Of Africa’s 54 countries, Lesotho stands out where others stand in this season of Coronavirus. Almost three months after Egypt became the first country in the continent to confirm a Coronavirus case, Lesotho remains the only country in Africa that has kept a clean slate for not having even a single case of the deadly infection, with all others battling to contain the community spread of the virus. Lesotho has since eased restrictions implemented as part of a two-week lockdown that put businesses, public services, state companies and other activities on hold.
As at the time of filing this report, the confirmed Coronavirus death toll in Africa stood at over 2,000, with over 51,000 confirmed infection cases and 17,590 recoveries. In a continent that is home to 1.2 billion people, the infection and fatality cases so far may not appear too bad, especially when compared with events in more advanced sections of the world where the highly infectious respiratory disease caused by the novel Coronavirus is still dealing them a deadly blow. However, despite steadily rising infections in many parts of the world (3.8 million cases globally and still counting), it appears political and health authorities are not in the mood to throw up their hands in frustration.
Who is testing most and least in Africa?
Amid fears that the crises caused by the global pandemic may escalate, world leaders appear to be giving the fight against Coronavirus all it takes by racing to find a cure for a deadly disease that has claimed more than 265,000 lives in 212 countries and territories. Many experts have expressed fears that fragile healthcare infrastructure in many African countries could be overwhelmed in the face of severe outbreak of the disease. They hinged their worry on the continent’s inadequate healthcare systems, insufficient health workers, and paucity of modern equipment, poor funding as well as inefficient data transmission capabilities, among other problems afflicting Africa’s healthcare industry.
Like in other parts of the world, testing plays a major role in the response to the coronavirus in Africa, as it helps in understanding how far the disease has spread. Interestingly, some of Africa’s smaller nations have achieved significantly better rates of testing than their larger neighbours. For example, Mauritius and Djibouti have both achieved high rates of testing per capita. Ghana has also been praised for its level of testing, which its government said will help contain the spread of the virus after the lockdown.
Data is not available in some countries on the continent, such as Eritrea and Algeria; while some suffer poor testing capacity. For example, Tanzania has released information intermittently, sometimes just giving out the numbers of people who have recovered from the virus. Another obstacle to mass testing is non-availability of chemical reagents needed to process tests, since African countries don’t produce their reagents and are forced to compete for limited global supplies. Thus, acquiring testing kits in a competitive global market, getting tests to where they need to be and setting up the labs to process samples is not a simple task for countries with less economic clout and weaker healthcare systems. There are also other barriers to increasing testing, including the lockdown measures to restrict movement, which can make it difficult for people to get to test sites.
According to the latest figures, more than 2,000 people have so far died from COVID-19 in Africa, while over 16,315 have recovered. A quick summary shows that North Africa continues to be the hardest hit of the five geographical regions in Africa with 18,500 cases, followed by West 13,400, Southern 8,100, East 4,800 and Central Africa with 4,600 cases. In terms of fatalities, North Africa has the highest figure of 1,100, followed by West with 320, Central 184, Southern 163 and Eastern 142. South Africa, a country of 58 million people, has the highest number of cases with confirmed 7,600, while Egypt (with 100 million people) has also recorded 7,200 cases so far.
However, in terms of death tolls, Egypt has lost 452 souls out of 7,200 cases, while South Africa has counted 148 with over 7,000 confirmed cases. Algeria has the highest number of deaths in North Africa with 470, while Morocco recorded 181. In West Africa, Nigeria has so far seen 103 deaths out of 3,000 plus cases, Burkina Faso 48, Niger 38, and Mali 32. In Central Africa, Cameroon recorded 108 deaths and the Democratic Republic of Congo registered 35; while in East Africa, Sudan saw 45 deaths and Somalia reported 38.
Fears are rife that Africa’s most populous country, Nigeria, is not testing enough. However, the government insists it is focusing on “clusters” of positive cases and scaling up its testing capacity nationwide. Since Nigeria recorded its index case on February 27, how to expand testing capacity and getting isolation facilities in place are issues on the front burner of the Presidential Task Force on COVID-19. The goal is to test 5,000 daily, but this has not been achieved in a country of over 200 million people.
