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COVID cases in Africa were 'underreported'

Isaac Mugabi | Muhammad Al-Amin
February 24, 2021

New studies indicate that COVID infections and deaths in Africa could have been higher than previously reported.

Südafrika | Muslimische Bestattungen während Corona-Krise
Volunteers in South Africa transfer a COVID-19 patient to a hospitalImage: Bram Janssen/AP Photo/picture alliance

In Zambia, nearly one in every five deceased people brought into Lusaka's central morgue over the summer tested positive for the coronavirus, according to a new study by the Boston University School of Public Health (SPH).  The authors of the study have said their results challenge the view that Africa somehow "dodged" the COVID-19 pandemic.

The findings, published in the BMJ global health journal last week, indicate that low numbers of reported infections and deaths across Africa may result from lack of testing, with the coronavirus taking a terrible but invisible toll on the continent.

"Our findings cast doubt on the assumption that COVID-19 somehow skipped Africa or has not impacted the continent as heavily," said study co-author Lawrence Mwananyanda, an adjunct research assistant professor of global health at SPH based in Lusaka.

COVID's rapid spread in Africa 

However, in a recent interview with DW, the director of the Africa Centres for Disease Control and Prevention (Africa CDC), John Nkengasong, said the coronavirus had also spread rapidly in Africa. That, he said, could be behind the discrepancies in the number of reported cases.

"We have to admit that we now know that the reported cases based on molecular PCR [polymerase chain reaction] test might underestimate the exposure, and we are seeing that many more people might have been exposed to the virus than has currently been reported," he said.

However, Nkengasong downplayed the notion that there were more COVID-19 deaths occurring in Africa than reported. "We have to understand that more deaths have occurred during the second wave and have been reported to the best of our knowledge," he said.

Data visualization COVID-19 New Cases Per Capita – 2021-02-24 – selected African countries - English

The Boston University researchers said they hope their findings will encourage African governments to look closer at the rollout of COVID-19 testing and empower Africans to take proactive steps — such as wearing face masks, physically distancing and skipping handshakes — to protect themselves.

"This study shows that with proper diagnostics and testing, we can begin to identify the scale of COVID-19 in African countries such as Zambia," said study co-author Christopher Gill, associate professor of global health.

The researchers noted that the high proportion of pediatric deaths — 10% of their sample group — they encountered was shocking, given the rare COVID-19 deaths in children that have been reported elsewhere. As a comparison, they cite the American Academy of Pediatrics as reporting that children in the same under-19 age group accounted for between 0.00% and 0.23% of all Covid-19 related deaths in the US as of November 2020, with 17 states reporting no deaths in children.

Ghana airport workers offload COVID-19 vaccines
Despite challenges, countries like Ghana have received their first delivery of the UN-backed COVAX initiativeImage: Nipah Dennis/AFP

Infections in Nigeria amounted to tens of thousands

In Nigeria's Lagos state alone, one in every five people had COVID-19 antibodies by the end of October, according to a study by the Nigeria Centre for Disease Control (NCDC) and Nigeria Institute for Medical Research (NIMR). The researchers surveyed four states between September and October 2020.

Blood samples were taken from more than 10,000 individuals living in a representative sample of households. According to the NCDC findings, the prevalence of antibodies was 23% in Lagos state — which is home to more than 16 million people — and Enugu, 19% in Nasarawa, and 9% in Gombe state. The number of confirmed infections amounted to tens of thousands at the time.

The surveys were designed to improve the estimate of the burden of COVID-19 infection in the country and provide a more detailed assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) — the virus that causes COVID-19. The findings offer the first detailed look into infections in Africa's most populous country.

A vaccine being administered
COVID vaccination campaigns have started in parts of Africa, with health workers the first to receive the jabImage: Siphiwe Sibeko/AP Photo/picture alliance

A lack of testing supplies has hampered authorities' ability to ascertain the spread of the virus altogether. Seroprevalence studies, which test the level of a pathogen in a population by looking at blood serum, are seen as the only way of revealing the actual burden of COVID-19 in Africa.

New variants emerging

New variants emerged quickly in Nigeria, the NCDC said, and continued to do so until transmission rates fell. It said the country is scaling up its sequencing capacity to understand the transmission of the virus and the impact of vaccines. The Nigerian study came amid recent reports indicating that a new COVID-19 variant — dubbed B.1.525 and different from the UK variant — has been detected in Nigeria.

"So far, this [new variant] has been detected among cases in five states in Nigeria. B.1.525 cases have also been reported in other countries in travelers from Nigeria," the NCDC said, calling the it a worrisome trend.

Researchers and scientists are conducting studies to understand whether the new variant has any impact on immunity, diagnostic severity, transmissibility or the efficacy of vaccines that have been approved. The number of COVID-19 cases detected in Nigeria in recent weeks indicates that the country risks losing the gains it has made so far in fighting the pandemic.

A young man sanitizes before entering a public building
COVID-19 protocols, which include hand sanitation in public places, are being strictly enforcedImage: AFP/M. Longari

Tough measures 

Rising infection rates have prompted the Nigeria Presidential Task Force to order the immediate closure of bars, nightclubs and a halt to public gatherings. Recreational venues and restaurants have been operating without observing COVID-19 protocols, leading to a spike in cases countrywide. Dauda Muhammad, a political analyst in Nigeria, blames the government in Abuja for failing to curb the infections.

"[There are no] restrictions in terms of gatherings, and the government is not doing enough to restrict passengers from high-risk countries from entering Nigeria," he told DW. "At the beginning, the government was quick to stop people from affected countries coming into Nigeria. But now it has failed Nigerians."

Yerma Ahmad Adamu, a consultant epidemiologist, is confident Nigeria will contain the virus if COVID-19 protocols are observed.

"We need to do a lot more than what we are doing. The Centre for Disease Control is now trying to restrict anybody coming into the country either by air, by road, or by sea," Adamu told DW.

More than 152,000 cases of COVID-19 have been recorded in Nigeria to date, with 1,862 deaths and over 129,000 recoveries, according to the Nigeria Centre for Disease Control.

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