The map that is emerging of the global situation of coronavirus disease, better named as COVID-19, is strange and surprising.
Take a map of the world with an all-white background and put black spots to mark the places where COVID-19 cases are high or significant. Africa stands out as the only continent that remains mostly white. The other continents have a large number of people who have COVID-19. Many of the countries with a high number of cases also have a correspondingly substantial number of deaths from the disease whilst African countries have recorded very few deaths.
What is strange about Africa? Why is COVID-19 unusually bypassing Africa?
Epidemiology is the study of incidence, distribution, and possible control of diseases and other factors relating to health. It uses a lot of data and statistical information to reflect its conclusions or findings. It gives an account of fundamental factors that influence course of diseases.
As in similar studies of humans, nature and society, when no coherent explanation is possible to explain a phenomenon, epidemiology infers, extrapolates and uses conjectures.
In understanding why Africa is spared to date of many cases of COVID-19, there are a lot of inferences and suggestions, but very little coherent or solid explanation. It is understandable. COVID-19 is a new and rapidly evolving disease. The scientific knowledge is growing but It is too early to draw conclusions.
Compared to the rest of the world, cases of COVID-19 are low in Africa. As at this time of writing, Egypt leads with 196 and also has the highest number of deaths at 6. South Africa is a distant second with 85 cases, followed by Algeria with 61 cases, Morocco has 38 cases and Senegal has 27 cases, in that order. Morocco has recorded 6 deaths and Sudan has one. All other African countries with COVID-19 cases are in single units.
The current situation on COVID-19 does not say a lot about where things maybe tomorrow or in the near future. Whilst China was dealing with the first major epidemic and a high number of cases, most countries that became almost overwhelmed with the disease did not foresee the trend. Within weeks, Italy has a raging epidemic with 31,000 plus cases and over 2,000 deaths, and Iran has more than 16,000 cases with almost one thousand deaths. Spain, Germany, France and the USA are battling with rising numbers.
There is, therefore, no valid reason to celebrate or be lackadaisical about the current situation in Africa. Rather, it is as good a time as any to adopt an active and serious preparedness stance. African countries should anticipate any eventuality. There are already lessons to learn from other parts of the world.
African countries cannot be over-prepared, because its best preparedness situation in medical and health services will be not anywhere as strong as the services in China, Iran, South Korea, Italy, France or the United Kingdom – which health care and management capabilities were overwhelmed fast by the epidemic. According to WHO, healthcare and services in Africa, especially in sub-Saharan Africa, are the weakest in the world.
“Keep it out and be prepared”. This is my shorthand of a combined strategic imperative that should drive Africa’s readiness on Coronavirus or COVID-19 given the facts and data available regarding the disease.
From reports and personal observation, African countries have set up testing facilities at airports to monitor travelers and identify possible infected persons. This is excellent. It is doubtful that the same kinds of facilities are available at land borders which are often too numerous to count, and very porous.
COVID-19 is said to have an incubation period of between 14 and 21 days based on current knowledge. It means that an infected person with no symptoms yet may pass through the temperature recording tests at airports and manifest the disease later on. It has probably been the case with several international travelers who have been identified with the disease days after their arrival in countries.
It is also assumed that COVID-19 or a variant of it is not indigenous to African countries. If it exists already, it is most likely to be passive or not as virulent as the type that is ravaging other parts of the world. The assumptions are reasonable until facts prove otherwise. If the assumption proves wrong with time, there will arise a need to respond to emergencies.
For the above reasons and others, the efforts to “keep it out”, may not be as successful as it is touted to be. Therefore, the second part of the strategy, “be prepared,” becomes even more important.
Most African countries have Centre for Disease Control (CDC), or National Institutes of Public Health and similar bodies that are a repository of knowledge and skills in control and preparedness for communicable and non-communicable diseases. They have capabilities to test, confirm COVID-19, treat and manage cases locally, including the capability for contact tracing, isolation and follow-through medical services.
However, medical and care services are most beneficial and effective when disease burden is limited. The fact that most people in the continent do not have reasonable access to health care facilities is a grave complication when epidemics strike.
The maxim, prevention is the cheapest cure, cannot be more appropriate at this time. In order to “be prepared”, African countries should adopt a preventive approach premised on behaviour change, a well-developed public health and change management field.
COVID-19 is a communicable, infectious disease. Unfortunately, merely reviewing measures taken by African countries to date reveal that less than 10 countries out of 54 have taken the preliminary steps of behavior modification and change that can enable people to “be prepared” to overcome the disease. Measures such as limiting the gathering of groups, enforcing reduced movement for social activities, and continuous enlightenment and education with rehearsals for practical understanding are very important.
It is difficult to ask people not to socialize, greet, congregate to celebrate, meet up with family and friends, as they normally do. It is challenging to ask people to wash hands with soap for at least 20 seconds every so often; not to touch mouth, nose and eyes; and to avoid handling public facilities. People just like to do what they normally do. It is human. The social and cultural practices of African peoples have proved tough and resistant to behavior changes that place individuals above groups and community. We have seen it in HIV and AIDS programmes, and in combatting Ebola.
Now with COVID-19, people must be ready and comfortable over time with the disruption of normal life and daily routines. It is difficult to stay home for days, weeks and maybe months, but people must be geared to practice and adopt the new behavior.
Official announcements setting stringent requirements to reorganize life in new ways, cancel public gatherings and events relating to education, work, leisure, and social life, are in order. People must be prodded towards changing their lifestyle.
Behavior modification and change are what it means to “be prepared” for COVID-19 in Africa. It is known that behavior change takes several steps from awareness to understanding, through acceptance, adoption, and ultimately the sustainability of new behavior. It also takes several supporting factors, including policy, politics, faith, social and economic contexts to effect a change of behavior in institutions, societies and amongst people.
The time to begin implementing a behavior change movement to contain COVID-19 in Africa was yesterday. There is no justifiable reason for any country to be taken by surprise having seen how the disease has evolved dramatically in several countries.
If, as time goes on, Africa remains unaffected by the ravages of COVID-19, nothing would have been lost by being prepared for the worst-case scenario. Indeed, it would be a much better situation than saying “had we known” after the unexpected havoc that the epidemic can wreak on a fragile continent.
Bunmi Makinwa was the first head of behavior change communication of UNAIDS at the global level from Geneva. He is the CEO of AUNIQUEI Communication for Leadership.