COVID-19 is only slowly reaching Africa. That’s no surprise

The COVID-19 outbreak is currently sweeping out of China across the world. To date, over 95,333 cases globally have been reported. Yet of these, only 27 have been on the African continent. Medical experts are reportedly confused – wondering if there is under-reporting going on in Africa. But to understand we only need to take a brief look at the history of how other epidemics and pandemics have spread, and a little economics.

The novel coronavirus – named COVID-19 by the WHO – originated in Wuhan in China, a city with a population of 11 million – approximately 8,500 square kilometres. To date, the huge majority of the confirmed cases (84%) and deaths (91%) from the highly contagious respiratory disease have occurred in China.

However, over the past two weeks we’ve seen outbreaks take hold across many communities across the globe and multiply rapidly.

At the same time, we have seen headlines such as “African countries are at severe risk”, and “Bill Gates warns the coronavirus could hit Africa worse than China.”Evidence of this potential was set out in a widely circulated Lancet study, which ranked the vulnerability of African countries to the virus.

That said, Africa has not yet been hit hard. Egypt reported the first African confirmed case of COVID-19 on February 14th, becoming the 25th country in the world to do so, 45 days after China alerted the WHO on December 31st.

Overall, outside China, a total of 14,768 cases of COVID-19 have been reported to the WHO from 85 countries, with 267 deaths.

Of these, seven African countries (in order of confirmation – Egypt, Algeria, Nigeria, Morocco, Senegal, Tunisia, and South Africa) have reported a total of 27 COVID-19 cases.  Considering the vulnerability that the Lancet study pointed out, surely this figure seems disproportionate?

Indeed, alongside the concerns for the African continent, we have also seen headlines such as “Africa’s low coronavirus rate puzzles health experts”, with excerpts such as “this is a remarkably small number for a continent with nearly 1.3 billion inhabitants, and barely a drop in the ocean.”

Is there under-reporting going on? Are Africa’s health systems unable to detect cases? Or perhaps, as being shared on social media, Africans have some sort of genetic make-up that resists the virus?

No. This is not about health systems, nor is it about racial differentiation. It is about Africa’s relationship with the rest of the world.

Despite the huge numbers in China and increasing numbers world-wide, it is not surprising that the first case was detected so late, and there are still so few cases. A glance at history and economics helps us understand why.

In the past, other major epidemics or pandemics with origins outside Africa have also seen significant delays in reaching the continent, and have reached in much smaller numbers compared to other regions.

For instance, in 2002-2003, SARS entered Africa 5 months after it first spread in China, with South Africa becoming the 17th country in the world to report. No other country on the continent reported a case thereafter.

In 2009, H1N1 reached 60 countries outside of Africa before Egypt reported its first case two months after its initial discovery in Mexico. H1N1 eventually spread to 41 African countries, with over 8000 cases and 160 deaths on the continent. Overall, the deaths across Africa represented 1% of the total reported deaths worldwide.

We are seeing exactly the same patterns with COVID19, simply repeated in a new decade.

Why? Africa is simply less connected to the rest of the world, including China, especially in people-to-people flows. While the Lancet study helpfully explored which countries within Africa do have stronger links to China in terms of tourism flows in particular, what the authors didn’t do was put that in context.

Africa gets approximately 5% of global tourism flows, and an even smaller 4% of China’s tourists.

There are also flows of workers to Africa from all other areas of the world, including China, but these are also fairly insignificant. Of the total Chinese workers that went abroad to deliver projects in 2017, only 16% went to Africa, and 23% of those went to one country – Algeria.

In this context, the reason why Africa is not yet being strongly affected by COVID19 is not that the continent is somehow more resilient, or that screening from flights and other necessary detection and management tools are poor.

Right now, African countries are, as they have been with other epidemics in past decades, effectively “onlookers” with regards to COVID19 because its relationship with both China and the rest of the world is far behind others.

More evidence for this has been provided by the fact that the seven African countries that have been affected so far have relatively more developed tourism sectors and/or more international residents.

Only four were on the list of 11 “vulnerable” African countries identified by the aforementioned Lancet study, and only two on a similar WHO list of “vulnerable” African countries that have been prioritised for screening and other preparedness support (although this low number is partly due to the fact that WHO classifies some of the North African countries as outside of the “Africa” region).

So, what now? Can the other 48 African countries not yet affected relax? Can those with the fewest international links on the continent reduce their preparation efforts?

The answer to that is they absolutely must not relax. History suggests that now, once on the continent, the virus may spread across borders. Only yesterday, Algeria reported four new confirmed cases of the virus, the first cases not “imported” from elsewhere.

The time for all African countries to get seriously prepared is right now.

The WHO, the AU and others need to extend their support across the continent, rethinking their original modeling beyond the initial 13 “priority” countries, and ensuring there is very clear, consistent messaging on how to measure and contain the virus – both to governments and the public.

On February 22, the African Union convened a Ministerial Meeting on Coronavirus Disease Outbreak, to discuss how to strengthen preparedness and response to the outbreak by Member States and established the Africa Task Force for Novel Coronavirus (AFCOR) to coordinate preparedness and response across the continent. It sounds promising, but how this is implemented in practical terms – and quickly – is the challenge.