According to the Nigeria Centre for Disease Control (NCDC), the country currently has 18 molecular testing laboratories. However, it is an open secret the country is facing enormous challenges to contain the spread of the disease, as efforts to ramp up tests are being undermined by the scarcity of test kits. In a tweet recently, Dr. Chikwe Ihekweazu, NCDC Director-General, disclosed that the country is desperately in need of more ribonucleic acid COVID-19 test kits – a situation he attributed to expanded testing for the virus. “We’re desperately looking for more RNA extraction kits as we expand #COVID19 testing. Product: Total viral RNA extraction kits (preferably spin column and with a lysis buffer). Manufacturers: Qiagen, Thermo Fischer, SeeGene, Inqaba, LifeRiver etc,” he said.
Since the country recorded its index case in Lagos in February, the virus has swept its way into virtually all the 36 states and the Federal Capital Territory (FCT). Nigeria has over 3,145 confirmed cases, with 534 recovered and 103 deaths. Lagos, the country’s economic capital, remains the epicentre of the contagious disease with over 1,308 cases, 358 recoveries and 30 deaths. Kano, which has been in the news lately for a worrying number of ‘mysterious’ deaths, comes second with over 427 confirmed cases and 13 deaths. The FCT comes next with over 316 confirmed cases and 14 deaths.
As global shortages of diagnostic kits and laboratory consumables increasingly impacts the optimal functionality of the laboratory system in Nigeria and across the world, NCDC has adopted an adaptive testing strategy to ensure the most vulnerable persons, those at elevated risk, and those with super spreading potential have access to testing. Amid increasing public criticisms that the country is not responding to demands of those desperately in need testing services, many public figures have complained that Nigeria is carrying out fewer testing that necessary – leaving many embattled citizens in dire straits.
Sadly, Nigeria, with a far higher population, tests fewer than many smaller countries in Africa. With over 3,000 confirmed cases and a population of over 200 million, Nigeria has done slightly above 10,061 tests since it recorded its index case on February 27. Yet, Ghana, with a population of 30.9 million people, has carried out over 100,622 tests. Same goes for Djibouti, with 1 a population of 985,433, which has conducted more than 11,741 tests; or Kenya, with a population of 53.5 million, which has done more than 17,492 tests. Even South Africa, with a 59 million population, has conducted more than 161,000 tests; while Egypt, with a population of 101.9 million, has done more than 90,000 tests.
Unlike Nigeria, South Africa has pursued a relatively aggressive testing strategy, and has managed over 200,000 tests among its 58 million population. A combination of mass screening, targeted testing and a draconian lockdown to control the early stages of a Coronavirus outbreak that threatened to overwhelm the country if left unchecked in its densely populated townships is gradually helping the country. The magic wand is mass screening, which has helped to stem the coronavirus tide in South Africa, as the country draws heavily on experience garnered while battling tuberculosis and HIV by using community health workers to identify cases.
In the past month, President Cyril Ramaphosa has mobilised 28,000 health workers to screen over 7 million people, more than one in 10 South Africans. Known as active case finding, the use of community health workers to identify patients with symptoms draws heavily on South Africa’s experience battling tuberculosis and HIV. It differs from the approach of most European governments that have relied on citizens coming forward for tests and then tracing their contacts. The country has increased its level of testing to more than 10,000 tests a day. All the while the number of positive tests has remained consistent at about 3 per cent, a sign that while infections are growing they are not outpacing efforts to find them.
The South African approach to date has relied heavily on an army of community health workers; whereas other countries hire thousands of people to conduct screening and contract tracing. According to one estimate, while the United States would require at least 100,000 contact tracers at a cost of $3.6bn, South Africa already had teams in place, detecting tuberculosis, a national killer, and bringing drugs to the millions of South Africans living with HIV. So far, about 3 per cent of tests referred from community screening have come back positive, similar to the proportion of positive results among patients tested at health centres. It means the government’s community health workers have successfully identified many cases that might have otherwise slipped through the net.
Although the screening programme has been extensive, wide variations exist in the approach and the number of tests administered in each of the country’s nine provinces. The Western Cape, which contains Cape Town, for example, has tested a higher percentage of its population than other parts of the country and overtaken Gauteng, the most populous region, as the province with the most active infections. About 6 per cent of tests have returned a positive result in Western Cape, compared with the 3 per cent average nationally. For the tests administered in the province on Monday that figure jumped to 13 per cent. The province has detected an especially large rise in cases in the sprawling township of Khayelitsha, just outside Cape Town.
