Mystery of low Covid-19 death rates in Africa compared with other continents

Author : Eugene Ngumi

Source : IPG-Journal

The number of Covid-19 deaths of Africa inhabitants is lower than on any other continent
11:00, 14 September 2020

Covid-19 in Africa
Open source

In early August, the African Centers for Disease Control and Prevention (Africa CDC) reported that the number of Covid-19 cases in Africa had reached a million. However, given the fact that as of August 28, there were 30,000 victims of the epidemic, the number of deaths here is lower than on any other continent. Africa appears to be handling the pandemic surprisingly well.

As the coronavirus escalated into a global pandemic in early 2020, there were well-founded fears that Africa could be hit particularly hard. Weak health systems, scarce emergency resources, and a long history of epidemic outbreaks did not bode well.

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According to the May forecast of the WHO Regional Office for Africa, in the first year of the pandemic alone, up to 190,000 deaths and from 29 to 44 million people infected with coronavirus were expected on this continent. Why didn't this scenario come true? This can only be explained by the interaction of many factors that, on the one hand, make Covid-19 less visible in Africa, and on the other, weaken its impact.

Covid-19 case reporting and control depend primarily on testing, and there is a shortage of tests and screenings in Africa. Testing resources are inadequate. WHO recommends one test per thousand inhabitants per week, but in Africa, on average, only half of that is done. In addition, laboratory facilities for testing in African countries are completely different: in South Africa, many tests are carried out, but in densely populated Nigeria, on the contrary, there are few.

The shortage of tests probably hides a significantly higher number of people with Covid-19. Antibody tests of donors in Kenya, conducted by the Kenyan Medical Research Institute in conjunction with the Wellcome Trust, have shown that approximately one in twentieth Kenyans aged 15 to 64, a total of 1.6 million people, have antibodies against SARS-CoV-2, that is, these people are presumably infected. But since March 12, Kenya has reported only 450,146 infections.

Due to the lack of mass testing, the spread of the virus can be assessed by the increase in mortality, the so-called increased or excess mortality. In South Africa, the number of deaths from early May to late June was four times the normal rate. But in other parts of the continent, this figure is difficult to determine. Recording mortality during a pandemic is complicated by the fact that many public health workers are involved in testing and tracking the chains of the virus, or are unable to move freely due to restrictions.

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According to the International Rescue Committee, because of the huge gaps in testing and control of the pandemic, Africa is fighting it "in the dark." And yet, it seems that healthcare facilities are not experiencing the same pressures that could be observed at the peak of the pandemic in Europe or the United States. Factors of a different kind are also at work here.

One of the leading causes of death in Africa is upper respiratory tract infections, in particular pneumonia or bronchitis, which account for 10% of deaths across the continent. Covid-19 and other respiratory diseases cause similar symptoms and can lead to pneumonia. Many doctors may attribute their patients' airway symptoms to common infections rather than a new type of virus that they cannot test for. Thus, due to incorrect diagnosis, a significant number of cases of Covid-19 infection can be hidden behind habitual respiratory diseases.

The African population is young. Young people, although they do not have immunity, are less likely to develop a serious illness or die from Covid-19, and therefore the pandemic is easier. 65% of the African population is under 35, almost 50% are under 19. For comparison: in the EU the average age is 42 years, in Africa - 19.7 years.

The young age of the African population, as well as the particularly active spread of the virus in urban areas where people live even younger, may provide an answer to the question of why most infections in Africa are either asymptomatic or mild. According to the Ministry of Health of Kenya, in 78% of cases, Covid-19 is either asymptomatic or mild and in Ghana, according to the country's health service, this occurs in 82% of all cases.

Although health systems in Africa are relatively weak, the countries of this continent have gained experience in dealing with a pandemic in the recent past.

In the aftermath of the Ebola outbreak in West Africa, the African Centers for Disease Control and Prevention were established to improve epidemic control across the continent and to ensure coordination among countries.

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This could explain the rapid response of many African countries to the Covid-19 pandemic. They have introduced various forms of travel restrictions and other restrictive measures to conserve the capacity of their health systems, cope with the virus, and slow its spread. In addition, states not only encouraged social distancing rules, hand hygiene, and the wearing of face masks but in many cases made them mandatory and people readily adhered to them. Despite the lack of testing facilities, there are a huge number of local medical volunteers across the continent to monitor the spread of the infection and to encourage people to follow the rules of conduct to ensure personal safety. This could contribute to the current slowdown in the spread of Covid-19.

If a few months or even years, we would see which of these factors most of all counteract the spread and negative consequences of Covid-19. What is clear is that global pandemics manifest themselves at the local and regional level in accordance with the complex environment that affects the severity of their course. As we continue to fight the virus and prepare for possible future outbreaks, to effectively address the pandemic, we need to align our mechanisms with this set of interconnections.

Therefore, the rest of the world can learn certain lessons for itself from the experience of Africa. First, when symptoms of an illness appear, quick action is needed, even if the measures taken are imperfect. Second, low-cost solutions such as employing community health workers and encouraging changes in people's daily behavior can have a profound impact on the minds of the general population.

Africa will be able to return to normal life faster than in other regions. While almost the entire world fears a second wave or an increase in the number of cases in winter, most African countries, for the lack of an alternative, are relying on herd immunity. Due to the shortage of tests, it is not possible to trace the chains of infection spread among a large part of the African population, which would make it possible to stop or slow it down.

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Nevertheless, due to the relatively young population, in many cases, the disease is asymptomatic or mild, and therefore the virus does not have such devastating consequences as in other regions. This is why most African governments are now in the process of starting up and rebuilding their economies severely hit by the pandemic. On a continent with most of its inhabitants struggling to make ends meet, the recession could be as devastating as the coronavirus.

Eugene Ngumi

Read the original text at  IPG-Journal

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