Hard and Fast: Africa Rapid Response to the Onset of Covid-19 Pandemic Averted Community Transmission in the First 70 Days of the Pandemic

Author: Lenias Hwenda

Africa CDC Addis Abbaba: Analysis Based on Covid-19: First 70 days by region.*Comparison of the number of Covid-19 cases reported over the first 70 days since the first case reported in each region. Euro- European region; PAHO- Pan America Health Organisation; EMRO- Esterna Mediterenean; SEARO- South East Asia; WPRO- Western Pacific. *Global numbers taken from the latest WHO SITREP: http://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Day 1 for the WPRO region was based on the first reported Covid-19 onset date of 08 December 2019: http://www.who.int/csr/don/12-January-2020-novel-coronavirus-china/en/

​Africa’s handling of the COVID-19 pandemic has received very little global but it is remarkable for the low number of deaths in a region with uniquely susceptible health systems. Adding high case loads of Covid-19 onto Africa´s health systems concurrently dealing with a high burden of infectious and chronic illnesses, malnutrition, inadequate water and sanitation and limited resources2 should have caused rampant death on a scale surpassing anything seen so far in the worst affected countries today. ​

Adding high case loads of Covid-19 onto Africa´s health systems concurrently dealing with a high burden of infectious and chronic illnesses, malnutrition, inadequate water and sanitation and limited resources2 should have caused rampant death on a scale surpassing anything seen so far in the worst affected countries today. However, on on 1 April, 70 days since the pandemic began, Africa had successfully averted rapid viral transmission within its communities, widespread illness and high fatality rates that should have inevitably resulted from the region´s close trade links to China and Europe, high mobility of goods and people across its borders and resource limited health systems. The interational community has barely noticed this result, but it is worth a closer look to explore what lessons it might offer global public health.
 
All countries had the same amount of time to prepare for the Covid-19 pandemic. Africa, a continent of 1.3 billion recorded 4´073 cases and 91 deaths amongst 42 countries of the WHO Africa region,1 Figure 1a-d significantly fewer than the US 163199 cases, 4´793 deaths, Spain, 94´417 cases; 8´189 deaths and Italy, 105´792 cases; 12´430 deaths.1  WHO data show many countries with much stronger health systems continuing to experience worse health outcomes than the Africa region has experienced.3

As soon as coronavirus was first detected in China in December 2019, Africa Centre for Disease Control (CDC) began coordinating with the World Health Organization (WHO) to prepare and support African Union (AU) member states with strategies and responses needed to limit the likely spread of SARS-Cov-2. Africa CDC´s rapid deployment of Africa´s Joint Continental Strategy4 helped AU member states avoid the respose lag that occurred in the US and Europe . Such delays in implementing strategies to suppress transmission have been shown result in worse outcomes and greater loss of life.5
 
Continent-wide collaboration for COVID-19 preparedness and response was managed by an Africa Taskforce for Coronavirus (AFTCOR) chaired by Africa CDC Director and brought together WHO Africa, governments and partners to pool efforts and maximise synergies.2 At the onset, the region´s highest priority was to implement rigorous infection prevention and control measures by tracing every contact in every country in the early stages, consistent with WHO test-and-trace guidelines that have been successful in suppressing transmission in countries like Ireland, Germany, South Korea and Singapore.3 At this early stage, the initial response delay in countries that initially disregarded WHO guidance, scientific evidence, public health principles and at times their own national experts quickily became overburdened, leading to much greater loss of life and the countries becoming epicenters for viral transmission to other countries.1
 
Africa´s Covid-19 Taskforce has working group for each technical area each focusing on a single issue - surveillance, including screening at points-of-entry, infection prevention and control (IPC) in healthcare facilities, clinical management of persons with severe Covid-19 and laboratory diagnosis. Each working group has experts from governments, multilateral institutions and partners and is responsible for building, testing, and expanding specific capabilities critical to limiting COVID-19 transmission amongst countries. They evaluate technical capabilities, identify and address gaps through guidance, trainings, and technical support to strengthen countries’ ability to respond effectively.2 They also coordinate risk communication amongst countries and oversee stockpiling and distribution of medical supplies for the region. The convene regular weekly remote meetings to evaluate the latest scientific data, adapt the regional strategy to the evolving situation and maintain regular briefing to governments on all aspects of the pandemic response in real time.6
 
These efforts have resulted in the low number of deaths that have been dismissed as a likely result of missed cases. However, the organised effort put into limiting Covid-19 trasmission suggests that the numbers in Africa compared to other regions like Europe (Figure 1) cannot be solely due to missed COVID-19 cases. Regardless of the relative number of tests performed, extensive silent spread of SARS-Cov-2 within African countries would have resulted in a concormitant increase in deaths that would be hard to miss. WHO Africa confirmed that Africa had no Covid-19 community transmission on 26 March and that cases in half of its countries were primarily imported.7 At this time, the US and some European countries were already overwhelmed with rapid community transmission.1
 
A more likely explanation is that Africa learned important lessons from its experience dealing with multiple outbreaks and successful control of the 2014-2015 Ebola outbreak. An appreciation of the high baseline vulnerability of Africa´s countries2 helped its Covid-19 reponse by spurring a prompt, aggressive, and well-coordinated regional response guided by WHO.4 The ebola outbreaks also taught African countries critical lessons on effective public health engagement with communities to successfully limit the spread of serious infectious diseases.8 Sustained daily efforts by Africa´s international institutions like the Africa CDC, the AU and WHO Africa to limit Covid-19 community transmission, Africa CDC´s leadership in coordinating governments and providing them with expertise, training, information and risk communication advice have underpinned a strong multilateral Covid-19 response.9 It was driven by solidarity and the principle that a threat to one country is a threat to all African countries. 
 
