UPDATE: This story was published on March 30, 2020. On April 8, the World Health Organization recorded 10,000 confirmed cases of COVID-19 in Africa, 500 deaths, and counting. “COVID-19 has the potential not only to cause thousands of deaths, but to also unleash economic and social devastation," said Dr. Matshidiso Moeti, WHO Regional Director for Africa. "Its spread beyond major cities means the opening of a new front in our fight against this virus.”
ABUJA, Nigeria—Since late February, when Nigeria recorded its first case of COVID-19, taxi driver Ola Yusuf has been picking up passengers arriving at the busy Murtala Mohammed International Airport in Lagos who are coming from countries badly hit by the coronavirus.
"Sometimes I carry up to four people, who are either friends or from the same family," Yusuf told The Daily Beast over the phone. "I'm often paid in cash" (a potential vector of disease).
A day after the country's 12th case of coronavirus was reported on March 18, Yusuf began to develop fever, cough and fatigue but he refused to make any move to get himself tested. Like many Nigerians, he likes to believe the virus cannot survive in the country because of its hot weather, even though there is no empirical proof that's the case with this new disease.
"The story all over Lagos is that the weather will kill the virus so fast," said Yusuf, who continues to work despite his symptoms and contacts with multiple potential carriers. "If what I have is coronavirus, it will go before you know it."
Across Africa, according to the most recent report by the World Health Organization on Sunday, more than 3,005 novel coronavirus infections have been reported in 42 sub-Saharan nations and territories, with another 1,317 in North Africa, and the number is now rising dramatically. There have been some 124 deaths, according to the WHO, but virtually all these numbers are vast undercounts since testing has been very limited, and some countries—notably Libya and Somalia—are in the middle of conflicts that make any public health initiatives difficult or impossible to carry out. Meanwhile the ability of the coronavirus to spread exponentially once it appears is all too well established.
Ken Ofori-Atta, Ghana’s finance minister and chairman of the joint World Bank-IMF Development Committee told the Financial Times in an interview published Sunday that Africa has reached a “break the glass moment,” that is, an emergency where drastic action is needed from the international community in order to avert catastrophe.
But with the richest nations in the world suffering their own enormous crises, help for the poorest continent may be hard to come by.
The fear here is that if the disease gets into Africa's poorest neighborhoods, overcrowding and miserable sanitation could cause extremely rapid community transmission. And already the belated, panicked reaction of some governments is creating some hideous spectacles.
In South Africa, the country’s health minister announced 10 days ago that the number of infections had increased from 52 to 202 in just a few days. Now the number of infections stands at 1,187, according to the WHO on Sunday, and 1,280 as of Monday on the Johns Hopkins coronavirus tracking site.
The country’s security forces began to enforce a three-week nationwide lockdown last Thursday in an attempt to contain the spread of the coronavirus. Those efforts turned wild on Saturday as soldiers trying to curb the spread of the virus fired rubber bullets at hundreds of grocery shoppers in Johannesburg in a bid to keep them at safe distance. Many scared pedestrians reportedly crowded together in fear when confronted with the firearms.
A similar scenario occurred in Kenya on Friday when police reportedly fired tear gas at a crowd of ferry commuters in the coastal city of Mombasa before the 7 p.m.-to-5 a.m. curfew came into force. Several human rights groups, including Amnesty International, said in a statement that they have continued to receive “testimonies from victims, eyewitnesses and video footage showing police gleefully assaulting members of the public in other parts of the country."
The rapid jump in the number of infections in the last few days means it's only a matter of time before COVID-19 moves from big cities, which have welcomed travelers infected in foreign nations, to rural areas where primary health care is almost non-existent.
In Nigeria, for example, the government announced 94 new cases between March 17 and 28 despite recording only three cases between February 24 and March 16.
Nigeria’s fight to contain the spread of the disease, difficult to begin with, was not helped by comments from United States President Donald Trump who claimed at a press briefing last week that chloroquine, a widely known anti-malarial drug, had been approved by the U.S. Food and Drug Administration (FDA) to treat COVID-19.
Despite the FDA’s subsequent denial that it had approved the use of the drug to treat the virus, Trump’s remarks that chloroquine had shown “very, very encouraging early results” in patients who tested positive for the coronavirus pushed thousands of anxious people in Nigeria to gather at pharmacies and patent medicine stores to buy the drug. A CNN report said at least three people in the city of Lagos overdosed on chloroquine and had to be hospitalized.
“We do not have any hard evidence that chloroquine is effective in preventing or managing COVID-19,” the Lagos State government said in a statement, and expectations of a miracle treatment have made its efforts to promote social distancing even more difficult.
