COVID-19 community transmission in 26 of 54 African countries: WHO

Several African countries have a poor healthcare system — about five hospital beds per 10,000 population

By Kiran Pandey
Published: Friday 12 June 2020

About 115 days into the novel coronavirus disease (COVID-19) outbreak in Africa, the World Health Organization (WHO) confirmed community transmission in at least 26 of 54 countries in the continent.

The continent reported over 197,000 confirmed COVID-19 cases and 5,300 deaths as on June 9, 2020. It confirmed its first case in Egypt on February 14, 2020.

Community transmission “is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories),” according to the WHO. 

In West Africa, 12 of 15 countries reported community transmission, with Nigeria and Ghana being the most affected. A closer look at the outbreak in these two countries showed that over 47 per cent cases were reported from Abuja, the capital city of Nigeria. Accra, the capital of Ghana, accounted for over 64 per cent of confirmed cases in the country.

Community transmission was underway in at least five out of seven central African countries. These include Cameroon, Democratic Republic of Congo, Gabon and Equatorial Guinea and Chad. Sudan, Kenya, Ethiopia and Tanzania in Eastern Africa reported community outbreak of the virus.

Algeria and Tunisia in North Africa, and South Africa and Zambia in South African region, also reported community outbreak.

What does it mean for Africa

There is a bigger need for public health measures such as social distancing, wearing masks and washing hands, the Africa Centres for Disease Control and Prevention (Africa CDC) suggested.

The WHO recommended strengthening of primary hospitals and expanding capacities to deal with implications of widespread community spread of the virus SARS-CoV-2.

Most countries with reports of community outbreak, however, have poor health systems, according to WHO data. Nigeria, for example, has only five hospital beds and less than four doctors per 10,000 of the population.

In fact, most countries in this part of African continent except Ghana have less than five hospital beds per 10,000 population; Ghana has around nine beds, and Ethiopia only one. Less than two doctors are available per 10,000 of the population in Ghana.

More testing

With a population of about 1.2 billion, the continent conducted about 2.4 million tests as on June 4, 2020.

Laboratories need to gear up to deal with a rise in the number of specimens that will need to be tested for COVID-19, according to the WHO. Governments should anticipate the constraints of testing infrastructure and should prioritise to assure the highest public health impact of reducing transmission using available resources, it added.

The body also recommended that testing be prioritised since not all areas in a country may have community transmission. While prioritising testing for optimal utilisation of limited resources, the focus should be on early identification and protection of vulnerable patients and health care workers.

In areas with no community transmission, the objective should be to test all suspected cases in an effort to detect first cases in new areas or settings as rapidly as possible, and take immediate measures to prevent (further) spread in that region, the WHO suggested.

Results of testing of specific populations (patients requiring hospitalisation for respiratory diseases) can give a rough estimate of the size of the outbreak in the area and be used to monitor trends.

John Nkengasong, the head of Africa CDC, thereby asked countries to modify the way they test their population. He asked the governments to divert their attention on surveillance testing of those with flu-like symptoms instead of testing people arriving at airports.

Africa CDC has set a target of conducting at least 10 million tests in the next two-three months under the Partnership to Accelerate COVID-19 Testing (PACT) announced on June 4, 2020 at the African Union Commission headquarters in Addis Ababa, Ethiopia.

“PACT is the game changer that will help capacitate Africa and enable it to build the strong partnerships needed to mobilise resources and support to defeat COVID-19,” said Nkengasong. But even if the continent achieves this target, less than one per cent of the African population will be covered, he added.

Challenges remain

Kate Dooley of the Tony Blair Institute for Global Change, West Africa regional director, appreciated PACT for timely testing, tracing and treatment to reduce COVID-19 transmission.

But challenges remain. The continent needs to conduct 65.5 million tests. Even accounting for known supplies in the pipeline, there is a supply gap of 25 million tests to achieve this. Under such a scenario, rationing of tests is needed, said Dooley. 

According to Tony Blair Institute, Africa CDC and African governments should source reliable antibody tests to complement limited PCR testing. These tests serve a different function but can also give peace of mind to health workers and provide governments with data to understand their COVID-19 outbreaks.

Community transmission in Africa in the unplanned cities is now an urban risk as well, with over half of the urban population living in slums. COVID-19 could travel faster in urban slums after community outbreak in the African cities as feared by UN-Habitat

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