Coronavirus: Could African countries cope with an outbreak?
12 March 2020
Africa has registered its first death from the new coronavirus - a German tourist who died in Egypt. Although cases have been confirmed in many countries, ranging from Egypt to South Africa - including Nigeria, the continent's most-populous country - it has so far been spared a major outbreak. The continent has close links to China, where the infection originated in late December, but the cases in Africa have all so far been linked to Europe. They have mushroomed in the last week, which is of particular concern as it is feared that poorer countries on the continent may struggle to cope if it does spread. The World Health Organization (WHO) admitted as much when it declared the coronavirus outbreak a global health emergency earlier in February. "Our greatest concern is the potential for the virus to spread to countries with weaker health systems," said WHO chief Tedros Adhanom Ghebreyesus, who is from Ethiopia, said at the time. As Michael Yao, WHO's head of emergency operations in Africa, has noted - because the continent's health systems "are already overwhelmed by many ongoing disease outbreaks" early detection is vital. "We're advising countries to at least detect cases early to avoid spreading the new virus within the community - that will be difficult to manage," he said. The continent has benefitted from the fairly slow arrival of the virus to Africa - giving its 54 countries a window to set up testing and treatment capabilities. Coronavirus tests should be ready "within a couple of weeks" across all African nations, according to the World Health Organization. Currently 33 of 47 sub-Saharan African countries have testing facilities, up from only two in January (in South Africa and Senegal). In Nigeria - with two confirmed cases - the Centre for Disease Control (NCDC) is publishing daily reports with updates on cases and any ongoing contact tracing. It has a free phone number and WhatsApp number for enquires and advice. South Africa's National Institute for Communicable Diseases also has a toll-free number. - EASY STEPS: How to keep safe - A SIMPLE GUIDE:  What are the symptoms? - MAPS AND CHARTS: Visual guide to the outbreak East Africa has no confirmed cases yet, although several people have been put in quarantine as a precaution. In Kenya, the government has opened a quarantine centre in the capital, Nairobi, for suspected cases. In Tanzania, the health minister announced that isolation centres in the north, east and west of the country had been identified. Thermometers have been stockpiled and more than 2,000 health workers trained. Last month, Uganda opted for regulated self-isolation at home for a number of passengers that needed to be quarantined on arrival at Entebbe airport. Airports across the continent are testing passengers' temperatures on arrival - and quarantining any suspected cases of the new coronavirus strain that causes Covid-19. Many countries have stopped flights to China, which has close trade links with the continent. China is Africa's biggest trade partner and around 10,000 Chinese firms are currently operating throughout the continent. According to Chinese state media, more than one million Chinese nationals live in African countries. It is estimated that African airlines have lost $400m (PS312m) since the outbreak began with airlines like South African Airways, Royal Air Maroc, Air Tanzania, Air Mauritius, EgyptAir, RwandAir and Kenya Airways all suspending flights to and from China. As all the cases detected so far originated in Europe, routes to Europe are likely to be affected soon and Kenya, for example, has also stopped flights to northern Italy, Iran and South Korea. The East African nation, which hosts many international conferences, has also banned such meetings for the next month. Uganda has introduced a mandatory 14-day period of self-quarantine for travellers arriving from 16 countries to prevent the spread of the coronavirus. The countries include the UK, the US and several European nations. The authorities have also said passengers arriving at the International Airport in Entebbe will soon be sprayed with a disinfectant. Dr Yao was involved in dealing with the outbreaks of Ebola in West Africa in 2014-2016 and more recently in the east of the Democratic Republic of Congo. He said he was concerned that there was not enough capacity to treat critical cases of coronavirus. Countries that dealt with the Ebola outbreak still have the isolation facilities and expertise in controlling infectious diseases. But when it comes to detection, Ebola is different to the coronavirus. Ebola only became infectious when symptoms showed, however there have been reports that in some cases, the coronavirus may have been transmitted before patients showed symptoms. In fact, it is