Nigerian authorities also have huge problems getting people showing symptoms of the coronavirus to come out for testing or self isolate. About two-third of the cases so far recorded (111 by the Johns Hopkins count) are people who returned to the country from Italy, Canada, France, Netherlands, Spain, the U.S., and Britain, according to authorities. Tracing their contacts has been largely impossible, leaving open the probability that Africa's most populous nation may have far more coronavirus infections than has been reported.
“Contact tracing is extremely important,” Nigeria’s minister of health, Dr. Osagie Ehanire, told a press conference in Abuja, the nation’s capital, over a week ago. He estimated then that there were about 1,300 people who need to be found. Now the number would be many multiples higher.
Most countries in West Africa have temporarily banned travel from places worst hit by the virus, but travel across the region under the Economic Community of West African States (ECOWAS) protocol on free movement of people remains unrestricted for nationals from most of the area. There has already been one reported case of a COVID-19 carrier—an American citizen—entering Nigeria through its land border.
Population mobility in West African countries is seven times higher than elsewhere in the world. The World Health Organization (WHO) noted in a report released in 2015 that the high degree of population movement across "exceptionally porous borders" in the region "created two significant impediments" to controlling the deadly Ebola outbreak of 2014, which killed over 11,000 people, mostly in West Africa.
"Cross-border contact tracing is difficult," the report said of the challenge it faced containing the spread of Ebola in the region six years ago. "Second, as the situation in one country began to improve, it attracted patients from neighboring countries seeking unoccupied treatment beds, thus reigniting transmission chains."
As the coronavirus spreads, West Africa is highly likely to see a repeat of the huge challenges the region faced during the Ebola outbreak, which lasted for two years, infecting more than 28,000 people and killing over one-third of that number. While governments in the region may have learned valuable lessons from that ugly experience, the health systems will definitely not be able to cope with a massive outbreak of the more highly contagious COVID-19.
Across the African continent, hospitals face enormous burdens already as high numbers of cases of infectious diseases and common ailments like malaria and measles are coupled with poor infrastructures and inadequate numbers of medical personnel.
In Nigeria, there are only 40,000 doctors in a country of nearly 200 million people, according to the country's medical association. Nigeria's doctor-to-patient ratio is four physicians per 10,000 patients, according to the World Health Organization (PDF), which also said Nigeria has only five hospital beds for every 10,000 people.
In Ghana, one of Africa’s most politically stable countries, the situation isn’t much better. Available statistics put the country’s hospital beds at 19,907. Ghana has nine beds per 10,000 thousand people, which is grossly inadequate.
The ratio of hospital beds to population is even worse in Senegal, where data compiled by the Central Intelligence Agency (CIA) put the figure at three per 10,000 people, and Mali, which reportedly had only one hospital bed for every 10,000 people as of 2010.
Of the continent's 54 countries, only 36 have the means to test for the coronavirus, according to a report by Bloomberg. A drastic increase in the number of suspected infections will make it extremely tough for laboratories to cope.
"It's clear that the health systems on the continent cannot handle a spike in coronavirus infections," says Dr. Collins Anyachi of the Department of Family Medicine, University of Calabar Teaching Hospital in southern Nigeria, where thousands of Cameroonians fleeing the Anglophone crisis in their country have sought refuge. "African governments have to put a lot of effort into educating their citizens on the benefits of maintaining good hygiene, social distancing, and the importance of self-isolating if experiencing symptoms of COVID-19."
Another concern dealing with the virus in Africa is the issue of discrimination against sufferers of the disease.
In Kenya, a man suspected of being infected with the coronavirus reportedly was beaten to death by a group of young men who threw stones at him after accusing him of having the respiratory illness.
In Ethiopia, anti-foreigner sentiment began to emerge following the outbreak of the coronavirus that has now infected six people. A security alert from the U.S. embassy has warned that “foreigners have been attacked with stones, denied transportation services, being [sic] spat on, chased on foot, and been accused of being infected with COVID-19.”
Public health and infectious disease experts in Africa, like their counterparts elsewhere in the world, are calling on their fellow citizens with symptoms of the coronavirus to self-quarantine. But such a simple request is unlikely to be followed in many places, where families squeeze in a single room and hundreds of people share a communal water pump.
While a focus on promoting good hygiene is important to preventing the spread of the virus, it is less likely it can be widely achieved in a continent where, according to the WHO, in 34 African countries fewer than 50 percent of the people have access to basic hand washing facilities where they live.
As for Ola Yusuf, the cab driver in Lagos, he says he is feeling a little better now. He’s not so tired. But he’s still coughing. And the passengers he has carried these last two weeks? Are they infected? Are they carriers? Nobody knows.