COVID-19 on the African continent
Authors: Chad R Wells, Jason K Stearns, Pascal Lutumba, Alison P Galvani
Journal: The Lancet Infectious Diseases (2020)

As of April 20, 2020, 14 068 people have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa, of whom 3158 (22·4%) are in South Africa.1WHOCoronavirus (COVID-19).https://www.afro.who.int/health-topics/coronavirus-covid-19Date accessed: April 20, 2020Google Scholar The transmissibility of SARS-CoV-2, combined with the scarcity of crucial health equipment and the challenges of implementing widespread physical distancing and case isolation, poses a grave threat to the continent. To illustrate the potential burden of SARS-CoV-2 epidemics within the most vulnerable countries in Africa, we simulated a SARS-CoV-2 outbreak in DR Congo in the absence of interventions. Using an age-structured epidemiological model (appendix p 1), and assuming a basic reproductive number of 2·72 (95% CI 2·56–2·87),2MIDAS NetworkMIDAS 2019 novel coronavirus repository.https://github.com/midas-network/COVID-19Date accessed: April 9, 2020Google Scholar we estimate that there would be 76 213 155 infections (95% CI 74 156 965–77 800 029) and 319 441 deaths (313 079–324 175) in the absence of physical distancing (figure). Although individuals younger than 20 years account for 42 752 770 (95% CI 41 551 696–43 683 014; 56·1%) of these simulated SARS-CoV-2 infections, individuals aged 50 years and older constitute 280 623 (275 356–284 509; 87·8%) of the deaths in our model prediction. Given the high prevalence of comorbidities in DR Congo, as there is in Africa more broadly, the death toll could even be much higher.3WHOCOVID-19. Situation update for the WHO African region.https://apps.who.int/iris/bitstream/handle/10665/331655/SITREP_COVID-19_WHOAFRO_20200401-eng.pdfDate: April 1, 2020Date accessed: April 20, 2020Google Scholar Sparse testing capacity makes assessing the true burden of coronavirus disease 2019 (COVID-19) and implementing effective case isolation difficult. For example, by mid-April 2020, DR Congo was only doing around 200 tests per day,4Ministry of Public Health of the Democratic Republic of the Congo. Comité National de Préparation et de Réponse contre la Pandémie de la maladie à Coronavirus 2019 en RDC; Kinshasa; April 6, 2020.Google Scholar Senegal around 300 tests per day,5Our World in DataDaily COVID-19 tests, rolling 3-day average.https://ourworldindata.org/grapher/daily-covid-19-tests-rolling-3-day-averageDate accessed: April 21, 2020Google Scholar and Ethiopia around 400 tests per day.5Our World in DataDaily COVID-19 tests, rolling 3-day average.https://ourworldindata.org/grapher/daily-covid-19-tests-rolling-3-day-averageDate accessed: April 21, 2020Google Scholar In addition, there are scarce resources for treating critically ill patients with COVID-19. Compared with the USA, a country with more than 120 000 ventilators, there are fewer than 2000 ventilators spread across 41 African countries, only five of which are in DR Congo.6Maclean R Marks S 10 African countries have no ventilators. That's only part of the problem.https://www.nytimes.com/2020/04/18/world/africa/africa-coronavirus-ventilators.htmlDate: April 18, 2020Date accessed: April 21, 2020Google Scholar, 7Wells CR Fitzpatrick MC Sah P et al.Projecting the demand for ventilators at the peak of the COVID-19 outbreak in the USA.Lancet Infect Dis. 2020; (published online April 20.)https://doi.org/10.1016/S1473-3099(20)30315-7Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar Physical distancing and other control measures have been implemented in some parts of African countries, including in the capital of DR Congo. However, authorities in Ghana and South Africa have already begun to consider lifting restrictions.8Nordling L South Africa flattens its coronavirus curve—and considers how to ease restrictions.https://www.sciencemag.org/news/2020/04/south-africa-flattens-its-coronavirus-curve-and-considers-how-ease-restrictionsDate: April 15, 2020Date accessed: April 21, 2020Google Scholar Given the dearth of health-care facilities and equipment across Africa, we urge investing heavily in prevention, including lockdowns focused on densely populated areas and shelter-in-place orders for the most vulnerable. Simultaneously, the socioeconomic considerations of the population and the disparate local realities of the 54 African countries must be taken into account. Mitigation strategies must be implemented in conjunction with social protection measures, such as price controls, the waving of utility bills and taxes, and targeted cash transfers.9Gentilini U Almenfi M Orton I Social protection and jobs responses to COVID-19: a real-time review of country measures.https://socialprotection.org/discover/publications/social-protection-and-jobs-responses-covid-19-real-time-review-countryDate: April, 2020Date accessed: April 10, 2020Google Scholar A concerted international effort is both moral and pragmatic for achieving this goal. However, on April 14, 2020, the US President announced that the USA will suspend its funding of WHO. Such action would be shortsighted, imperilling the containment of SARS-CoV-2. Protecting Africa is essential, not only for the continent itself, but also to safeguard the rest of the world. Given the potential for SARS-CoV-2 to reseed, even as some countries extinguish their current epidemics, the worldwide population is only as safe as its most vulnerable nations. We declare no competing interests. APG gratefully acknowledges funding from the National Institutes of Health (UO1-GM087719 and 1R01AI151176–01), the Burnett and Stender families' endowment, the Notsew Orm Sands Foundation, and the National Science Foundation, Grants for Rapid Response Research (2027755). We thank Jonathan Mboyo Esole for his insight on the COVID-19 situation evolving in DR Congo. Download .pdf (.24 MB) Help with pdf files Supplementary appendix SARS-CoV-2 epidemic in African countries—are we losing perspective?In their Correspondence, Chad Wells and colleagues1 wrote about COVID-19 in the African continent, proposing more rigorous measures of prevention and lockdown and predicting a total death toll of greater than 300 000 for DR Congo alone. We question the appropriateness of the mathematical model used by the authors and of the conclusions drawn. A more accurate prediction must go beyond this model and encompass long-term health strategies of the country, as well as death tolls attributable to the prevention measures themselves. Full-Text PDF