Q&A: Africa’s coronavirus enigma

Abidjan, Ivory Coast | AFP | Three months ago, Africa recorded its first case of coronavirus, sparking fears that the world’s poorest and least-equipped continent faced a catastrophe.

But so far, the virus has not come anywhere close to wreaking the same damage in Africa as in Europe and the US — a phenomenon that has stirred much debate.

– What are the figures? –

Africa’s first case was announced in Egypt on February 14 and two weeks later, the first patient south of the Sahara was documented in Nigeria.

Since then, Africa’s 55 states have notched up around 72,000 cases, according to an AFP tally compiled from official figures.

This amounts to less than two percent of the global total, whereas Africa accounts for 17 percent of the planet’s population.

The proportion of fatalities also seems far lower in Africa — the 2,500 fatalities, expressed as a proportion of known cases, yields a death rate roughly half that of the rest of the world.

Experts sound a note of caution about the figures, saying the tally of infections in Africa, as elsewhere, could be under-represented by lack of testing.

– Early measures ? –

If Africa seems so far to have been relatively spared, several explanations come to mind, say specialists.

One is that Africa, lying outside the main pathways of infection from China, used the precious weeks wisely and responded quickly when the virus eventually showed up.

“Confinement measures were taken quite early, and this slowed the curve. Most countries implemented these measures almost as soon as the first case was detected,” Michel Yao, based in the Congolese capital of Brazzaville for the World Health Organization (WHO), told AFP.

“In France, it took 52 days after the first case for measures to be taken. In Ivory Coast, the schools and borders were closed five days after the first case. A week later, there was a curfew,” said Jean-Marie Milleliri, an epidemiologist and specialist in tropical public health based in Abidjan.

– Young continent? –

Another protective factor for Africa is that so many of its people are young, according to one idea.

Coronavirus deaths are typically concentrated among the elderly and people with underlying health conditions, said Omar Sarr, a professor of medicine at Dakar’s Cheikh Anta Diop University.

Around 60 percent of Africa’s population are under 25.

“The median age (in Africa) is around 19 years,” said Milleliri. “Also, there are fewer elderly people because life expectancy is lower. So there are fewer cases and a virus that is less active.”

Yap Boum II, an epidemiologist in Cameroon with the French medical charity MSF, also noted: “The population density in Africa is lower, which limits the spread of the virus, and Africans are less mobile compared with western populations.”

Within African countries, “most cases are concentrated in the capital and large cities, and less in rural areas,” Yao agreed.

– An ‘African immunity’? –

Another theory is that people living in Africa may have a better resistance to the novel virus than in the developed world.

“There is crossover immunity, due to long exposure to various micro-organisms, and high vaccine coverage, notably with BCG,” suggested Sarr, referring to a venerable anti-TB jab that intriguingly may be linked to protection against COVID-19.

Milleliri, more cautious, said, “There are lots of diseases in Africa, so populations are possibly better immunised than European populations against pathogens like coronavirus.”

He pointed to Darwinian pressure as the potential reason: “When several pathogenic viruses are competing against each other, some can block out others.”

– What about the future? –

African countries have begun easing anti-coronavirus restrictions, many of them fearful of the impact of lockdowns on the urban poor.

Such moves have to be matched by vigilance, say experts.

“We are really very prudent, we are doing all we can to identify, test and isolate and keep tracing all contacts to be able to contain the pandemic before it gets out of proportion,” said Boureima Hama Sambo, the WHO’s representative in Ethiopia.

“We hope the worst will be behind us but for now we are not there yet.”

A modelling study this month suggested the pandemic could infect 44 million people in Africa in its first year, causing between 83,000 and 190,000 deaths.

Several African leaders are already warning, like disease experts, that in the absence of a vaccine the virus is here to stay.

“We now have to live with the virus, modifying our individual and collective behaviour,” Senegalese President Macky Sall said.

In South Africa, the worst-hit nation on the continent, President Cyril Ramaphosa struck a Churchillian tone on Monday, saying a nationwide lockdown “gave our country a strategic advantage” in the fight with the virus.

But, he warned, “we can and must expect infections to rise as more people return to work.

“We must accept the reality, prepare for it and adapt to it.”