COVID-19: Sub-Saharan Africa is faring better than expected as ‘First World’ countries go into second lockdown
AS of November 2, according to data obtained from the website of the European Centre for Disease Prevention and Control, 46,597,299 cases of COVID-19, including 1,201,162 deaths, have been recorded across the world.
Out of the number, Africa accounted for 1,796,748 cases, including 43,302 deaths.
The United States – a ‘First World’ country – recorded 9,207,362 out of the total of 20,807,415 cases on the American continent. The US also recorded 230,996 deaths.
Also, majority of the 10,324,515 cases recorded in Europe were in highly developed, ‘First World’ countries such as France, 1,413,915; Spain, 1,185,678; United Kingdom, 1,034,914; and Italy, 709,333.
UK, Italy, France and Spain also have the largest share of the 270,313 deaths recorded in Europe, with 46,717, 38,826, 37,019, and 35,878, respectively, as of November 2.
As of that date, the countries that reported the most cases in Africa were South Africa, 726,823; Morocco, 222,544; Egypt, 107,736; Ethiopia, 96,583; and Nigeria, 62,964.
South Africa has recorded the most COVID-19-related deaths in Africa, 19,411; followed by North African countries – Egypt, 6,278; Morocco, 3,762; Algeria, 1,973 – and Ethiopia, 1,478. Nigeria, as of November 2, had recorded 1,146 deaths.
While the data from Nigeria and other African countries – especially Sub-Saharan Africa – are generally seen as not reflecting the exact COVID-19 situation due to low levels of testing, it is instructive to note that life in the region has largely returned to normal, as most governments have lifted lockdowns imposed to check the spread of the virus.
But, on the other hand, a number of the highly developed ‘First World’ countries are going into a second lockdown at the same period.
When Nigeria recorded sub-Saharan Africa’s first case of coronavirus on February 25, doomsday predictions for the region came in thick and fast as experts predicted the annihilation of the continent, which is home to most of the ‘Third World’ countries.
Even as the virus was already having a huge toll on the US and other Western ‘First World’ countries before it officially arrived in Africa, all the worst case scenarios projected by experts indicated that millions would perish in Sub-Saharan Africa. In early April 2020, when the figure stood at 13,814 confirmed cases of COVID-19 in 52 countries across Africa, with about 747 deaths, Melinda Gates, wife of billionaire Bill Gates, and Co-Chair of the Bill and Melinda Gates Foundation, predicted that dead bodies would litter the streets of African countries in the coming days.
In an interview with CNN, she said, “It’s going to be horrible in the developing world. Part of the reasons you are seeing the case numbers still do not look very bad, is because they don’t have access to many tests. Look at what is happening in Ecuador, they are putting bodies out on the streets, you are going to see that in countries in Africa.”
Speaking of her concern when the world was watching as China struggled to isolate an enormous part of its population, Gates noted, “My first thought was Africa. How in the world are they going to deal with this? I have been in townships all over Africa and slums. When we talk in-country physical distancing and hand-washing, if you live in slums you can’t physical distance, you have to go out and get your meals. You don’t have clean water to wash your hands.”
The World Health Organisation, and the United Nations, ramped up the doomsday prophecies, when, also in April 2020, the global health agency warned that Africa could become the next epicentre of the COVID-19 outbreak.
The UN Economic Commission for Africa added that it is likely that the pandemic will kill at least 300,000 people in Africa.
For Nigerians, fears that the pandemic would have a huge human toll in Africa’s most populous nation were heightened by reports that there are just a few functional ventilators in the country. Ventilators are required for treatment of critical cases of coronavirus, especially those involving breathing difficulties.
Panicked, the Federal Government, through the Ministry of Finance, in April 2020, openly, on Twitter, begged a US billionaire, Elon Musk, owner of American automotive and energy company, Tesla Inc, to support Nigeria with ventilators for the treatment of coronavirus patients in the country.
The Federal Government had resorted to ‘online begging’ after Mr Musk, in a post on Twitter, announced that his company had extra ventilators available for shipping worldwide and that anyone who needed should indicate interest so as to have it delivered for free.
The tweet by Mr Musk read, “We have extra FDA-approved ventilators. Will ship to hospitals worldwide within Tesla delivery regions. Device & shipping cost are free. Only requirement is that the vents are needed immediately for patients, not stored in a warehouse. Please let me or @Tesla know.”
Pouncing on the opportunity, the Federal Government responded, saying that Nigeria needs about 100-500 ventilators to assist with the rising cases of COVID-19 in the country.
The tweet by the Ministry of Finance read, “Dear @elonmusk @Tesla, Federal Government of Nigeria needs support with 100-500 ventilators to assist with #Covid19 cases arising every day in Nigeria.”
The Federal Government’s action was roundly criticised by Nigerians, who felt that the development was embarrassing, but it reflected concerns that the country, and other Sub-Saharan African countries, lacked the ability to withstand the coronavirus pandemic.
