Notes on COVID-19 in Africa

Monday, April 27, 2020 · 5 min read

An essay I wrote to my grandfather’s mailing list on the COVID-19 pandemic in Africa.

Since living in West Africa for the better part of the last two years, I have adopted a critical eye towards media coverage and reporting about the continent. The content of news about where I live rarely matches with the actual experience of living here.

The current pandemic is an illustrative example. Most media coverage on Africa focuses on negative news, so it is little surprise that media commentary surrounding the pandemic on the continent continues this trend. Commentators from The Guardian, to the New York Times to the New England Journal of Medicine have questioned whether Africa is prepared for the pandemic.

There are serious challenges to be sure.

It is notoriously difficult to predict the spread of the virus, and it is possible that we are still in the very early stages of transmission on the continent. There is ample evidence of community spread. We may still be very early on our pandemic curve, even as the rest of the world starts to see a drop in daily cases and deaths.

The economic and social effects are also a potential threat. The World Food Programme says that the virus will contribute to food shortages for over a quarter billion people. International Monetary Fund forecasts predict that Africa will have its first recession in 25 years. As with the rest of the world, individuals are struggling, businesses are struggling, and we don’t know the long-term effects of one of the fastest economic downturns in history.

There is a lack of social safety nets and government funds to combat these issues. Here in Togo, social funds are being made available through an e-money program, but reviews I’ve heard are mixed and it is unavailable to key populations like students.

The virus is also exacerbating existing social tensions. In Togo, there have been various reports of police beating and violence surrounding the curfew. Similar stories have come out of other countries as well.

Health services are limited across the continent. Most countries have very few hospital beds and public health spending per capita. Rural populations have limited access to health care. In cities, cost and availability will all limit are likely to limit access to the few ICUs and ventilators that are available. There are also serious concerns about testing capacity.

Yet as the US and much of Western Europe struggle to contain the virus, there are less than 40,000 reported cases and under 1,500 deaths attributed to the disease across the entire continent of Africa. Meanwhile, deaths from the virus have risen to over 50,000 in America alone.

It is likely that some of this is unrelated to preparations. It is possible that the virus has seasonality that makes it less contagious or less severe in warmer climates. The coronavirus is far more severe for older populations and Africa’s population is young: over 60% of the continent is under 30.

However, I think it is also likely that Africa was more prepared for the pandemic than many believe. A few anecdotal examples will illustrate this point:

• Since late 2019, an infrared camera has reported my temperature coming off flights at Lomé’s international airport. On my last return trip at the beginning of March, the health checkpoint had been expanded, with doctors in masks and gloves diligently checking every arrival. Many African countries restricted international travel from countries with reported cases of the virus, or preemptively closed their borders.

• Countries were relatively quick to institute social distancing measures and other lockdowns. My daughter has been out of school since the second week of March. Cases were pilling up in the US, as states debated closures for schools, restaurants and public spaces. By contrast, Togo has had it’s borders closed since the first cases appeared. We have been under curfew for over a month and a half. Visitors from abroad were given mandatory quarantine orders. Ghana started restricting entry to foreigners on March 17th, closed its borders less than a week later, and entered full lockdown on March 30th. At the time cases only numbered in the low thousands.

• I have not seen a shortage of personal protective equipment here. While hospitals in the US are buying PPE off the black market, in Lomé, masks and gloves are for sale on almost every street corner. Many of these are recently manufactured by the local clothing industry, displaying wax patterns or fabricated from simple fabric. Police stopping motorists to enforce mask wearing has become a rather common site while waiting for red lights.

• I have not had an issue getting food or daily supplies. The supermarket shelves are stocked and the market is still functioning to bring staples. I’ve had eggs every day for breakfast. But I also have chickens running around in my front yard. Even though Africa is a net-importer of food, much of the basic food supply chain is local. In Togo, 60% of food products are produced in the country.

• I also think there is Africa has more institutional memory and process knowledge related to dealing with pandemics. I have heard many people refer to the recent memory of the Ebola virus. Ebola is still a very recent memory here, and countries have returned to their contract tracing and containment playbooks from the previous outbreak to combat the new virus. Years of fighting HIV, Malaria and other infectious diseases has honed the African response to pandemics.

It is still early days for the virus on the continent. However, I think that the news is not all negative. I’m not sure that Africa is as underprepared as some people think. Especially compared to the response I’ve seen coming out of the US and other Western nations. As we wait to see the continued spread of the virus across the continent, I think it is important to look at all aspects of the response. In many ways, the actions African countries took to prepare of the virus preceded and exceeded that of Western nations. Time will tell whether it has been enough to prevent the same kind of crisis that has played out in the states.