This does not mean that Africa has escaped the worst. The pandemic that is still unfolding and It remains to be seen how Covid-19 will unfold past day 70. Though some of Africa´s worst affected countries like South Africa and Kenya are beginning to see community transmission, the numbers remain relatively low and Africa´s results so far provide a glimmer of hope. According to WHO, Africa could contain this virus in many countries if the draconian measures put in place by countries are accompanied by continued enforcement of quarantine measures and social distancing.7 WHO Africa has however cautioned African countries not to lower their guard and risk losing the window of opportunity to contain COVID-19 which may be narrowing with each day. The best strategy continues to be to flatten the curve by all means and if Africa continue to successfully suppress community transmission as it has done so far, the region may be able to prevent loss of life at the scale seen in Europe and the US. 

References
1. WHO, Geneva: WHO COVID-19 Situation update for the WHO  African Region, External Situation Report 5 1 April 2020: Source: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200401-sitrep-72-covid-19.pdf?sfvrsn=3dd8971b_2. 
2. Africa CDC Adis Ababba: Africa Joint Continental Strategy for COVID-19 Outbreak: Source: https://africacdc.org/download/africa-joint-continental-strategy-for-covid-19-outbreak/Africa Joint Continental Strategy for COVID-19 Outbreak: https://africacdc.org/download/africa-joint-continental-strategy-for-covid-19-outbreak/ 
3. WHO Geneva: Coronavirus disease 2019 (COVID-19) Situation Report – 79. Data as received by WHO from national authorities by 10:00 CET 8 April 2020. Source: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200408-sitrep-79-covid-19.pdf?sfvrsn=4796b143_6 
4. WHO Geneva: “Novel Coronavirus (2019-nCoV) situation reports” https://apps.who.int/iris/bitstream/handle/10665/331655/SITREP_COVID-19_WHOAFRO_20200401-eng.pdf Now 4 
5. Imperial College, London Infectious Diseases: Delays in implementing strategies to suppress transmission will lead to worse outcomes and fewer lives savedSource: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/ 
6. Nkengasong J N and MankoulaLooming W. Looming threat of COVID-19 infection in Africa: act collectively, and fast. Lancet March14 2020; 395  www.thelancet.com 
7. Bishop C: WHO: Sub-Saharan Africa reporting at least 300 COVID-19 cases a day: CNBC Africa March 26 2020. Source : https://www.cnbcafrica.com/news/2020/03/26/who-sub-saharan-africa-reporting-at-least-300-covid-19-cases-a-day/ 
8. Richards, P., Mokuwa, E., Welmers, P., Maat, H., Beisel, U.: Trust, and distrust, of Ebola Treatment Centers: a case-study from Sierra Leone. PLoS ONE2019; 14: 12: Source https://doi.org/10.1371/journal.pone.0224511. 
9. Africa CDC, Addis Abbaba: Guidance for Assessment, Monitoring, and Movement Restrictions of People at Risk for COVID-19 in Africa Source:  https://au.int/en/documents/20200320/africa-cdc-guidance-assessment-monitoring-and-movement-restrictions-people-risk 
10. WHO Geneva: Medicines for Africa anaylsis based on Covid-19: First 70 days by region.*Comparison of the number of Covid-19 cases reported over the first 70 days since the first case reported in each region. Euro- European region; PAHO- Pan America Health Organisation; EMRO- Esterna Mediterenean; SEARO- South East Asia; WPRO- Western Pacific. *Global numbers taken from the latest WHO SITREP: http://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Day 1 for the WPRO region was based on the first reported Covid-19 onset date of 08 December 2019: http://www.who.int/csr/don/12-January-2020-novel-coronavirus-china/en/ 
11. WHO Geneva: Coronavirus disease 2019 (COVID-19) Situation Report – 74. Situation report - 74. 3 April 2020. Data as reported by national authorities by 10:00 CET 3 April 2020. 
12. Africa CDC Addis Abbaba: Analysis Based on Covid-19: First 70 days by region.*Comparison of the number of Covid-19 cases reported over the first 70 days since the first case reported in each region. Euro- European region; PAHO- Pan America Health Organisation; EMRO- Esterna Mediterenean; SEARO- South East Asia; WPRO- Western Pacific. *Global numbers taken from the latest WHO SITREP: http://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Day 1 for the WPRO region was based on the first reported Covid-19 onset date of 08 December 2019: http://www.who.int/csr/don/12-January-2020-novel-coronavirus-china/en/