COVID-19 and sub-Saharan Africa

An ounce of prevention is worth a pound of cure, often repeated, always true.

Every so often, the planet experiences public health nightmare scenarios: SARS, Ebola, MERS, H1N1 and now, COVID-19. While humans have been in a battle with viruses since the beginning of time, our global community has grown at an exponential pace and the accessibility of travel and people moving into densely populated cities has opened the door to the rapid transfer of viruses.

By eliminating contact with infected individuals and surfaces that may contain the virus, COVID-19 infection is preventable.

Our collective goal is now containment and isolation of the virus to try and “flatten the curve” and reduce infections. Containment can buy researchers time to develop a vaccine, but also slow the infection rate to lessen the overburdening of health care systems, especially the respirators and intensive care unit beds that will inevitably be in high demand.

We are only beginning to understand what this might look like in sub-Saharan Africa (SSA). Globally, what is clear so far is that countries with universal health coverage (UHC) and strong, decisive leadership that heeds science and evidence fare better and have lower mortality rates from this pandemic. We also know that most of the cases to date in SSA have been imported via Europe, the United States and China. Travel bans and quarantines are extremely important preventive measures. This virus has an average fatality rate about 10 times that of the flu and it is entirely novel to humans, so there is no latent immunity in the global population. Given the relatively weak health systems in SSA, it is clear that getting out in front of the virus through prevention, testing and case containment is critical. Several countries, like Kenya, are taking early and decisive actions in this regard.

Information is power so let’s review what we know, and what we don’t know:
• According to the WHO, there are four country profiles – isolated, imported cases (the person returning from their Europe vacation for example); sporadic cases (contamination from the imported, isolated ones), clustered cases (for instance, in the Touba mosque in Senegal where the imam may have been infected and then infected worshippers) and finally, community cases (when the vector is no longer identifiable and spread is happening exponentially). The key for SSA is to avoid the last stage, where controlling the spread of the virus becomes unmanageable.

• How long does the virus last? On surfaces, 4-20 hours depending on the surface type. It is transmitted via droplets (i.e. a cough or a sneeze). Wash your hands frequently and avoid touching your face.

• We don’t know whether COVID-19 is seasonal but if it subsides over the warmer months, it may roar back with cool weather, just as the 1918 Spanish flu did.

• One can be infectious between 2-14 days before being symptomatic. We don’t know how infectious before symptoms are apparent, but we know that highest level of virus prevalence coincides with symptoms. This is why social distancing and isolation are so critical.

• Older adults and people living with co-morbidities (underlying respiratory health issues especially) are at higher risk.

We know it’s going to get far worse before it gets better. And we know our lives are going to look different for the next year, and also after this pandemic. ACS will continue to support UHC in SSA, and we will actively track, document, and share information and lessons learned during this ordeal. Our approach of providing support through country experts and regional institutions and ecosystems means we are fully engaged and active despite travel restrictions. We believe, more than ever, that UHC and strong, resilient health systems are critical for our collective humanity and to ensure that people have access to quality and equitable health care regardless of their ability to pay.