Preparing for a COVID-19 resurgence in the WHO African region
Authors: Benido Impouma, Franck Mboussou, Francis Kasolo, Zabulon Yoti, Matshidiso R Moeti
Journal: The Lancet (2021)

The emergence of COVID-19 in January, 2020, has led to the largest pandemic in recent history. With fragile health systems, limited testing capacities, and potentially vulnerable populations, Africa was projected to be the worst affected continent.1The LancetCOVID-19 in Africa: no room for complacency.Lancet. 2020; 3951669Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar However, as of Dec 31, 2020, the African region, with 14% of the global population and 47 member states, remains among the least affected of the WHO regions, accounting for 2·4% of confirmed cases and 2·4% of deaths globally. In 2020, following substantial increases in June and July, COVID-19 cases declined in August and September, before plateauing in October and steadily increasing again in November and December. Although several countries in Europe are experiencing second waves of the pandemic,2Looi MK Covid-19: is a second wave hitting Europe?.BMJ. 2020; 371m4113Crossref PubMed Scopus (95) Google Scholar there is rising fear of a COVID-19 resurgence in the African region. The recent upsurge seen in South Africa, Nigeria, and Senegal indicates possible resurgence, with notable signs of reduced adherence to public health and social measures (PHSM). As a result, transmission in households, schools, prisons, and other close settings has increased. This increase in transmission might force member states to reinstate lockdown measures with the associated negative socio-economic consequences. Three interventions are crucial to prepare for and respond to a possible COVID-19 resurgence. First, communities should be empowered as first responders. The experiences during recurrent Ebola outbreaks, and the HIV pandemic, suggest that member states should invest more in engaging the community in the COVID-19 response by involving community leaders as partners, so improving buy-ins for PHSM, and mitigating harm from misinformation. Member states are urged to form local committees responsible for community dialogues on preventive measures with tailored messaging based on feedback around COVID-19 risk perceptions. Second, the risk of continued spread at subnational levels should be assessed to inform tailored responses. We recommend WHO's new guidance on implementing and adjusting PHSM in the context of COVID-19,3WHOConsiderations for implementing and adjusting public health and social measures in the context of COVID-19.https://www.who.int/publications/i/item/considerations-in-adjusting-public-health-and-social-measures-in-the-context-of-covid-19-interim-guidanceDate: Nov 4, 2020Date accessed: November 7, 2020Google Scholar which uses a risk–benefit approach at the lowest administrative level, with transmission intensity and health systems' response capacity used to assign a risk level to each area. Third, member states should plan for the worst-case scenario by anticipating when health system capacity might be overwhelmed, developing contingency plans aimed at improving and adjusting testing strategy and capacity,4Seidu AA Hagan Jr, JE Ameyaw EK Ahinkorah BO Schack T The role of testing in the fight against COVID-19: current happenings in Africa and the way forward.Int J Infect Dis. 2020; 98: 237-240Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar scaling up active case finding in areas with widespread community transmission, increasing capacity to isolate all cases, and maximising the current health workforce including redeploying health workers to high-need areas. Sustainable and rapidly implemented interventions require strengthened response coordination to reduce transmission to levels that allow economic activity to continue across the region. We declare no competing interests. The views expressed in this Correspondence are those of the authors and do not necessarily represent the official position of WHO. COVID-19 in Africa: no room for complacencyDespite over 100 000 confirmed cases and infections in every country, the passage of COVID-19 through the African continent remains somewhat enigmatic. High numbers of deaths were expected in the region due to fragile health systems, lack of access to preventive measures, barriers to testing, and potentially vulnerable populations. But, according to WHO, Africa is the least affected region globally, with 1·5% of the world's reported COVID-19 cases and 0·1% of the world's deaths. Although comparisons are inaccurate, mortality rates have been lower compared with outbreaks of similar size elsewhere. Full-Text PDF