COVID-19: Egypt, South Africa, Algeria at highest risk in Africa

Labs ill-equipped, health systems lack isolation and quarantine facilities: Lancet paper

By Banjot Kaur
Published: Thursday 20 February 2020

Egypt is estimated to be at the highest risk of importation of novel coronavirus (COVID-19) infection among all African countries. The modelling study published in The Lancet on February 19, 2020, pointed towards discrepancies in the assessment of the risk COVID-19 posed in Africa assessed by the World Health Organization (WHO). 

“Algeria, Ethiopia, South Africa, and Nigeria were part of the 13 top priority countries identified by the WHO on the basis of their direct links and volume of travel to China. Egypt, which we estimated to be at highest risk, was not part of that list, although Cairo was identified as the African airport with the highest passenger volume from the affected areas (in China),” the paper read.  

The importation risk has been calculated by the volume of air traffic connections from areas where the virus currently circulates in China to African countries. 

According to the Lancet paper, other than Egypt, the countries that had the highest risk included Algeria and South Africa. Their ‘functional ability to detect and respond’ reported to WHO from time to time in the form of State Party Self-Assessment Annual Reporting (SPAR) score was ‘moderate to high’. Out of 100, Egypt, Algeria and South Africa had scored 87, 76 and 62 respectively.

Countries with the second-highest importation risk ranking included Nigeria and Ethiopia. Their SPAR score was 51 and 67 respectively but substantially larger populations were exposed to the infection. Morocco, Sudan, Angola, Tanzania, Ghana, and Kenya had similar moderate importation risk and similar populations. Their SPAR scores ranged from 37 to 75.  

Is Africa prepared?

So far, Africa has reported  only two positive cases; one each in Egypt and Cameroon. While the number of positive cases remain only two, experts fear that a potential COVID-19 outbreak in Africa could lead to a huge catastrophe due to weak health systems which are already burdened by a number of other outbreaks.

“The risk and likelihood of getting an outbreak is very, very high,” another Lancet report quoted Ambrose Talisuna, the WHO Africa team lead for emergency preparedness. 

This paper said a lot needed to be done to ensure preparedness on the continent. “Some countries remain ill-equipped. Some are without the diagnostic capacity for rapid testing for the virus; thus, if cases are imported, tests will need to be done abroad, which might critically increase the delay,” the paper said.

The WHO has also scaled up the number of labs but critical gaps remain even in their functioning.  “The capacity of these laboratories is still limited by the shortage of personnel trained to run the tests, and inadequate stock of materials needed to do these tests,” the paper said. 

A number of high, middle and low-middle income countries have evacuated their citizens from Wuhan. The African countries are no way prepared to do so. Moreover, the resources to set up quarantine centres at airports and hospitals are also lacking there. 

The African countries’ scarcity of resources includes personnel, centres, and equipment for quarantine and isolation.  Most countries do have a pandemic preparedness plan but they are completely outdated. 

The last statement issued by African CDC on February 17 said it was coordinating with member states to rapidly detect, test and curtail the spread of the COVID-19 in Africa.

After the outbreak, many African countries introduced flight bans. Seven African countries – South Africa, Ethiopia, Nigeria, Ghana, Rwanda, Uganda and Zambia – increased screening at their airports.

Nigerian Civil Aviation Authority put in place a high level of vigilance by airlines. Ghana and Ethiopia too have taken similar steps. 

A few African airlines have stopped their services to China.

“These bans are not expected to prevent importations. Not all connections between Africa and China have been cut — the main transporters continue to fly between the two countries.  Ethiopian Airlines, the largest carrier in Africa, is operating almost half of the flights from Africa to China together with all Chinese airline companies, and others,” the paper read.

Notably, COVID-19 cases spread to Europe and the United States as tourists travelled from China to these countries. However, cases may get imported to Africa due to business and commercial links between the continent’s countries and China. 

While Africa needs to ramp up its facilities fast, the Lancet paper also said panic must be avoided.  The overall risk of importation to Africa was lower than that to Europe: One per cent versus 11 per cent, respectively, the paper said.

With inputs from Kiran Pandey

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