While it is true that community screening cannot identify asymptomatic cases, health experts say it can point to emerging clusters, and help later contact tracing to find asymptomatic carriers. South Africa has also taken a different approach to contact tracing than many western countries, which are largely placing their faith in voluntary smartphone apps. South African covid-19 testing profile showed that the private sector, which tests 3,161 daily, has carried out a total of 123,580 tests; while the public sector, which tests 11,900 daily, has done 122,167 tests so far. This means the country, which does 15,061 tests daily, has done a total of 245,747.
This has attracted applause from far and wide. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, has lauded South Africa’s aggressive strategy but has warned that Africa overall needs to test more. “Incredible, that much testing for that return,” Michael Ryan, head of the World Health Organisation’s emergency operations, said recently. But the strategy faces a critical test. South Africa, which imposed one of the world’s strictest lockdowns before it had recorded a single death, has begun a phased lifting of the most severe restrictions.
The country has had more than 7,200 cases and 130 deaths, and in some townships, testing is now picking up a faster spread of the virus. Tough measures, including a nightly curfew, remain in force, and public frustration is rising, particularly after allegations of police violence. But there are warnings that South Africa is still early in its epidemic, which means it will have to keep up these screening, testing and tracing efforts for many months to come.
In Ghana, with over 2,719 cases, the government is trying to enforce its ‘no mask, no entry’ policy in all offices and public buildings. The case count, as of May 4, stood at 2,719 cases with 294 recoveries and 18 deaths. Ghana remains West Africa’s second most infected behind Nigeria who have 3,000-plus cases. According to Ghana Health Service, the country has a 0.66 per cent mortality rate and a 2.1 per cent infection rate based on the 130,000 samples done so far. The country is noted for its rigorous contact tracing, enhanced testing and mandatory quarantine. Ghana has expanded testing beyond Accra and Kumasi, with every region getting ready to start conducting COVID-19 tests by end of May. Ghana has been releasing figures every other day for the past few weeks – unlike most African countries where tallies are released daily either by the disease control outfit of via other government channels.
Persons without face masks are being prevented by police from accessing the country’s capital. The ‘no mask no entry’ operation is in line with enforcement of COVID-19 directives issued by the Greater Accra Regional Coordinating Council and Ministry of Health. The wearing of masks in public was made compulsory days after the lifting of a lockdown by President Akufo-Addo. The CEO of the Food and Drugs Authority, Delese Darko, also gave guidelines for the production of face/nose masks, stressing that more locally produced products are being given priority. Greater Accra was first to impose the use of face masks days after a lockdown was lifted. “Indeed Ghana is the only other country in Africa to have conducted more than 60,000 tests and we are ranked number one in Africa in administering of tests per million people. The decision to impose restrictions on movement was backed by the data at hand and our next course of action is backed by data and by science,” the president said.
In just a month, Tanzania went from having only 20 Coronavirus cases recorded to 480 cases, an alarming increase which has put the country with the highest number of cases in East Africa. However, the country’s president, John Magufuli, is convinced the number may be exaggerated due to technical hiccups with the imported testing kits. Magufuli, who holds a doctorate in Chemistry, said the testers had randomly obtained several non-human samples on animals and fruits which included a sheep, a goat and pawpaw and the results came out positive. The samples were given human names and ages and were submitted to the country’s National Referral Laboratory to test for Coronavirus without the lab technicians knowing the true identity of the samples.
This prompted Magufuli to believe some people who were tested positive for COVID-19 might not have contracted the novel virus after all. He has ordered a probe into the country’s testing protocols, which suggested possible interference by unnamed saboteurs. But Tanzania has long been criticised by public health experts for enabling a more relaxed approach to the pandemic compared to the strict lockdowns and restrictions in neighbouring East African countries, with authorities asking Tanzanians to pray away the virus and left places of worship open since the COVID-19 outbreak began. The country has now put its trust on a herbal treatment touted as a cure for COVID-19 by Madagascar, which the World Health Organisation (WHO) has warned that there was no proof of any cure.
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