Coronavirus Disease 2019, or COVID-19, is an infectious disease caused by a novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV2). The disease emerged in December 2019 from Wuhan, China, and spread globally at a dizzying pace. It is important to distinguish between the virus (SARS-CoV2) and the disease (COVID-19), since there are more people infected with SARS-CoV2, than there are symptomatic COVID-19 cases.
Following infection, individuals can pass the virus to their contacts during the “incubation period”, which can last more than two weeks, before symptoms develop. With new cases trickling into Africa, actions to halt transmission are more urgent now than ever.
SARS-CoV2 is a novel virus, which means humans are encountering it for the first time. Although it is related to other coronaviruses, the sequence and structure of SARS-CoV2 are distinct enough, such that humans do not have any pre-existing immunity against it.
Since candidate SARS-CoV2 vaccines are still in development, humans can only acquire protective immunity through an actual infection, where the outcome can range from no symptoms to severe hospitalisation and admission to intensive care units, or even death. Among younger individuals, fatalities are rare, and symptoms can be mild. The reasons behind these divergent outcomes of infection are not fully understood.
Risk factors include other conditions (co-morbidities), such as diabetes, cardiovascular disease, asthma and chronic obstructive pulmonary disease (COPD), immunodeficiency or immuno-suppressive therapy. These are important considerations for Africa where these co-morbidities and other infections are prevalent.
What does this mean for Africa?
The disease is currently classified as a pandemic, since there is community-wide spread in several countries globally. There are over 700,000 COVID-19 cases in over 170 countries, which are tracked daily. COVID-19 has been slow to invade Africa, but official cases are now reported in almost all African countries.
As SARS-CoV2 infections spread across communities, the numbers will very likely underestimate the real case counts, especially with the limited availability of clinical tests. In addition, as explained by Next Einstein Forum fellow Zaheer Allam, Africa has very specific challenges around the centralised nature of cities and essential services. Even in a lock down, people are expected to buy food and other essentials in centralised locations where social distancing is impossible.
Busting myths about COVID-19 spread in Africa
One circulating myth surrounding the slow pace of COVID-19 in Africa, is the possibility that Africans are resistant to severe disease progression for genetic and environmental reasons, or the relatively younger age of Africans compared to those in other continents. Since COVID-19 affects the elderly disproportionately, it is natural to assume the disease will not take hold in Africa in the way it ravished other continents. This is wrong.
Since younger people are likely to experience milder COVID-19 disease, they are likely to assume they are “well” and in no need of quarantine, while still very much contagious. “Social distancing”, which is standing at least one metre (three feet) from others and avoiding contact by self-isolating, has been suggested as the most effective public health measure to curtail SARS-CoV2 transmission. The primary premise of social distancing is to slow down transmission of the virus and flatten the transmission curve so as not to overburden healthcare systems. Given the few number of hospital beds that can be spared to COVID-19 patients, it is critical to enforce social distancing as a priority.
Is social distancing even possible in Africa?
“Social distancing” in African households with large numbers of family members living together, or crowded housing settlements is impossible to implement in practice. Africans also rely heavily on an informal labor sector, so economic support, especially for low-income households, for extended periods of quarantine is a big challenge. So even if Africa’s demographics provided some advantage, this would be cancelled out by the challenge of implementing effective social distancing. As well, the prevalence of so many other infectious diseases, such as HIV and tuberculosis, will inevitably increase the risk of both SARS-CoV2 infection and COVID-19 disease severity, especially as these diseases directly compete with available healthcare resources to fight the looming epidemic.
Another dangerous myth for the slow spread of SARS-CoV2 in Africa is the argument that warmer weather stops transmission. However, since the virus only started circulating in December 2019, we do not have any historical data to accurately predict the seasonality patterns. Further, the spread of the COVID-19 pandemic in several countries with different climates argues against a clear temperature advantage for Africa.
The more likely scenario is that COVID-19 cases are underreported in Africa and that SARS-CoV2 already has started spreading in many communities, even if it has in fact started spreading later than other continents. Accurate estimation of cases and spread of infection is contingent on the availability of testing kits.
An opportunity for African scientists
The clock for action is ticking as the number of COVID-19 cases rise in Africa. The situation requires rapid and unprecedented creativity and collaboration among healthcare providers, scientists and policy makers.
Currently, vaccines and treatments are still in the research and development phases, and it is an opportunity for African scientists to meaningfully partake in that global mitigation efforts. Despite the COVID-19 anxiety, African scientists and public health experts can be at the forefront of the local response against the pandemic and contribute to the emerging SARS-CoV2 science. Nigeria, for instance, isolated the first African sequence for SARS-CoV-2 and made it available to the entire scientific community. Efforts such as these will quickly generate data to analyse disease patterns in the African context and help African-based clinical trials better tailor the development of treatments and vaccines.
There are also the diagnostic testing kits being worked on in Senegal. There needs to be urgent, coordinated support from African countries to help increase production capacity of the kits as well as connecting medical laboratories so that testing and results can be delivered quickly and locally.
Finally, together with drastic measures we are seeing across the continent such as restricting travels from Europe and other affected countries and banning public gatherings, there needs to be a serious effort to lean on the expertise of African scientists and public health officials, not just during crisis, but as an important part of national life. We would also like to see the strengthening of platforms, like the Next Einstein Forum, that bring together African scientists with policymakers, civil society and the private sector and funders to discuss how to prepare for future shocks.
With the rise in climate change, we will see new and evolving viruses and pandemics. We must arm Africa with science.
Sara Suliman, MPH, PhD, is a Next Einstein Fellow, and an instructor in Medicine in the Division of Rheumatology, Immunity and Inflammation, Brigham and Women’s Hospital and Harvard Medical School. Christophe Toukam Tchakoute, MPH is a PhD candidate at the Division of Epidemiology and Population Health, Department of Medicine, Stanford University. Catherine K Koofhethile, MSc, PhD, is a Postdoctoral Fellow in the Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health.
The opinions expressed in this piece are our own and do not reflect those of our employers or institutions.