This week, South Africa reached macabre milestones in the COVID-19 pandemic—now leading the continent with the number of infections, surpassing the 1,000 mark of confirmed cases, and escalating its national state of disaster into a 21-day nation-wide lockdown.
At the behest of President Cyril Ramaphosa, the orders went into effect midnight Thursday. All non-essential activities were suspended in an effort to break the chain of transmission in the country, where 1,170 people have tested positive for the virus.
In Nigeria, the government called for the immediate closings of international airports and land borders for the next four weeks, according to the Office of the President. This was in addition to banning inter-state travel to curtail the outbreak, accounting for 81 confirmed cases in the country.
Rwandan citizens are not even allowed to travel from city to city, according to its Ministry of Health. They also are not permitted to make non-essential movements outside the home as the nation fights to contain the spread of the virus that has infected 54 people there.
This is the moment for heightened vigilance, agreed medical experts from the World Health Organization, but they reminded governments on Thursday that these responses alone are insufficient.
“What we’re seeing is that some of the rather Draconian measures like border closures and flight stoppages need to be better accompanied by very strong public health interventions in countries,” said Dr. Matshidiso Moeti, the regional director for WHO-Africa.
Governments must be rigorous in their implementations, Dr. Moeti said, as she outlined the measures that are echoed in nearly every WHO news conference: Authorities must identify all the cases and isolate those infected to limit onward transmission; officials also must trace the contacts of the infected and isolate their contacts until they are proven free of infection. Of course, those infected should receive necessary treatment, and suspected cases should be monitored.
As a warning, Dr. Moeti cautioned governments that go to the extreme in their pursuit to protect territories could end up interfering with emergency relief efforts.
“We are emphasizing humanitarian corridors so that the response does not get compromised,” said Dr. Moeti in reference to the closed borders. “These corridors should be opened to enable essential supplies and equipment for the response and the movement of essential experts and partners to mitigate against the impact of this virus.”
Locking in Families
Certain precautionary measures, however, may prove to be unrealistic or counterproductive for some on the continent.
For instance, physical distancing and lockdowns are among the most commonly used methods to suppress the viral infection. Yet this presents a challenge across Africa, where average households are the largest, according to population estimates from the United Nations.
The latest report from the UN Department of Economic and Social Affairs shows that Senegal has the largest households in the world, with an average of nine people.
While those numbers may be accurate, they may not tell the full story. Some families in Africa have several households under one roof, which means there could be up to 100 people in cramped living quarters, explained Dr. Samba Sow, director of the Center for Vaccine Development in Mali.
“This is real daily life in Africa. How can you ask a household where there are 60 to 100 family members inside to be locked down?” asked Dr. Sow, who is a COVID-19 special envoy for WHO.
“You’re kind of putting them in jail,” he said, suggesting it may be better that they were outside rather than locked up in a small place where they could potentially kill each other.
There needs to be a better understanding by high-level policymakers of how communities behave, said Dr. Sow, adding that many of those polices enacted at the top may not be followed on a community level, which will have an impact on contact tracing and containment.
“We need to be creative and much more flexible, innovative and adaptive,” Dr. Sow said.
There’s no easy answer, said Dr. John Nkengasong, who is also a COVID-19 special envoy for WHO and serves as the director of the Africa Centres for Disease Control and Prevention.
“We have to think through the issues of social distancing in the context of our own cultural and social living,” said Dr. Nkengasong. “Our households are large. At the same time, we have to recognize this is a public health measure that must be implemented if we are to have a chance at fighting this enemy.”
Though they may not have the answer, said Dr. Nkengasong, there may be a solution in working closely with the communities.
Tracing the Contacts
According to the Africa CDC, there are 3,977 infections and 117 deaths, as the number of confirmed cases continues to climb across the continent. Though experts acknowledge there are still gaps in the system, they’re still confident about the established platforms that will aid in managing this current crisis.
“No country has all the required capacities to adequately respond to this type of pandemic,” said Dr. Zabulon Yoti, WHO-Africa’s regional adviser for Outbreaks and Disaster Management. “However, there has been significant improvement over time in some countries, especially those that have experienced related outbreaks where systems have been put in place for coordination and surveillance for mobilizing in-country and international resources.”
Many countries are demonstrating the efficacy of those platforms.
For weeks, Uganda had avoided a single occurrence of the virus until a traveler returning from Dubai became the first infection.
Now the country has 23 reported cases, according to the Ministry of Health. Ugandan officials identified 574 passengers who traveled to Dubai in the past two weeks. Of those, 129 are in institutional quarantine and 40 who presented symptoms were tested for COVID-19. The test were all negative.
In Zimbabwe, another infected passenger had also traveled to Dubai, according to the Ministry of Health and Childcare. The 52-year-old man, who had a cough with no fever, is under self-quarantine. He is assisting officials as they trace his contacts.
He is the third of five confirmed cases in Zimbabwe. The first case was a resident who traveled to the United Kingdom. The second case, a prominent broadcaster who traveled to the United States, died. Cases three and four are still under investigation.
There are 58 confirmed cases in Ghana, including three deaths of people who all had preexisting conditions. Of the 55 survivors, 41 are responding to treatment in isolation awaiting negative test results, and 14 are being managed at home, according to Ghana Health Service.
Most of the infected are Ghanaians who had traveled to affected countries in Europe and Asia.
The government has identified and is tracking 1,006 contacts; of those, 204 have completed a 14-day mandatory followup.
Sierra Leone continues to report zero cases of COVID-19. Since February 4, 2020, there have been 719 people under quarantine; of those, 383 people have been released, according to its Ministry of Information and Communication.
“We still have a window, but it it’s true that is narrowing every day,” said Dr. Moeti. “In more than half the countries in the region we still only have imported cases. We have not yet identified that local spread is occurring.”
Following up on the contacts is what will make the difference, Dr. Moeti said. “We still could contain this virus in many countries.”