Intended for healthcare professionals


Covid-19: Africa records over 10 000 cases as lockdowns take hold

BMJ 2020; 369 doi: (Published 08 April 2020) Cite this as: BMJ 2020;369:m1439

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  1. Owen Dyer
  1. Montreal

Africa, so far the continent least affected by covid-19, registered 10 268 confirmed cases and 491 deaths on 7 April, passing a worrying landmark for public health experts who are still hopeful that mass spread can be averted.

The virus has been detected in 53 of Africa’s 54 countries, all but Lesotho. Most have now restricted movement to some degree, and 17 have imposed partial or complete lockdowns.

With just 2% of the world’s commercial air traffic stopping in Africa, the coronavirus took time to gain a foothold. There were early signs of complacency in some governments’ responses. Burundi was coronavirus-free, the president’s spokesperson said, because it put “God first.” God’s mercy shone on Africans because of their faith, said Tanzania’s president John Magufuli, urging his people to crowd into churches and take communion because “corona is satanic and cannot survive in the body of Christ.”

But many African governments were exceptionally swift to adopt social distancing measures, in some cases before their hospitals had recorded a single death. In east Africa, where Ebola raged in 2014, and in southern Africa, where HIV and tuberculosis have long been public health issues, governments are attuned to the risks of contagion and think that their experience in contact tracing will stand them in good stead.

The World Health Organization still thinks that containment is possible. “Africa still has an opportunity to reduce and slow down disease transmission,” said Ahmed Al-Mandhari, director of WHO’s Eastern Mediterranean region, which includes north Africa. But, he added, the continent should “plan for the worst.” John Nkengasong, director of the Africa Centers for Disease Control and Prevention, told a recent press conference that covid-19 “is an existential threat for our continent.”

Africa has the advantage of the relative youth of its population. Only 3% of Africans are aged 65 years or older, compared with 11% in China, 15% in the US, 18% in the UK, and 23% in Italy. Set against this are a daunting array of disadvantages. Africa accounts for 17% of the world’s population but just 1% of global health spending and 3% of health workers. Italy has one doctor per 243 people, whereas Zambia has one per 10 000. New York’s governor pleaded that 15 000 ventilators were not enough. The Central African Republic has three.

Of great concern is the high burden of other diseases like malaria, tuberculosis, and HIV. The World Health Organization is cautiously optimistic that those who have achieved viral suppression through HIV antiretroviral therapy will show no unusual susceptibility to severe covid-19.1 But even in relatively wealthy South Africa, only 63% of people with HIV are on antiretroviral drugs.

Most African lockdowns are planned to be brief but strict, with curfews enforced by police and soldiers. But in a continent where security forces rarely hold the public’s trust, citizens have complained of police using lockdown arrests to assert power or extort bribes. In Nigeria, Rwanda, Uganda, and Senegal videos and news reports circulated showing police beating alleged lockdown violators. In South Africa, a policeman was arrested for killing a man and wounding three children on their porch after curfew. In Mombasa, Kenya, the army apologised after soldiers attacked a crowd at a train station with tear gas, clubs, and whips.

South Africa’s 21 day lockdown, now half over, is one of the strictest. It includes a total ban on sales of tobacco, to protect lung health, and alcohol, to prevent domestic abuse. It has brought a sharp decline in daily new cases.

But social distancing and hand washing are hard in the densely packed informal settlements where many Africans live. “I have to queue for water, I have to queue for food,” Zimbabwean Thandekile Moyo told Time. “A lockdown in these kinds of areas might actually end up spreading the virus even more.”

The gravest concern is the effect of lockdowns on people’s ability to feed their families. About 7 in 10 Africans work in the informal economy, and safety nets are threadbare at best. “If we take measures that starve everybody, they’ll quickly end up being defied,” said Benin’s president, Patrica Talon.

“If you’re a middle class Kenyan with a fully stocked fridge and live-in staff, it’s easy to quarantine,” Elijah Wanjala told the Telegraph. The pandemic eliminated his job as a waiter. “I live in one room with my wife and five children, and I have no money for food. What do I do? This is a disease that affects rich people. But it is poor people like us who are being made to pay the price.”

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