Corona Virus: is southern Africa prepared?
Public Health emergencies and disasters negatively impact social and economic development as can be seen by the acute slowdown of the global economy in the wake of the COVID-19 (commonly known as Corona virus) outbreak. Commerce and industry is disrupted whilst other sectors such as education are equally affected, with schools shutting down indefinitely. Novel and re-emerging infectious diseases can rapidly spread, leading to high levels of morbidity and mortality. Since December 2019, the world has witnessed the rapid spread of the novel Corona virus. Although there were initial delays in responding to the virus, China with support from other stakeholders, including the World Health Organisation (WHO), quickly implemented a sound emergency response which includes isolation, quarantine and treatment to curb, contain and control the virus. Unfortunately, in spite of all these efforts and financial investments into the response, the virus is outpacing international efforts to contain it. China has struggled to control the virus and the country continues to register new infections. By Tuesday, 27th February 2020, the death toll in China alone had reached a record 2,810 with nearly 82,548 confirmed cases. Globally , the virus has spread to over 30 other countries including the U.S., the U.K., Singapore, France, Russia, Spain and India.
Recognising the gravity of the outbreak, WHO, on the 30th of January 2020, declared the novel virus a public health emergency urging all countries to roll out preparedness plans. To date, resources have been mobilised to fill the gaps of public health infrastructure in countries around the world although WHO indicates there is need for more investments. There are a few countries earmarked as high risk countries in Africa. WHO has so far identified and prioritised 13 countries for support based on their close transport and business links with China. The countries include Algeria, Angola, Côte d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia.
Although, only 4 cases of the Corona Virus have been confirmed on the continent, (Algeria, Egypt and Nigeria), the risk of more cases developing remains very high. The heightened risk of an outbreak in Africa is very concerning given the state of most health systems on the continent and indeed in southern Africa. Africa’s health systems are fragile, they do not have sufficient diagnostic equipment, health workers, medical supplies, medicines as well as bed space. A majority of the continent’s primary health care services are barely functional and millions of citizens have to travel long distances to access health care. In some cases, the health sector is already struggling to deal with disease outbreaks including malaria, diarrhoeal diseases and Ebola in the case of the DRC. There are also factors around the way African societies are structured. In towns and cities, there is a boom of informal settlements with no access to water or any form of sanitation. In the rural areas, value is placed on communal compounds with many families sharing space and housing. Porous borders and migration tendencies especially in southern Africa make the corona virus not only a national but also a regional concern.
The question therefore is whether Africa, and particularly, southern Africa is prepared to tackle the Corona Virus. Would southern Africa manage to control a Corona virus outbreak? The answer is simple but complex, given the state of health care, communal way of life and many other factors around economics, poverty, illiteracy and environmental factors. Without necessarily sounding alarmist, it is likely that the corona virus will spread like wild fire once it reaches southern Africa. Regardless, there is a very small window of opportunity to undertake emergency preparedness initiatives, and this is a window that is closing at a very fast pace given the confirmation of a cases in Algeria, Egypt and more recently, Nigeria.
In the wake of the alarm sounded by WHO, there have been various international efforts to support countries develop preparedness plan. Such efforts include health worker trainings and disaster preparedness initiatives that a select number of African countries including Rwanda and Kenya have participated in. A lot of the preparedness efforts seem to be led by international actors and, although this is important, it is quite critical that these discussions and plans do not remain exclusive to international agencies and government technocrats. It is important that outcomes are translated into contextualised and meaningful action in African countries. I argue, therefore, that in spite of the alarm sounded by WHO, very few southern African countries have taken the time to develop emergency preparedness plans and engage citizens with clear protocols on what the government and citizens would do should cases of Corona Virus emerge. In cases where plans have been developed, the plans have not been adequately popularised and citizens are in the dark, uninformed and unsure what to do. It is imperative that countries in the region intensify internal discussions around the virus to develop home grown emergency preparedness plans.
Country level Corona Virus preparedness plans should be a product of discussion with all stakeholders. As earlier stated, the spread of the Corona virus is affected by factors that are sometimes outside the realm of health. For example, living conditions might fall under the Ministry of Lands and housing or other local government and municipality entities depending on country arrangements. Countries should also draw lessons from the Ebola response in the DRC and begin to involve communities and citizens at large to ensure plans developed are in line with societal culture and values. It should be noted that plans developed in collaboration with communities are likely to get more traction as there is citizen ownership and shared accountability. Government departments should reach out to citizens in communities, traditional leaders, churches, schools and women’s groups, among others, to work together and develop a collaborative context specific plan that can work on the African continent, the sub–region and at national level.
Given what we currently know about the Corona virus, it is imperative that early detection is included as a key pillar in the preparedness or response plan. Early detection will trigger the roll out of other critical response pillars such as isolation and quarantine to ensure we avoid/ minimise the risk of transmission and the development of multiple cases that can overwhelm the treatment capacity. For the execution of an early detection strategy, countries need to urgently invest in robust screening processes that are coupled with in-country testing equipment and capacity. In Swaziland for example, it took more than 72 hours for a suspected case’s specimen to be sent to South Africa for testing. Time is of essence in the response and containment cycle of the Corona Virus and a 72–hour turnaround is certainly unacceptable! Again lessons can be drawn from how Nigeria managed patient zero in the wake of the Ebola crisis. Nigeria was able to control its outbreak by quickly identifying and containing “patient zero” and then systematically tracing all his contacts.5
The question of resources is a critical one for any emergency response. Although a substantial amount of funds has been raised on the international arena, countries in the region need to mobilise in–country resources. This is especially important because WHO has already indicated that the current resource envelope is inadequate to tackle the emergency. It is, therefore, important for key responsible ministries such as Ministries of Health and Disaster Preparedness, for example, to initiate internal financing discussions with Treasury departments and Ministries of Finance. Resources need to be ring–fenced and on standby. Donor organisations and the private sector need to be involved in the financing discussions if we are to leverage on the resource pool in our countries.
Most importantly, the call is for governments to be open and transparent with information, on preparedness plans and confirmed cases. It is unhelpful to politicise the confirmation of cases. Also, there is need to refrain from prioritising concerns around the implications of a confirmed case on the economy or the tourism industry while neglecting the social impact of the virus spread. Acknowledgement of confirmed cases triggers a quick response and increases the chances of managing and containing the virus which, in the long term, benefits affected countries. China, for example, hesitated in acknowledging cases and this hesitancy – although short-lived – has proved to be fatal, for the lives lost and for the economy.
The central lesson for southern Africa is this: stop thinking beyond emergency preparedness for the Corona Virus. Rather, countries must critically assess and address the loopholes in the health system to ensure the development of a robust and resilient health sector that can deliver health to all; a health sector that can deal with all the public health emergencies of our time and beyond. The time is now!
Cynthia Ngwalo Lungu is the Health Rights Programme Manager at OSISA.
April Zhou, Which African Countries are most vulnerable to the Corona Virus, 27.02.2020 online at https://allafrica.com/stories/202002250002.html
Aylin Woodward and Ruobing Su et al , What to know about the Corona Virus outbreak in 8 charts and Maps, 28.02.2020 online at https://www.businessinsider.com/coronavirus-in-charts-covid-19-symptoms-spread-deaths-warnings-2020-2?IR=T
Munyaradzi Makoni, Africa Prepares for the Corona Virus ,27.02.2020 online at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30355-X/fulltext
Yasmin Khan, et al, ‘Public health emergency preparedness: a framework to promote resilience’ (2018) BMC Public Health, 18: 1244 online at https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-018-6250-7