not yet known exactly how the coronavirus spreads from person to person. However, similar viruses are spread via respiratory droplets, such as those produced when an infected person coughs or sneezes. Plus, with richer, more developed nations also battling the new coronavirus, they may not be quick to turn their focus and assist Africa. South Africa, the continent's most developed economy, is arguably most able to deal with an outbreak. But there are particular concerns related to the country's long-running HIV epidemic - the worst in the world. More than seven million people in South Africa live with a virus that seriously weakens immune systems, leaving many people potentially more vulnerable to Covid-19. Some international experts and observers have speculated that Africa's relatively low number of cases might simply be the result of poor reporting and low testing rates. Nigeria for instance has identified over 200 people who had come into contact with an Italian man who brought the first case of the virus into the country, but it has so far tested only 33. Still, many African health officials bristle at the suggestion that they are not adequately addressing the crisis, saying there has been an unprecedented level of mobilisation for Covid-19, as well as a growing reserve of experience to draw on. "I'm happy and proud [about] what Africa has done this time because usually we spend time running after epidemics when it is there but in this time we have been prepared," said Dr Amadou Sall, director of the Pasteur Institute in Dakar. At the onset of the outbreak, the institute trained 35 laboratories around the continent to do Covid-19 testing. Dr Sall says African health officials have also learned a lot from the West African Ebola crisis in 2014, and have created critical communications and collaborative networks aimed at containing the virus. "We put together a whole group of people that are going to be together working on referral of samples and confirmation, we're going to do the [genetic] sequencing... and also very important we're going to do research. Research is absolutely critical because three months ago nobody knew about this virus so understanding how it evolves in an African context is... absolutely important." If the new coronavirus works like other viruses, it may be that warmer weather in some parts of the continent has stopped it spreading so fast. "We've seen with other viruses that there does seem to be seasonality," Sarah Jarvis, a British doctor and clinical director of the health website Patient, said. "That may be for several reasons - for instance the droplets that carry the virus may not stay suspended in humid air for as long - and warmer temperatures can lead to the virus degrading when it's outside the body more quickly," she told the BBC's Newsday programme. The Sars outbreak, which started in November 2002 did end the following year in July - a summer month in the northern hemisphere - but it was not clear if weather was a factor, she said. However, Mers, a coronavirus that emerged in 2012, "didn't show any sign of being seasonal", Dr Jarvis added. Others point to fact that it is being cooped up in confined spaces during the winter that helps spread viruses. "In the summer months we perhaps spend less time indoors close together," Dr Jarvis said.
The continent has benefitted from the fairly slow arrival of the virus to Africa - giving its 54 countries a window to set up testing and treatment capabilities. Coronavirus tests should be ready "within a couple of weeks" across all African nations, according to the World Health Organization. Currently 33 of 47 sub-Saharan African countries have testing facilities, up from only two in January (in South Africa and Senegal). In Nigeria - with two confirmed cases - the Centre for Disease Control (NCDC) is publishing daily reports with updates on cases and any ongoing contact tracing. It has a free phone number and WhatsApp number for enquires and advice. South Africa's National Institute for Communicable Diseases also has a toll-free number. - EASY STEPS: How to keep safe - A SIMPLE GUIDE:  What are the symptoms? - MAPS AND CHARTS: Visual guide to the outbreak East Africa has no confirmed cases yet, although several people have been put in quarantine as a precaution. In Kenya, the government has opened a quarantine centre in the capital, Nairobi, for suspected cases. In Tanzania, the health minister announced that isolation centres in the north, east and west of the country had been identified. Thermometers have been stockpiled and more than 2,000 health workers trained. Last month, Uganda opted for regulated self-isolation at home for a number of passengers that needed to be quarantined on arrival at Entebbe airport.
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Is it possible to prevent the spread?
