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Africa confronts COVID-19 with a poor prognosis

Martina Schwikowski
April 24, 2020

Unreliable health sector data, a dire shortage of hospital beds and poor testing capacities in Africa make for a poor COVID-19 prognosis. To beat the pandemic, countries on the continent need new strategies, experts say.

A vendor sewing handmade face masks at an outdoor stall
Image: Getty Images/AFP/T. Karumba

Only half a hospital bed is what would be available to 1,000 Nigerians in the event of an emergency. At least that is the official figure put forward by the World Health Organization for Africa's most populous nation. In Kenya, the situation is marginally better with 1.4 beds per 1,000 inhabitants.

The picture is even darker when it comes to beds in Intensive Care Units (ICU): 43 African countries combined have fewer than 5,000 ICU beds, according to the WHO. That is about five beds per one million people. Europe, by comparison, has 4,000 beds per one million people.

The figures are terrifying in the face of a pandemic, and as the coronavirus spreads in Africa. However, some medical experts have cast doubt on them and others say the numbers are out of date. Nigeria's last hospital bed count dates back to 2005, whereas Kenya's was in 2010. The latest available information for Africa is from 2011.

Read more: COVID-19 compounds Africa's pre-existing health sector problems

Few tests  — unreliable data

It is already clear that the COVID-19 pandemic stretches Africa's healthcare facilities to their limits. "In Kenya, the health system, which is severely stressed by diseases such as malaria, cholera, HIV/Aids, is already overwhelmed by the crisis," said Kathryn Tätzsch of the humanitarian organization World Vision in Nairobi.

The number of patients in Kenya with potentially fatal pneumonia has been on the increase since January, and is currently at just under 300. "There are far too few beds in ICUs and the care for a patient including protective clothing costs €1,200 ($1,300) per day. That is immense for one system that is already struggling with many problems," Tätzsch told DW.

A health worker in protective clothing
Can Africa become the next epicenter of the pandemic?Image: Getty Images/AFP/M. Spatari

The WHO has warned that sub-Saharan Africa could become the next epicenter of the pandemic. The global health body's model calculations assume at least 300,000 Africans could succumb to the virus and more than 30 million could slip into extreme poverty.

And there is another problem: "Test capacities are limited, many countries have only now begun rolling out a few dozen tests. Kenya started to do so just recently. But the estimated number of unreported cases is much higher," said Tätzsch.

The situation is similar in Kano, in northern Nigeria. According to DW's correspondent Nasir Salisu Zango: "Doctors say the government is not prepared for the fight. Nursing staff are not work properly because they do not want to put their lives at risk. They fear greatly of being infected by patients."

Read more: Coronavirus in slums: Helpers left high and dry in infection hot spots

No reliable sources

This is also the conclusion reached by researchers at the London School of Hygiene and Tropical Medicine (LSHTM): "The data on the number of people infected with the coronavirus and treatment capacities in Africa is very incomplete," said Professor Francesco Checci.  

"This means that the number of those infected do not provide a very reliable source of how strongly the virus is being transmitted." It is also difficult to determine to what extent clinics, doctors and nurses can respond to the crisis, Checci added.

Why is there no reliable data to assess the situation? "The health sector in sub-Saharan Africa is understaffed and poorly equipped, so the starting point for data collection is very poor," according to Checci.

Fortunately, there are ways to work around the data shortage so that the WHO, the African Union and African governments can make decisions. "You can use mathematical models to predict trends and choose strategies to respond to the crisis."

But that also has its own problems. The current forecasts for the pandemic in Africa are based on evaluations of the COVID-19 in Europe and China, according to Checci. In Africa, however, the situation could develop differently: for example, through more infections in urban poor areas than in rural areas.

In spite of all the uncertainty, one thing is clear: "If we look at the prognosis for infections in Africa, it is clear — with a few exceptions like South Africa — that we are standing in front of a huge mountain, when we compare the expected critical cases with the available ICU beds," Checci told DW.

Read more: Coronavirus: The lessons to learn from Ebola

Two scentists at a laboratory in Senegal
The health sector in sub-Saharan Africa is poorly equippedImage: Getty Images/AFP/Seyllou

More emphasis on prevention

The main focus of African governments is on the provision of better healthcare, but Checci see that as problematic. "It is almost not feasible given the number of patients to be expected."

Nobody knows exactly to what extent Africa is prepared for the pandemic. Therefore, Checci sees prevention as the only sensible approach to reduce transmission of the coronavirus.

He believes that measures such as self-isolation, social distancing and protecting high-risk groups should be made a priority.

"If all three strategies are well combined and followed, they will provide an opportunity for African governments to reduce the pressure on their healthcare systems and cut death tolls without months of curfews and the economic damage that could possibly be worse than the virus itself," said Checci.