Why Sub-Saharan Africa needs a unique response to COVID-19_World Economic Forum :: COVID-19

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07/04/2020

Why Sub-Saharan Africa needs a unique response to COVID-19 | World Economic Forum

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WORLD

ECONOMIC

FQRUM

I sexent

Why Sub-Saharan Africa needs a unique

response to COVID-19

Africa faces specific challenges in tackling coronavirus.

30 Mar 2020

Neema Kaseje

Founder, Surgical Systems Research Group

Image: REUTERS/Zohra Bensemra

e Malnutrition and disease means COVID-19 could be more deadly in Africa than

elsewhere in the world.

e Health systems in Africa have limited capacity to absorb the pandemic.

e The strategic approach should focus on containment and aggressive preventive

measures.

As of 29 March 2020, there have been more than 680,000 confirmed cases of COVID-19

disease in 203 countries around the world.

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On 11 March, the World Health Organization characterized COVID-19 a pandemic. Africa was

initially soared, however this is changing rapidly. In the last two weeks, the number of affected

African countries increased from 9 to 41. As people continue to travel, it is only a matter of

time before COVID-19 spreads to the rest of the 54 countries on the continent. As | write this

from Monrovia, Liberia - a country whose health system has suffered enormous challenges

due to civil wars and the Ebola epidemic in 2014 — | am compelled to highlight that one size

does not fit all, and special considerations need to be taken into account as we develop the

COVID-19 response for Africa.

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The continent’s population and health systems make it different from other regions that have

experienced COVID-19 to date. Three factors are important at the population level.

First, the continent’s demographic structure is different from other regions in the world. The

median age of the 1.3 billion population in Africa is 19.7 years. By contrast, the median age in

China is: 38.4 years, and the median age in the European Union is: 43.1 years.

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outbreak?

Experiences in Asia and Europe showed that people over 60, and those with significant health

problems are most vulnerable to severe cases of COVID-19. Although Africa’s youth may be

considered a significant protective factor in the pandemic, how the virus will evolve and

manifest itself on the continent remains unknown.

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The second factor within the population is the high prevalence of malnutrition, anemia,

malaria, HIV/AIDs, and tuberculosis. Liberia, for example, has one of the highest rates of

stunting in the world: one in three children under five years old are stunted. In recent weeks,

we have witnessed an increase in the incidence of malnutrition. Moreover, the rainy season

has come early this year, which means that malaria cases will rise rapidly and peak malaria

cases in 2020 may coincide with the ongoing COVID-19 pandemic.

We should therefore anticipate that in Africa a higher incidence of severe forms of COVID-19

will occur in younger patients because of the demographics and associated endemic

conditions that affect the immune system. Malnutrition, anemia, malaria, HIV/AlDs, and

tuberculosis are likely to increase the severity of COVID-19. Africa may not see the same

narrative of “most people who get it will be fine” play out.

Third, social cohesion and social gatherings are of great importance in Africa. For example,

weekly attendance of a religious service is highest in Africa with rates as high as 82% in

Uganda and Ethiopia. As a result, measures to impose social and physical distancing may

prove to be more challenging, as demonstrated by the protests that broke out on 20 March

2020 in Senegal after public gatherings, including gatherings at mosques were banned as

cases of COVID-19 rose. Earlier this week, Tanzania came under scrutiny when it was

announced that the country will not close places of worship.

Weekly worship attendance highest insubSaharan Africa

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they attend worship services at least weekly

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Brazil 45%

Nigeria 89%

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Uganda 62%

Chile 19% —

Uruguay 14%

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“y indonesia 72%

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PEW RESEARCH GENTER

There are two major health system factors that will make the COVID-19 response in Africa

more challenging. First, the continent is experiencing the double burden of diseases: in

addition to dealing with these endemic infectious diseases, health systems in Africa are facing

non-communicable diseases, including injury, and cancer. As a result, the health systems are

stretched thin to begin with, and there is very little room to absorb the COVID-19 pandemic.

Second, the capacity to provide critical care is the lowest in the world. Severe forms of

COVID-19 lead to respiratory failure requiring ventilation support. The ability to treat severe

forms of COVID-19 will depend on the availability of ventilators, electricity, and oxygen. A

recent analysis of countries with the highest numbers of intensive care beds per capita does

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not include any country from Africa. In Liberia for example, there are no intensive care units

(ICU) with ventilators. Uganda has 0.1 ICU bed/100,000 population. In contrast, the United

States has 34.7 beds/100,000 population.

Lessons learnt in Italy and China are extremely valuable. However, they cannot be

extrapolated directly to Africa because of these differences in demographics and health

system constraints.

Because health systems in Africa are strained to begin with and have very limited capacity to

absorb the pandemic, the overall strategic approach should focus on containment and

aggressive preventive measures.

Early and aggressive physical distancing and frequent handwashing will prevail as the most

effective and affordable interventions for the continent, with parallel testing, contact tracing,

and isolation of cases. For aggressive preventive measures to work, we will need the full

support of populations. Full support of populations can only be achieved with community

engagement and strong health leadership.

Furthermore, given the youth of the continent, youth leadership and engagement will be

critical for prevention and containment activities. And lastly, given the priority given to religious

services, religious leaders will need to participate actively in the COVID-19 response. At the

health system level, operating rooms and teams could be reorganized and repurposed to build

critical care capacity in district hospitals.

The African context is unique. There are population structure differences, high prevalence of

endemic diseases and the double burden of disease, with health systems that are stretched

thin with minimal critical care capacity.

A robust COVID-19 response for the continent will need to take these factors into account and

include community engagement, health leadership, and involvement of youth and religious

leaders to drive containment. At the health system level, temporary repurposing and

reorganizing of the surgical system will be key to increasing critical care capacity during the

response, focusing on what we have as we move forward.

License and Republishing

World Economic Forum articles may be republished in accordance with our Terms of Use.

Written by

Neema Kaseje, Founder, Surgical Systems Research Group

The views expressed in this article are those of the author alone and not the World Economic Forum.

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