COVID-19: How Africa is coping despite fragile healthcare systems

When British researcher Jonathan Beloff told his friends about his plans to travel to Rwanda, they discouraged him. Amid unabated spread of novel coronavirus disease (COVID-19), it was a natural thing to do. 

“I left London on March 5 and reached Rwanda on March 6. I was not worried about COVID-19 much because some basic things had to be followed to avoid it. I had wipes, and I made sure everything I touched was clean. Although people in the UK warned me to no go,” he said.

The COVID-19 scare has prompted airlines to suspend flights – on March 3, Kenya suspended flights from Italy. It had suspended flights from China a month ago.

Mauritius and Seychelles followed suit. After suspending all flights to Guangzhou on January 31, RwandAir cancelled all its flights on March 20 for one month. But Ethiopian Airlines, Africa’s most profitable carrier, continued to fly to and from China despite calls to suspend services.

Most countries have put in place travel restrictions. Angola has banned direct travel from seven countries. Meanwhile, several students and tourists continue to travel from China to Africa and vice-versa – China is, after all, Africa’s main trading partner.

According to John Nkengasong, director, African Centres for Disease Control and Prevention (CDC), this has increased air traffic between China and Africa.

Mary Stephen, a public health expert at WHO Africa, said they have assessed pillars of preparedness and response to tackle the outbreak. One such pillar is case management capacity and availability of facilities.

Surveillance and response facilities

Since the World Health Organisation (WHO) termed the outbreak a global emergency, one major worry was the spread in Africa – a continent home to more than 1.2 billion people and an abysmally weak healthcare system.

According to economist Charles Bigabiro, most African countries claimed they were prepared. But they are not.

“Most countries are not ready, authorities are not yet aware of the pandemic. They lack the commitment needed to handle the pandemic,” he said.

Nigeria reported sub-Saharan Africa’s first COVID-19 case on February 28.

Chikwe Ihekweazu, Chief Executive, National Coordinator of the Nigeria Centre for Disease Control, told Conversation Africa that over last three years, they focused on strengthening their emergency coordination, surveillance, public health laboratory and risk communications capacities.

“In December 2019, we completed training rapid response teams in all states in Nigeria. All 36 states have a team ready to be deployed in the event of an outbreak,” he had said.

Rwanda confirmed its first case on March 14, a day after Kenya and Ethiopia reported their first cases. It was an Indian who traveled from Mumbai on March 8.

When asked about measures taken to tackle the spread, Julien Mahoro Niyingabira, director, media relations, Rwanda’s health ministry, said:

We do screenings at all 38 entry points and isolate people with symptoms. Samples are tested at National Referral Laboratory in Kigali. If the person tests positive, he is taken to the treatment centre. About 78 hospitals across the country have prepared at least two rooms to isolate COVID-19 patients. We have 25 rooms at the Rwanda military hospital as well as 20 isolation centres across the country.

Jonathan claimed everyone was being screened at arrival.

“When I arrived in Kigali, I saw people at the airport wearing masks and gloves. People were checked for their body temperature at the airport. Those having fever were asked to wear gloves and masks and taken to a separate room,” he said.

However, all countries are not as prepared, and there are hurdles. 

On February 16, at the opening speech of nation leadership retreat, Rwanda President Paul Kagame claimed he ordered testing of all 400 delegates.

However, when he was told that it was not necessary, he pressed for answers on country’s readiness to deal with the disease. He was reportedly told that Dr Diane Gashumba, the former health minister, had kits enough to deal with only 3,500 cases. Taking out 400 for participants would deal a great blow to country’s preparedness measures.

Kagame then assigned people to follow up on the matter, and found that available equipment would have worked for only 95 people.

“When I got the report back, I reached out to the Minister and confronted her with the information. She admitted her mistake,” he said.

The situation was no different in Kenya. The country’s first case was confirmed on March 12 – a Kenyan woman who traveled from the United States to Nairobi through London.

A day before, Sabina Chege, co-chairperson of Parliamentary and Senate Health Committee, tried to verify the country preparedness during a committee sitting attended by Health Cabinet Secretary Mutahi Kagwe.

Chege called up the toll-free number assigned for the purpose, but her call did not go through. She then called another non-toll-free line shared by the ministry and introduced herself as a regular Kenyan citizen. She claimed she had cough and wasn’t feeling too well since she came back from China.

The receiver then reportedly told her she did not have COVID-19 because it had not reached Kenya yet.

But with global tally rising each day, many countries toughened preventive measures and cancelled leisure meetings and sports events. In Rwanda, all meetings, church services, schools and universities are closed until further notice. Weddings have been put on hold and funerals are allowed with only a few people. Hospitals, shops, bars and restaurants are keeping hand sanitisers at their entrance.

Meanwhile, stigma can also affect personal prevention.

To address this, experts have pointed to media’s role. Ida Jooste, global health advisor, Internews told DTE:

In an information climate as complex as that surrounding COVID-19 outbreak, local media has a vital role to play in communicating with communities, providing timely, accurate and trustworthy information, as well as channels for gathering and addressing feedback from vulnerable people, to help dispel some of the myths that are also going viral.

But the continent continues to report fewer cases – around 800 people tested positive with 19 deaths so far.

This can be explained by its geographical location and ability to cope with outbreaks.

“Africa has delat with epidemics such as cholera, Ebola. It has a great resistance and coping capacity,” Michael J. Ryan, Executive Director for WHO Health Emergencies Programme, said.

WHO’s Mary Stephen said despite fragile health systems, countries’ surveillance system is helping them deal with the epidemic.

“The statistics coming from China tell us that 81 percent of the cases are mild, 14 percent are severe and 5 per cent critical. So 19 per cent cases would require hospitalisation,” she said.

Testing ability

Responding to DTE in a virtual press conference recently, WHO Director-General Dr Tedross Adhanom Ghebreyesus said they decided to invest as much as they can in sub-Sahara African countries.

“We started from improving diagnosis capability and that has improved significantly. As you know, all countries, except a few, have been sending samples elsewhere. Now, more than 40 countries in the continent can do in-country test for novel coronavirus disease,” he said.

Stephen said about 39 out of 47 countries in the Afro-WHO region can now test and confirm.

“Preparedness is an ongoing process. At the beginning of the outbreak, we had only few laboratories that could confirm COVID-19 cases. But now, now 39 countries can do it. For those that don't have the capacity yet, we recommend they send their samples to countries close to them or to the laboratories in South Africa and Senegal,” she told DTE.

Africa CDC officials said they have been collaborating with African Union member states to establish preparedness measures, have initiated a continent-wide network of clinicians which met for the first time on 9 March.

They also initiated design of an online portal with training materials via online courses, online case studies, and social media vignettes to support evidence-based care of COVID-19 patients.

Dr Sabin Nsanzimana, Director-General of Rwanda Biomedical Centre, said that the country has one main laboratory for testing which is equipped with different machines. The most popular machine is the ABI machine.

“We have two of these and they can run about 100 samples simultaneously. We’ve been working with manufacturers who help us get relevant material and trainers. Later, the CDC from the US also brought experts to our lab and spent some time with us,” he said. 

“The long test is called the reverse transcription-polymerase chain reaction (RT-PCR) test. Practically, it is like DNA testing. It takes time and costs an estimated $150 per test. The new test will be less costly; less than $10, depending on the quantities you are purchasing. This new testing will not require huge capacity in terms of machines and training. It would be something a nurse could do outside the lab. You can put a drop of blood on a piece of plastic and confirm if you are positive or negative,” he added.

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