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

Dear Editors,

Thank you for your recent publication by Dyer, which highlights Africa’s handling of the COVID-19 pandemic that has received little global attention. The author highlighted the incredible achievement it is for a region with highly susceptible health systems, a concurrent high burden of disease, malnutrition, inadequate water and sanitation and limited resources to successfully avert rapid viral transmission within its communities, widespread illness and high fatality rates that was all but inevitable. Many countries with much stronger health systems were struggling to contain viral transmission and experiencing worse health outcomes than Africa.

Until 1 April, 70 days since a new strain of SARS-Cov-2 that causes Covid-19 was reported in Wuhan, Hubei Province, all countries had the same amount of time to prepare an effective public health response. At this timepoint, global cases had reached almost a million with rapidly rising deaths in Europe; the USA had 163 199 cases, 4793 deaths; Spain, 94 417 cases, 8189 deaths; and Italy, 105 792 cases, 12 430 deaths. [1] Africa, a continent of 1.3 billion people recorded 4073 cases and 91 deaths amongst 42 countries of the WHO Africa region [1].

Adding such high case loads of Covid-19 onto Africa´s fragile health systems and socio-economic challenges should have caused death on a cataclysmic scale surpassing anything seen so far anywhere. This did not happen. The global community is better for it, but it has barely noticed this remarkable achievement.

Where better resourced countries were complacent and inward looking, disregarding WHO guidance, scientific evidence, public health principles and even ignoring their own national experts, Africa mounted a rapid, multilateral response that deployed its limited resources in a highly targeted manner that effectively delayed Covid-19 taking hold within communities. From the onset, Africa region´s highest priority was to implement rigorous infection prevention and control measures by tracing every contact in every country in the early stages, consistent with WHO test-and-trace guidelines that have been successful in suppressing transmission in countries like Ireland, Germany, South Korea and Singapore.

As soon as SARS-Cov-2 was first detected, the Africa Centre for Disease Control (ACDC) began coordinating with the World Health Organization (WHO) preparing and supporting African Union (AU) member states to respond and limit the likely viral spread. ACDC´s rapid deployment of Africa´s Joint Continental Strategy helped AU member states avoid the respose lag that occurred in the US and Europe. Delays in taking action to suppress transmission have been shown to cause worse outcomes and greater loss of life.

An Africa Taskforce for Coronavirus (AFTCOR) chaired by Africa CDC Director managed Africa´s continent-wide collaboration for COVID-19 response bringing together WHO Africa, governments and partners to pool efforts and maximise synergies. The Taskforce comprised of working group for each technical area focusing on a single issue - surveillance, including screening at points-of-entry, infection prevention and control (IPC) in healthcare facilities, clinical management of persons with severe Covid-19 and laboratory diagnosis. Each working group has experts from governments, multilateral institutions and partners and is responsible for building, testing, and expanding specific capabilities critical to limiting COVID-19 transmission amongst countries. They evaluate technical capabilities, identify and address gaps through guidance, trainings, and technical support to strengthen countries’ ability to respond effectively. They also coordinate risk communication amongst countries and oversee stockpiling and distribution of medical supplies for the region. Weekly remote meetings are used to evaluate the latest scientific data, adapt the regional strategy to the evolving situation and to provide regular briefs to governments on all aspects of the pandemic response.

These concerted efforts effectively resulted in fewer deaths that have been dismissed as a likely result of missed cases. The large comparative difference however suggest more than just missed cases as extensive silent spread of SARS-Cov-2 within African countries would have resulted in a concormitant increase in deaths that would have been hard to miss. WHO Africa confirmed that Africa had no Covid-19 community transmission on 26 March and half of its countries' cases were primarily imported. At this time, the US and some European countries were already overwhelmed with extensive community transmission.

A more likely explanation is that Africa learned important lessons from its experience dealing with multiple outbreaks and successful control of the 2014-2015 Ebola outbreak. Africa understood its high baseline vulnerability and mounted a prompt, aggressive, and well-coordinated regional response guided by WHO recommendations.

African countries have learned critical lessons from Ebola, on effective public health engagement with communities to successfully limit transmission of serious infectious diseases. Africa´s multilateral institutions like the ACDC and WHO Africa are sustaining their concerted efforts to limit Covid-19 transmission. ACDC has shown strong leadership coordinating governments, providing them with expertise, training, information and risk communication advice. Africa´s solidarity is based on the principle that a threat to one country is a threat to all African countries.

This does not mean that Africa has escaped the worst. The pandemic that is still unfolding. It remains to be seen how Covid-19 will develop. Some of Africa´s worst affected countries like South Africa and Kenya are beginning to see community transmission. However, the numbers remain relatively low and Africa´s results so far provide a glimmer of hope. According to WHO, Africa could still contain the virus in many countries. However, the challenges are many. Countries must not to lower their guard and risk losing the window of opportunity to contain COVID-19.

The best strategy continues to be to flatten the curve until a vaccine or treatment becomes available. A vaccine will be the best tool to prevent SARS-Cov-2 transmission and unmitigated spread. If Africa can continue to successfully suppress community transmission just until vaccination becomes possible, it may manage to prevent catastrophic loss of life on a scale surpassing Europe and the US. Africa´s fate and that of the world are tied. Countries that became overburdened became epicenters for viral transmission to other countries. The same could happen with Africa. The global community has a stake in Africa´s ability to contain Covid-19 and to Africa rapidly accessing a vaccine as soon as one is available.


WHO, Geneva: WHO COVID-19 Situation update for the WHO African Region, External Situation Report 5 1 April 2020: Source:

Lenias Hwenda
Founder and CEO: Medicines for Africa, Johannesburg, South Africa
The authors declares no competing interest.
The author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained
The article manuscript did not require ethics approval, clinical trial data or require a funder.

Competing interests: No competing interests

16 April 2020
Lenias Hwenda
Medicines for Africa
​33 Ballyclare Drive Ballywoods Office Park, Cedarwood House, Bryanstone, Johannesburg, South Africa