Algeria (33,626) and Kenya (24,411) complete the top five as per the WHO data.

About five months since the first Covid-19 positive case was recorded in Africa, the continent’s caseload remains a small share, just five per cent of the global burden, but there are concerns about the lack of capacity to roll out mass testing of the population.

“Lack of testing is leading to some under-reporting of Covid-19 cases and preventing us from understanding the full picture of the pandemic in Africa,” said the WHO Regional Director for Africa, Dr Matshidiso Moeti, in a media briefing this week.


“We need to turn this around so countries can calibrate their response, ensuring it is most effective, and as cases move into the hinterlands, testing must be decentralised from the capital cities.”

Dr Moeti says that experts are worried the true burden could be higher than reported, because of a lack of testing kits and other barriers.

“I am often asked whether they reflect the true picture of the epidemic. One of the constant and concerning challenges in many African countries is a shortage of kits to test people for Covid-19,” she said. “At the same time, some countries have increased their testing per capita while maintaining a low positivity rate, countries such as Mauritius, Rwanda, Cabo Verde and Botswana.”

African countries were among the last to report first cases of the pandemic, since December last year.

Nearly 22,000 have so far died from the disease in Africa, compared to a global infections tally of more than 19 million and over 715,000 deaths.

The US has the highest caseload in the world with nearly five million infections, while South Africa is the fifth worst-hit globally.

In the past two weeks, new cases have increased by more than 20 per cent in 16 African countries. This is compared with the previous fortnight, as per the World Health Organisation data. After many months of a slow rise in the cases, last month, the WHO warned about “acceleration” of the disease, in Africa.

Although measures like early lockdown and restrictions on movement contributed to slow spread, containment measures are not fully respected in many countries. Most people work in the informal business sector, such as in crowded open air markets, making strict lockdown measures difficult to implement. Some African governments have recently been pressured to relax lockdown measures.

For example, in Kenya, WHO has termed rising transmission as being partly a reflection of this general apathy and non-compliance to safety measures.

Decentralising response

In Rwanda, which has reported 2,104 cases and five deaths so far, health minister Dr Daniel Ngamije says officials are looking at novel ways of handling treatment with a national preparedness plan that, so far, has cost $73 million.

Dr Ngamije said officials quickly realised they needed to study how to manage the virus within the home and at the district level.

“We realise at the beginning, that our response was driven by the central government, at the central level, from the Ministry of Health. And it appears that we could not sustain that kind of intervention initiated from the central level. That is why we decided to decentralise Covid-19 response,” said Ngamije.

WHO on Wednesday deployed a team of health experts to South Africa to assist the country to contain the coronavirus pandemic. Experts predicted millions of Covid-19 deaths in Africa citing many countries’ poor ranking on the United Nations Development Programme’s Human Development Index. However, prevalence and mortality are still low, and it remains unclear if Africa will be spared from substantial cases and deaths.

According to a team of scientists who published an article in the Science Magazine on August 7, many African countries implemented testing early on which meant the continent carried out more tests per the number of cases than in other countries at similar phases of the epidemic.

Regarding the number of deaths, the team says, few functional civil registration services and thus statistics exist on the continent, raising questions about the reliability of mortality data.

Material support

“Potential under-reporting of Covid-19-associated deaths would not be specific to Africa, but the margin of error could be wider,” the scientists wrote.

With community transmission occurring in more than half of countries in Africa, WHO is beefing up community engagement and health education and providing direct material support to strengthen testing capacity.

To help meet the demand for essential medical equipment across Africa, WHO and other UN agencies have formed a global procurement consortium that taps into their networks, expertise, and product knowledge to support countries that have limited access to markets. The WHO-led consortium has secured critical volumes of testing kits and other key diagnostic supplies from manufacturers.