Understanding The Low Rate of COVID-19 Infections In Africa

As the confirmed number of COVID-19 infections and mortality goes up, institutions such the World Health Organisation (WHO) have indicated that the biggest test as to whether this moves from an epidemic to a pandemic will happen when the disease confronts less well-resourced health systems, especially in Africa and Latin America. So far, although there have been over 102,000 confirmed cases, only 43 cases have occurred in Africa across six countries, the latest being Togo. This represents 0.042% of the total cases reported worldwide. The situation has set many public health experts thinking as to what may be contributing to the low incidence in Africa.

From a logistic standpoint, some have argued that this could either be a result of a lack of appropriate testing facilities in many of the fifty-four countries on the African continent. At the start of the epidemic, only five African countries (9% of countries) could test for this virus. By mid-February, the number of countries that could test had increased to eleven (20%). As we put this piece together, over 40 countries in Africa (74%) can test for the virus with some having multiple facilities. This situation makes it very unlikely that the low incidence in Africa could be down to logistics alone.

Another school of thought is that since the majority of those who contract the virus will have very mild symptoms which may mimic other tropical diseases and thus many in Africa may have been infected without knowing or even reporting. We must say this may be plausible but, in our view, very unlikely. The reason is a simple check on the disease spread in many countries where the epidemic has taken hold shows how exponentially confirmed case numbers rise initially from single digits to multiples. This means that if countries in Africa were that badly affected, the disease would have gained traction by now. Currently, all confirmed cases in Africa have had a European travel connection. More importantly, person-to-person spread has not been significant.

Others have impugned many conspiracy theories such as the African genetic makeup, the hot and humid weather, spirituality and sorcery to explain this away. Apart from the climate hypothesis that we feel must be investigated further, we fail to see the merit of giving the other claims traction. For us, there must be other reasons why Africa and South America are the two continents holding up COVID-19 and preventing it from the attainment of worldwide spread; status that if achieved will take this infection from an epidemic to pandemic status. To help explore the possible reasons we would like to investigate human behaviour and why most pandemics throughout history have their origins and spread in North America, Europe, and Asia with Africa often spared.

Analysis of most pandemics will indicate that most of the implicated microorganisms originate from animals and crossover into the human population. When they do, our immune systems are incapable of dealing with these thus making humans extremely vulnerable. Initially, most of these microorganisms were of a single animal origin. This is seen in pandemics such as bird flu, where the virus was of avian origin and swine flu from pigs, just to name a few. As the domestication of animals continued and animal husbandry got intense, many of these microorganisms altered their genetic codes inculcating components from other animal microbe species, resulting in the production of previously unknown pathogens. This happened because of the close proximity within which different animals were farmed by humans and the destruction of wild animal habitats due to human encroachment. These previously unknown pathogens, upon crossing to humans become even more problematic. This is known to have happened in the case of Spanish Flu (H1N1 influenza virus) which occurred in 1918 but mutated and recurred in 2009 as Swine Flu - a variant.

Thanks to travel and commerce, people move from areas of these original infections to other parts of the world and spread pathogens from person to person thus increasing the world’s population affected by the new infection. As a result of excessive availability of direct flight travels mainly between Asia, North America, and Europe, when such mutations occur in any of these continents, it is much easy for them to spread amongst their populations. However, the travel routes to Africa from Asia have often involved transits and are less busy. These transits often occur in a country that possesses a more robust health system. Hence currently, Africa is further remote from the epicentres of epidemic outbreaks.

A combination of the relatively low intensity of uncontrolled animal husbandry, the minimised exposure to epicentres of epidemic outbreaks and the fact that the intermediary continent for travel transit is often Europe where health systems are much more robust may be combining to shield Africa from these potential dangers.

These factors may be key and could also explain why South American countries, many of whom lack direct flights to China and transit in North America, are also holding their own in this COVID-19 crisis. As at the time of writing, there were only 45 confirmed cases in seven countries on that continent. It is instructive to note that though some epidemics such as Ebola have originated from Africa, these same factors may have mitigated against them spreading widely across the world. It is known that since the mid-1970s there were up to 20 different outbreaks of Ebola within Central and Western Africa and never spread widely because they never got into Europe or North America to any great extent. Indeed, China has never reported a single case of Ebola in all the outbreaks that have occurred.

Similarly, the viral mutation that eventually became HIV/AIDS took over sixty years starting around 1918 from Cameroon, through present Democratic Republic of Congo and was sent into Haiti probably by colonial workers. However, HIV/AIDS did not become a concern until it got into North America and started spreading to the rest of the world thanks to the availability of trade routes.

How long these barriers will last, especially now that China has set its eyes on Africa as a trading partner remains to be seen. For us, the real test will be how countries in Africa’s health systems respond to epidemics moving forward when these barriers crumble. If anything, our national health system’s response to outbreaks of cholera and meningitis should give us an indication. Our continent needs more trade and investment to develop but this will come with increased exposure to potential pathogens that may predispose us to epidemics. This trade-off is what we believe should be engaging our thoughts in a changing global space, rather than assume that the factors that shield Africa from these potential dangers. will always hold.

Edited by Winifred Awa