Sub-Saharan Africa fare better than expected
However, seven months later, by November, the doomsday prophecies have not come to pass. Rather, Sub-Saharan African countries are faring better than expected, unlike the ‘more distinguished’ First World countries.
On the whole, Africa’s COVID-19 figures are far lower than those in Europe, Asia or the Americas, and reported cases are continuing to decline. The region has a population of more than one billion, but has just about 1.7 million cases, according to data compiled by the John Hopkins University.
While the low testing levels in Sub-Saharan African countries have been cited to cast doubts on the accuracy of the official COVID-19 situation in the region, the fact remains that the expected mass deaths has not happened.
Despite low testing rates, Dr John Nkengasong, the head of Africa Centres for Disease Control and Prevention (Africa CDC), told the BBC that there is no indication that a large number of COVID-19 deaths have been missed.
Also, a recent continental study by Partnership for Evidence-based Response to COVID-19 (PERC), which brings together a number of private and public organisations, noted that Africa was recording a fewer number of COVID-19 fatalities, compared to other continents.
“The case-fatality ratio (CFR) for COVID-19 in Africa is lower than the global CFR, suggesting the outcomes have been less severe among African populations,” the PERC report noted.
Why has Sub-Saharan Africa fared better than expected?
The PERC report praised many African countries for waging an effective campaign to combat the spread of COVID-19, even though they are known to have fragile heath systems.
The PERC study noted that African countries acted fast to contain the spread of the coronavirus disease. Public health measures, including avoiding handshakes, frequent hand-washing, social distancing and wearing of face masks, were quickly introduced and some countries, such as Lesotho, acted even before a single case was reported. Lesotho declared an emergency and closed schools on March 18, going into a three-week lockdown for about 10 days. It was only days after the lockdown was lifted, in early May, that Lesotho recorded its first confirmed cases.
Also, a survey conducted in 18 countries in August by PERC noted that public support for COVID-19 safety measures was high as 85 percent of respondents said they wore masks in the previous week.
“With strict public health and social measures implemented, African Union member states were able to contain the virus between March and May,” the report said, noting that ”minor loosening (of restrictions) in June and July coincided with an increase in the reported cases across the continent”.
Africa’s relatively younger population has also been cited as a reason for the ‘milder’ nature of the COVID-19 disease in the continent, particularly in Sub-Saharan Africa. WHO Africa Head, Dr Matshidiso Moeti, observed, “The pandemic has largely been in younger age groups. About 91 percent of COVID-19 infection in sub-Saharan Africa are among people below 60 years and over 80 percent are asymptomatic.”
Those aged 65 years and above make up just about three percent of the population in Sub-Saharan Africa. In comparison, Europe, North America and wealthier Asian countries have the oldest inhabitants.
“One of the big drivers (for COVID-19 infection and death) in Western countries is that the elderly people were living in specialised homes and these became places where the transmission was very intense,” Moeti added.
Older peoples’ homes are uncommon in most African countries, where older people are more likely to be living in rural areas. In most African countries, people return to their rural homes when they retire from employment in urban areas. Also, according to a report by the BBC, population density in rural areas is lower and therefore it is easier to maintain social distance.
The BBC report also noted that an underdeveloped transport system within and between countries means that Africans do not travel as much as people do in more developed economies, thereby minimising contact.
The climate in Sub-Saharan African countries has also been suggested as a reason for the lower level of COVID-19 infection and deaths in the region. A study conducted by the University of Maryland in the US found a correlation between temperature, humidity and latitude and the spread of COVID-19.
”We looked at the early spread [of the virus] in 50 cities around the world. The virus had an easier time spreading in lower temperatures and humidity. Not that it doesn’t spread in other conditions – it just spreads better when temperature and humidity drop,” Mohammad Sajadi, the lead researcher in the University of Maryland study said.
The study’s findings have mirrored the situation on the ground in the continent – North African countries, which are colder, have been worse off and while the spread of the virus accelerated in South Africa as the southern hemisphere went into winter, the number of cases dropped significantly when it became warmer, impacting the continental outlook, as South Africa accounts for almost half the total number of cases and deaths on the continent.
The experience gained from combating seasonal Ebola outbreaks in Sub-Saharan Africa was also cited as a reason for the region’s ‘good performance’ in containing the coronavirus disease. The BBC report noted that several West African countries, which battled the worst ever outbreak of Ebola from 2013 to 2016, had mastered the public health measures that have been used to prevent COVID-19, including isolating the infected, tracing their contacts and then getting them quarantined while they get tested.
Africa CDC head, Dr Nkengasong, in an interview with The Telegraph, added that African countries took bold, aggressive and courageous steps in locking down their economies very early.
He also pointed to a large number of asymptomatic coronavirus cases in the region.
A review by the World Health Organisation’s Africa Office in September noted that more than 80 percent of African COVID-19 cases have no symptoms, compared to about 40 percent in parts of Europe and the US.