Airports across the continent are testing passengers' temperatures on arrival - and quarantining any suspected cases of the new coronavirus strain that causes Covid-19. Many countries have stopped flights to China, which has close trade links with the continent. China is Africa's biggest trade partner and around 10,000 Chinese firms are currently operating throughout the continent. According to Chinese state media, more than one million Chinese nationals live in African countries. It is estimated that African airlines have lost $400m (PS312m) since the outbreak began with airlines like South African Airways, Royal Air Maroc, Air Tanzania, Air Mauritius, EgyptAir, RwandAir and Kenya Airways all suspending flights to and from China. As all the cases detected so far originated in Europe, routes to Europe are likely to be affected soon and Kenya, for example, has also stopped flights to northern Italy, Iran and South Korea. The East African nation, which hosts many international conferences, has also banned such meetings for the next month. Uganda has introduced a mandatory 14-day period of self-quarantine for travellers arriving from 16 countries to prevent the spread of the coronavirus. The countries include the UK, the US and several European nations. The authorities have also said passengers arriving at the International Airport in Entebbe will soon be sprayed with a disinfectant.
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What about travel?
Dr Yao was involved in dealing with the outbreaks of Ebola in West Africa in 2014-2016 and more recently in the east of the Democratic Republic of Congo. He said he was concerned that there was not enough capacity to treat critical cases of coronavirus. Countries that dealt with the Ebola outbreak still have the isolation facilities and expertise in controlling infectious diseases. But when it comes to detection, Ebola is different to the coronavirus. Ebola only became infectious when symptoms showed, however there have been reports that in some cases, the coronavirus may have been transmitted before patients showed symptoms. In fact, it is not yet known exactly how the coronavirus spreads from person to person. However, similar viruses are spread via respiratory droplets, such as those produced when an infected person coughs or sneezes. Plus, with richer, more developed nations also battling the new coronavirus, they may not be quick to turn their focus and assist Africa.
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Have any lessons been learned from Ebola?
Some international experts and observers have speculated that Africa's relatively low number of cases might simply be the result of poor reporting and low testing rates. Nigeria for instance has identified over 200 people who had come into contact with an Italian man who brought the first case of the virus into the country, but it has so far tested only 33. Still, many African health officials bristle at the suggestion that they are not adequately addressing the crisis, saying there has been an unprecedented level of mobilisation for Covid-19, as well as a growing reserve of experience to draw on. "I'm happy and proud [about] what Africa has done this time because usually we spend time running after epidemics when it is there but in this time we have been prepared," said Dr Amadou Sall, director of the Pasteur Institute in Dakar. At the onset of the outbreak, the institute trained 35 laboratories around the continent to do Covid-19 testing. Dr Sall says African health officials have also learned a lot from the West African Ebola crisis in 2014, and have created critical communications and collaborative networks aimed at containing the virus. "We put together a whole group of people that are going to be together working on referral of samples and confirmation, we're going to do the [genetic] sequencing... and also very important we're going to do research. Research is absolutely critical because three months ago nobody knew about this virus so understanding how it evolves in an African context is... absolutely important."
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Might there be lots of cases going unreported?
If the new coronavirus works like other viruses, it may be that warmer weather in some parts of the continent has stopped it spreading so fast. "We've seen with other viruses that there does seem to be seasonality," Sarah Jarvis, a British doctor and clinical director of the health website Patient, said. "That may be for several reasons - for instance the droplets that carry the virus may not stay suspended in humid air for as long - and warmer temperatures can lead to the virus degrading when it's outside the body more quickly," she told the BBC's Newsday programme. The Sars outbreak, which started in November 2002 did end the following year in July - a summer month in the northern hemisphere - but it was not clear if weather was a factor, she said. However, Mers, a coronavirus that emerged in 2012, "didn't show any sign of being seasonal", Dr Jarvis added. Others point to fact that it is being cooped up in confined spaces during the winter that helps spread viruses. "In the summer months we perhaps spend less time indoors close together," Dr Jarvis said.
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Is heat a factor?