Despite the continent’s experience facing epidemics, countries will need help to expand resources and protect health care workers.
AS CASES OF THE NEW coronavirus that originated in China continue to rise, most of the focus has been on Asia.
After a halting start, there has been a strong mobilization of resources. Asia has experience with infectious disease outbreaks, including SARS in 2003 and periodic Avian Influenza outbreaks. They knew what to do.
The Asian response lies in stark contrast to a place that has yet to report a single case: sub-Saharan Africa. This likely won’t last. It’s unlikely that this coronavirus, or COVID-19 as it is technically known, hasn’t arrived in Africa. It is highly likely that the under-resourced and unprepared national health systems of Africa cannot detect its presence. And its impact there could be especially devastating.
Africa is a large continent with deep ties to China. Chinese companies have been building roads, schools, hospitals, high rise buildings and extracting natural resources from African countries in the name of friendship and economic development for over two decades. More than 1 million Chinese are living in Africa, and more than 80,000 African students are studying in China’s universities. There is ample travel between China and Africa. So why have we seen cases in Europe and North America, but none on African continent (as of this writing)?
As soon as Asian countries started looking for cases, they started finding them. But even the act of looking for cases requires surveillance systems that can screen the population for symptoms like fever. It requires hospitals and health care clinics that can talk to each other through mandatory reporting into information systems. Diagnostic tests are needed to differentiate between a case of influenza and a case of this coronavirus. For the first month of this coronavirus outbreak, no laboratories on the entire continent of Africa could test for it. No testing means no confirmed cases — not to be confused with no cases.
But the African continent can draw from significant experience dealing with epidemics. The continent is currently waging battles against epidemics of Ebola, measles, cholera and meningitis just to name a few. And the lessons learned in controlling and containing viruses such as Ebola can inform the fight against this coronavirus.
Uganda, for example, has been on high alert for more than a year looking for imported cases of Ebola virus from across the border in the Democratic Republic of Congo. Officials there have repurposed that response to begin screening visitors for symptoms of this new coronavirus and have the reporting systems and isolation plans in place should either disease arrive on their doorstep. The World Health Organization, however, has provided the Ugandan government tens of millions of dollars to maintain this level of preparedness during the past year.
Unfortunately, this best practice example cannot be replicated at scale across Africa due to resource constraints. What should the global health community do?
Africa needs eyes. It needs laboratory capacity to test for this strain of coronavirus. It is flying blind without it. We must expand the capacity to test to every national and regional reference lab on the continent as soon as possible and provide the reagents and supplies needed to test in accordance with WHO guidelines.
Protect health care workers. African health systems are severely constrained because there are not enough doctors and nurses to meet basic health care needs of the population. We must protect this workforce in order to keep health systems from collapse. Ebola killed 10% of the health workforce in Liberia during the West Africa epidemic in 2014-15. One report coming out of China reported 40 health care workers in a single hospital had been infected with the virus. Health care facilities need to be equipped, supplied and the health workers trained on how to prevent the spread of infection within facilities, both from patient to patient and from patient to health care worker.
Communicate, communicate, communicate. Disinformation is already a huge problem in this response. We’ve seen in the current Ebola outbreak how distrust between the population and the medical community leads to further spreading the disease. Home care will be an important part of this response and providing good information to families and communities on how to care for the sick and when to seek care will be an important component of this response. We need to disseminate as much information as possible to the public about the nature of the virus and the response, to allay community suspicion and mistrust.
Global health experts are increasingly coming to the same conclusion: this coronavirus will circle the globe. The unknown at this point is how quickly or slowly it will spread. Those of us who have experience in responding to disease outbreaks know that ever moment of lead time is precious, not to be squandered. For the African continent and its fragile health systems we’re not too late — but we don’t have time to waste.