Dr Nkengasong also pointed to the continent’s youthful population. According to him, the median age of the continent is about 19 years old while the median age in Europe is around 43 to 45. It had been established that older people are far more likely to die of COVID-19. Only about three percent of the population of Sub-Saharan African countries are over 65 years old, compared to nine percent in Brazil and 19 percent in the UK.
However, Dr Nkengasong did not rule out genetic factors for the lower Case-Fatality Ratio in the continent.
He said, “What we don’t know yet is if this (lower number of deaths and higher number of asymptomatic cases) is due to genetic factors. We need to extensively sequence all the viruses on the continent to understand if there are certain mutations that are happening that are making (Africans to) behave differently. The second and more important point is to look at the host factors, to look at the genetic factors on the continent to see there are common traits genetically that are making a high rate of asymptotic cases. Thirdly, I would ask the continent to look at preexisting conditions, to look at how BCG vaccines or Tuberculosis may lead to some kind of immunity.”
In the same vein, a recent paper in the journal, Science, reportedly suggested that early and frequent exposure to a host of other pathogens could mean the immune systems of people in Africa are better able to fight invaders, such as the coronavirus.
Be that as it may, Dr Nkengasong noted that the Doomsday prophecies concerning Africa were based on stereotypes, and not science.
He told The Telegraph, “They were embedded in a shallow understanding of the continent, and a rush to make headlines. If you say that three million Africans are going to die, or half a million are going to die in six months, that is news. And then, of course, it is convincing because the continent is poor and has weak health systems. It was not based on science. I don’t think the assumptions were solid. I think they were based on stereotype.”
Dismissing the Doomsday prophecies, Dr Nkengasong pointed to South Africa, Senegal, Rwanda and Nigeria as ‘success stories’.
South Africa has been the worst-hit African nation but the Africa CDC head sees things differently. According to him, “Success should be seen as anyone who can deploy public health measures to control and bring down the pandemic and South Africa has done that twice. Look at what Nigeria has done. A country of 200 million. Everyone said it was impossible to lock down a city like Lagos. But they did it for weeks. It could have been millions of cases. Look at what is going on in Brazil or India. But we don’t see that in Nigeria or South Africa.”
A second lockdown in the ‘First World’
Last week Europe registered a record 1.5 million new cases of COVID-19, making it once again the centre of the pandemic. The more developed countries in the continent accounted for most of the cases and England will enter a new lockdown on Thursday, November 5. Prime Minister, Boris Johnson announced the decision after the UK passed the milestone of one million coronavirus cases. The Office for National Statistics now estimates that 1 in 100 people in England have COVID-19, an average of 568,100 people.
Germany imposed wide-ranging lockdown measures from Monday, November 2, in an attempt to slow down the spread of the coronavirus, after the country reported a record number of cases for a fourth day in a row on Saturday with 19,059 new infections in 24 hours, according to the country’s disease control agency, the Robert Koch Institute (RKI).
The number of new infections on Saturday broke Friday’s record of 18,681 cases. Germany’s death toll has risen to more than 10,452, according to data from RKI.
In the new lockdown, bars, restaurants and cafes will remain shut except for takeout. Theaters and concert halls will be closed, as will amateur and recreational sports facilities.
Also, Belgium imposed new lockdown measures for six weeks starting from Sunday. Belgium has the second highest number of infections per 100,000 people in the European Union and UK, after the Czech Republic.
In the same vein, France entered a second national lockdown on Friday that will last an initial four weeks, until December 1 at minimum. French President Emmanuel Macron noted that the virus was circulating at a speed that “even the most pessimistic had not predicted”.
The World Health Organisation’s Europe director, Hans Kluge, last Thursday noted that COVID-19 deaths rose by 32 percent across Europe last week.
Alarming situation in the US
The New York Times, on November 3, reported that at least 540 new coronavirus deaths and 93,581 new cases were reported in the US on November 2. In an update posted on its website, the New York Times reported that over the past week, there has been an average of 85,563 cases per day, an increase of 44 percent from the average two weeks earlier.
“Case numbers in the United States have reached alarming new records in recent days as outbreaks continue to grow across the country. Weekly infection reports reached record levels in more than half the country during October, and there were few hopeful signs in the data,” the New York Times said.
The New York Times observed that American life has been fundamentally reordered because of the virus as concerts, parades and high school football games continue to be called off.
COVID-19 and ‘myth’ about First and Third world competence
Interestingly, in an article titled ‘COVID-19 has blown away the myth about ‘First’ and ‘Third’ world competence’, published in The Conversation on May 13, Steven Friedman, Professor of Political Studies at the University of Johannesburg, observed that Britain and the US have been two of the biggest failures at handling COVID-19 while other Western countries, such as France, Italy and Spain, have battled to contain the pandemic.
After an assessment of measures by national governments to protect their citizens from the pandemic, Friedman noted that “the star performers are not in the traditional First World”.
Friedman went ahead to suggest that developments arising from the COVID-19 pandemic should trigger new thinking in Africa and other ‘Third World’ countries.