Because of the high volume of air traffic and trade between China and Africa,
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Africa is at a high risk for the introduction and spread of the novel coronavirus
disease 2019 (COVID-19); although only Egypt has reported the first case, from a non-national.
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The greatest concern for public health experts is whether COVID-19 will become a pandemic,
with sustained year-round transmission, similar to influenza, as is now being observed
in several countries.
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What might happen to Africa—where most countries have weak health-care systems, including
inadequate surveillance and laboratory capacity, scarcity of public health human resources,
and limited financial means—if a pandemic occurs? With neither treatment nor vaccines,
and without pre-existing immunity, the effect might be devastating because of the
multiple health challenges the continent already faces: rapid population growth and
increased movement of people; existing endemic diseases, such as human immunodeficiency
virus, tuberculosis, and malaria; remerging and emerging infectious pathogens such
as Ebola virus disease, Lassa haemorrhagic fever, and others; and increasing incidence
of non-communicable diseases.
Models that enable the continent to better allocate scarce resources to better prepare
and respond to the COVID-19 epidemic are crucial. The modelling study by Marius Gilbert
and colleagues in The Lancet
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identifies each African country's risk of importation of COVID-19 from China, using
data on the volume of air travel from three airports in provinces in China to African
countries. Gilbert and colleagues use two indicators to determine the capacity of
countries to detect and respond to cases: preparedness, using the WHO International
Health Regulations Monitoring and Evaluation Framework; and vulnerability, using the
Infectious Disease Vulnerability Index. Based on their analysis, Egypt, Algeria, and
South Africa had the highest importation risk, and a moderate to high capacity to
respond to outbreaks. Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya
had moderate risk with variable capacity and high vulnerability. In the model, the
risk mainly originates from Guangdong, Fujian, and Beijing. The study provides a valuable
tool that can help countries in Africa prioritise and allocate resources as they prepare
to respond to the potential introduction and spread of COVID-19.
The study should also be interpreted in light of the fast-evolving nature of the COVID-19
outbreak. First, with the exception of Ethiopian airlines, all African airlines have
suspended flights to China. Although these measures might delay, but not stop,
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the importation risk of COVID-19 into Africa, their implementation is still worthwhile.
Second, although Beijing, Shanghai, and Fujian do not report the highest number of
cases of COVID-19 in China, the volume of travel from these cities to Africa is high,
which might increase the risk of exporting cases to Africa. Lastly, almost half of
the flights from Africa to China are operated by Ethiopian Airlines, so it is possible
that cases might pass through Ethiopia and affect destination countries.
The report by Gilbert and colleagues
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provides an important tool to map out the continental risk for the spread of COVID-19
in Africa, which should be used to inform a framework of action to prepare the continent
for any potential importation and spread of COVID-19. First, collectively, Africa
needs a unified continent-wide strategy for preparedness and response. The strategy
must be comprehensive, and member states, donors, and partners should immediately
commit to releasing financial resources to support country-customised implementation
plans derived from the strategy. To help develop a common strategy that will allow
for effective coordination, collaboration, and communication, the African Union Commission,
Africa Centres for Disease Control and Prevention (Africa CDC), and WHO, in partnership
with African countries, have established the Africa Taskforce for Coronavirus Preparedness
and Response (AFTCOR). The partnership has six work streams: laboratory diagnosis
and subtyping; surveillance, including screening at points of entry and cross-border
activities; infection prevention and control in health-care facilities; clinical management
of people with severe COVID-19; risk communication; and supply-chain management and
stockpiles. Because mitigating the potential spread of COVID-19 in Africa will require
rapid detection and containment, the laboratory work streams of AFTCOR, Africa CDC,
and WHO are working closely to expeditiously scale up diagnostic testing capacity
linked to enhanced surveillance and monitoring—eg, at the beginning of February, only
two countries in Africa had the diagnostic capacity to test for COVID-19. However,
as of Feb 25, 2020, more than 40 countries would have been capacitated to accurately
diagnose COVID-19 infection, thanks to the coordination efforts of AFTCOR.
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As testing becomes more available, it is possible that more cases might be detected.
Second, any effective preparedness and response strategy for COVID-19 requires a committed
political will; as such, the African Union Commission, Africa CDC, and WHO convened,
on Feb 22, 2020, in Addis Ababa, Ethiopia, an emergency meeting of all ministers of
health of 55 member states to commit to acting fast and collectively to develop and
implement a coordinated continent-wide strategy. AFTCOR taskforce was formed, and
a continent-wide strategy was endorsed at the end of the emergency meeting, with a
call for strong coordination of efforts. To prevent the occurrence of a social, health
security, and economic tragedy, actions agreed at the emergency ministerial meeting
will need to be acted on quickly, before any additional COVID-19 cases are introduced
to the continent, and result in sustained human-to-human transmission. The potential
social, economic, and security devastation that COVID-19 could cause in Africa should
be enough of an incentive for African governments to invest immediately in preparedness
for the worst-case scenario. Third, commitment and release of financial resources
from partners and donors before a crisis hits Africa will help anticipate demand and
address supply chain management, mapping, and stockpiling of COVID-19 response needs,
such as large quantities of personal protective equipment, gloves, surgical masks,
coveralls, and hoods, and medical countermeasures like antiviral agents. Supplies
of these items will be limited in Africa because of reduced manufacturing capacity.
© 2020 Luke Dray/Stringer/Getty Images
2020
Since January 2020 Elsevier has created a COVID-19 resource centre with free information
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is hosted on Elsevier Connect, the company's public news and information website.
Elsevier hereby grants permission to make all its COVID-19-related research that is
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Fourth, national, regional, and international organisations need to cooperate and
collaborate to optimise limited supplies, using a whole of government approach. Fifth,
all member states will need to urgently develop and put in place proper quarantine
and infection control protocols, including procedures for implementing social distancing
(mass gathering and potential closure of public facilities). Lastly, the capacity-building
training efforts that Africa CDC and WHO are conducting must be implemented and cascaded
immediately down the health system pyramid in each country. Medical staff at major
hospitals must be trained in the proper protocols of quarantining individuals who
are at-risk of COVID-19 infection, as well as isolation and safe treatment of patients
who test positive. As the Director General of WHO has stated several times, the window
of opportunity to act is narrowing. Africa needs to be supported to act now, and needs
to act fast.