Can Africa Keep Coronavirus Under Control?

By Bunmi Makinwa

The map that is emerging of the global situation of coronavirus disease, better named as COVID-19, is strange and surprising.

Coronavirus Map: Distribution of COVID-19 Cases Worldwide, as of March 17, 2020. Credit: WHO

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.

South African Development Community unites to tackle COVID-19. Credit: WHO

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.

Senegal partners with UK lab to develop a hand-held coronavirus test kit. Credit: CNN.

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.

Facts and Lessons on Coronavirus

By Bunmi Makinwa

It is highly unlikely that you will be infected by Coronavirus, code-named COVID-19, according to prominent facts from the ongoing epidemic of the virus. This is not what you would think given the hysteria, myths and information that spread every day on the disease.

Coronaviruses are a large family of viruses that may cause a range of illnesses in humans or animals. Among the most well-known coronaviruses are Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Swine Flu. The most-recently discovered coronavirus causes coronavirus disease and has been code-named COVID-19 by the World Health Organisation (WHO). It is known so far to have originated from an animal.

Prevention and avoidance of infection is easy and possible through simple actions that each individual can take, and which organizations, companies and communities can facilitate.

The chances of recovery from the disease are also very high compared to other recent viral epidemics. Facts and data on COVID-19 reinforce the positive conclusions stated above. Yet the spread of COVID-19 is real and new facts are likely to surface as the epidemic becomes scientifically more familiar.

The caricature of Chinese people as being carriers of COVID-19 is incorrect. Though the first known cases of the disease and the largest number of infections and deaths were in Wuhan in Ubei province of China, COVID-19 has appeared in at least 64 countries, three of them are in Africa – Algeria, Egypt and Nigeria.

Egypt was the first African country to report a Coronavirus case, a Chinese person who has since tested negative and has been discharged from quarantine. Algeria has two suspected cases and one of them was confirmed for infection. The two cases were Italians. Nigeria has reported a case and the Italian who travelled to Lagos on February 25 had his case confirmed on February 27. He has been quarantined at a facility in Lagos.

According to the government of Lagos State, the patient’s symptoms have subsided. It means that his potential to infect others has decreased. If the trend continues, he will be released as he will no more pose any danger to others.

It is likely that more Africans will be infected by COVID-19 as time goes on, especially Africans who live in or visit places that have a high number of cases of the disease. For example, two South Africans were detected to have the disease on board the cruise ship, The Diamond Princess, in Japan. The Diamond Princess has recorded 705 cases of COVID-19 and 6 deaths to date. It carried 3,711 people and was sailing from Singapore to Japan when the first case was discovered.

Unfortunately, infected people may carry the virus for many days before they show symptoms, and they can infect others. Infection takes place through droplets when infected persons sneeze or cough. Fomites, object or substance that is capable of transmitting infectious organisms from one individual to another, also may carry the virus through to others. Metals and metallic objects are said to be efficient fomites for COVID-19.

Estimates by credible organizations are that infected people have 98 per cent recovery rate from the disease. The two per cent of patients who die from it are predominantly vulnerable

persons such as older people above the age of 50 and most of them have pre-existing conditions, such as diabetes, cardiovascular disease, hypertension, chronic respiratory disease or cancer. It means that young people have a very high capability to recover from infection based on what is known to date about the virus.

In a larger context, whereas SARS has 9.6 per cent and MERS has 34 per cent mortality rates, COVID-19 has about 2 per cent mortality rate.

How does one avoid COVID-19? Remember the following simple measures.

Wash and rinse hands thoroughly with soap and water for at least 30 seconds. Do it frequently and encourage others to do the same. The hands are the major carriers of viruses and washing hands with soap and water properly kill most viruses. In the absence of water and soap, sanitizers are also effective but not as well as soap and water. Water alone if it is all that is available is useful but very weak as a cleaner for viruses.

Avoid touching the nose, mouth, eyes with hands. The hands pick up viruses and transmit them easily through these parts of the body.

Stay a good distance, about one metre or three feet, away from anyone who sneezes or coughs. The droplets from their sneeze or cough cannot reach you at this distance. Anyone who sneezes or coughs should cover their noses and mouths to avoid spreading droplets to others.

Fomites, such as clothes, utensils, and furniture, also transmit viruses. In public places especially, use fomites sparingly and clean hands frequently when public objects are used.

Stay at home if you feel ill and seek medical care as soon as possible if the illness persists.

It is important to be informed and to obtain new information on the new virus. However, avoid misinformation and myths. For example, the WHO recommends the use of face masks for those who are taking care of patients with COVID-19 or for those who may have a cough, cold, or sneezing. Wearing masks is not a substitute for regular hand cleaning.

There is a lot of wrong information about the current epidemic given the power of social media that turns just about anyone into “specialists”. Each country has credible sources of information and there are various international organizations that competently provide information. Top of the list is the World Health Organization, Center for Disease Control, National Public Health agencies, and well-established, reputable media organizations.

Bunmi Makinwa is the CEO of AUNIQUEI Communication for Leadership.