Devi Sridhar

AMID the constant news on Covid-19 emerging from Europe, North America and Asia, one region seems to have gone under the radar.

Sub-Saharan Africa had been predicted to be a potential hotspot for the disease early on, due to the region’s close economic ties with China.

Yet, for now, the countries in this region seem to have escaped the brunt of the disease, even as close neighbours Egypt and Algeria have witnessed growing numbers of cases.

While countries in Europe have reported 74 000 confirmed cases, countries in the World Health Organisation (WHO)’s African Region have reported less than 1 000 confirmed cases.

This could in part be attributable to low levels of testing or mislabelling of viral pneumonia.

But given that roughly a third of cases require admission to intensive care units and 29 percent develop acute respiratory distress according to a Lancet study, if Covid-19 has indeed been spreading rapidly across the continent, we would expect to hear of clusters of patients with these symptoms appearing in the hospital.

So far, this does not appear to be the case.

Europe might have lost the window of opportunity to contain the virus, but African countries still have a chance. For real preparedness to occur, the continent will rapidly need more international support and potentially additional social-distancing measures.

The next two weeks will decide the fate of the African continent in terms of Covid-19. As Tedros Adhanom Ghebreyesus, director-general of WHO, has said, African countries need to wake up.

There are reasons for concern already. First, though case numbers are still low, confirmed cases on the continent have increased rapidly with over 30 countries affected.

In South Africa, cases have been spiralling, so is the case in Democratic Republic of Congo, Senegal and Burkina Faso.

In some countries, a shift is occurring from “imported” cases to local transmission, suggesting that the virus might be starting to circulate within communities.

Second, testing is still inadequate. While epidemic surveillance networks built on past Ebola and flu outbreaks exist in the region, WHO only reports a few hundred tests in its African Region so far.  Without more tests, we still run the risk of ignoring a larger outbreak taking place in the region that is going undetected.

As the experience of South Korea, China, the United States and other countries has shown, the more testing that is done, the more cases seem to be found.

This testing is crucial to conduct contact tracing and ensure that chains of transmission are broken.

Third, the continent bears the brunt of fighting several infectious diseases, including tuberculosis, HIV/Aids and malaria (93 percent of the global burden of malaria is in the region), while parts notoriously suffer from inadequate water and sanitation.

Primary health care is often barebones and many countries struggle to reach WHO recommended health spending targets to provide essential healthcare packages. Preventable illnesses such as childhood pneumonia and diarrhoea are still a challenge to address.

This makes it even harder for governments to be able to address the challenge of Covid-19 and could make the situation dire if an outbreak emerges.

Finally, the region does not have the financial resources to fight yet another pandemic.

While the World Bank and International Monetary Fund have pledged tens of billions of dollars to help developing countries in their fight against Covid-19, these financial stimuli pale in comparison with the hundreds of billions that China, Europe and the United States are capable of mobilising for themselves.

There is, however, a glimmer of hope.

Africa’s currently low number of cases provides a window for containment.

In addition, the newly established African Centre for Disease Control has started extensive preparatory measures for Covid-19, and both governments and the public have heightened awareness about the virus and how devastating outbreaks can be.

Some countries are taking the crisis seriously. Senegal, the hardest hit West African country, has moved particularly quickly to contain this virus.

The country has actively sought to track known cases and, anticipating testing shortages, is working to develop a cheaper diagnostic test that could be available to distribute quickly throughout the region.

South Africa has ordered a lockdown to try and contain the rising numbers of new infections. Several countries, including Senegal, Nigeria and Mali, have restricted travel from affected countries and limited public gatherings and school attendance.

Given that many in the region rely on self-employment and unsteady income, it remains to be seen how these instructions are followed, but these are early signs of strong action.

There are still many unknowns about this virus: how it will operate in a warmer climate, the genetic susceptibility of different populations and whether re-infection is possible. In the absence of more detailed information about the virus, we must use the window of opportunity that Africa’s low case number currently provides.

Complacency kills in outbreaks — and, after Ebola, African governments know this all too well.

Devi Sridhar is a professor of global public health at Edinburgh Medical School. This article was originally published in the Washington Post.