Cape Town — South Sudan, the Democratic Republic of Congo, Nigeria and Sudan are particularly vulnerable to the spread of COVID-19, says a new survey of factors contributing to the risks which the pandemic poses to African nations.
The seven countries of Cameroon, Ethiopia, Chad, Somalia, Uganda, Egypt and the Central African Republic are the next most vulnerable, according to research done by the Africa Center for Strategic Studies in Washington, DC, a research institution within the United States Department of Defense.
It is worth noting that the top four countries named by the survey as most vulnerable to COVID-19 are all dealing with intransigent conflicts, as are most of the next seven most vulnerable. For years, African scholars and peace advocates have been calling attention to the link between violent conflict and social inequities, and the same combination of factors favors the spread of diseases.
Paralleling the conclusions of African peacebuilding researchers, the survey says that one of nine risk factors - conflict magnitude - magnifies the other risks:
- Armed conflict disrupts public health systems in affected areas and limits access to basic goods like food, water, and medical supplies.
- The degree of intensity and geographic spread of conflict shapes the level of disruption caused for a society.
- Conflict-affected populations are also often starting from higher levels of vulnerability with fewer resource buffers than other populations, making the impact of exposure to an infectious disease all the more severe.
The center's study evaluates the vulnerability of each of the continent's nations in nine risk categories: international exposure, the strength of their public health systems, the density of their urban areas, the total population in urban areas, the age of the population, the transparency of their governments, the press freedom they enjoy, levels of conflict and the numbers of displaced people.The other eight risks identified are international exposures, health system weaknesses, urban density, size of urban populations, population age, transparency of governance, press freedom and numbers of displaced peoples.
The risks which the most vulnerable countries face highlights "the importance of trying to identify and limit the spread of the SARS-CoV2 (corona) virus at the early stages, before it becomes entrenched in the high density urban or displaced person areas", the center says.
A brief window for three countries to intensify containment measures.
Three of the most vulnerable countries - Democratic Republic of Congo, Sudan and South Sudan - have made potentially significant progress at conflict resolution, or have had successes despite ongoing conflict. The victory against an Ebola outbreak in eastern Congo this year, despite militia activity that killed both United Nations peacekeepers and health workers, was regarded as remarkable among both political and medical analysts. South Sudan negotiated peace between competing armies for control of the government, and 'people power' in Sudan toppled a long-lived despotic ruler who had been convicted of war crimes by the International Criminal Court.
The survey says that the limited exposure of the three countries to international travellers gives them "a brief window to ramp up containment measures". The hope of reformers and peace activists is that the same popular determination and courageous actions by Africans in each of those nations can be brought to the efforts against COVID-19. Only Nigeria - of the most at-risk countries - has had high rates of international travel. The majority of Nigeria's identified cases so far were brought across borders by international travelers or Nigerians returning from abroad, or were among people who were exposed to them, who were found through contact tracing.
Key to efforts at containment, says the survey, "will be enhanced and transparent public communications regarding COVID-19, public health guidance, and candid information about what the government is doing and what individuals should do if they exhibit symptoms. For some of these countries, given their constricted space for sharing information, this will require significantly improved levels of transparency and space for independent media."
Turning to the seven countries next most vulnerable, the center says they, also, among the African countries with less international exposure. But they need to mitigate areas of risk and draw on areas of strength.
The study says that, initially, international exposure, the size of urban populations and a nation's capacity to test for the virus will determine the number of cases which are reported. It adds that "subsequent stages [in the spread of the virus] are likely to also exploit other vulnerabilities such as weak health systems, densities of urban populations, conflict, size of displaced populations, trust in government, and openness of communications channels".
Corona virus cases are likely to be much larger than those reported or confirmed.
The center points to the fact that the number of cases reported, as opposed to the actual numbers of people infected, will depend on the strength of a country's public health system. "In fact," it says, "cases of the coronavirus may be widespread elsewhere, though they are not identified and reported."
Looking beyond nations with relatively higher numbers of reported cases, it says that despite not having Africa's largest urban populations, countries in the Sahel and Great Lakes regions "appear to be at high risk for severe outbreaks". It urges that attention be given in those countries to densely- populated cities and towns, to supporting public health systems and being transparent with the public.
" However, each country faces a unique mix of vulnerabilities that will require a customized response."
" Much remains unknown about the trajectory of the transmission of COVID-19 in Africa. Many fear that with its high levels of poverty, weak health systems, and crowded urban areas, the virus could be particularly devastating. Others hope that with its warmer climate, youthful population, and experience fighting infectious disease, that Africa will be able to avoid the worst of the pandemic."
" African urban areas are often remarkably densely populated, creating conditions where viruses can spread quickly and undetected in crowded informal settlements. Urban density is characteristic even of relatively sparsely populated countries in the Sahel, where the concentration of human settlements in capital cities creates high levels of vulnerability. A similar pattern is seen in South Sudan, where inhabited areas average 8,730 people per square kilometer. Urban layouts and architectures in these locations are similar to the compacted towns of Spain and Italy, where the virus has hit Europe the hardest to date."
- " Built-up areas across much of Africa have higher population densities than those in Europe and the United States. Influenza transmission rates in India have been found to increase above a population density of 282 people per square kilometer. The density of many built-up areas in Africa is over five times this threshold."
- " Stay-at-home orders will be particularly difficult to maintain in African cities where many residents lack adequate shelter, sanitation, and the monetary means to stock up on supplies and to stop work."
- " Approximately 80 percent of COVID-19 fatalities have been among people over the age of 60. With 70 percent of Africa's population under the age of 30, Africa's youth bulge may be a buffer against the most devastating human costs of the disease on the continent."
- " The benefits of a more youthful population, however, will need to be balanced against other underlying health factors facing many African populations such as malaria, malnutrition, tuberculosis, and HIV/AIDS."
" Refugees and internally displaced populations may be congregated in large camps with inadequate access to water, soap, or sanitation. Health services are often overstretched and inaccessible. The close quarters typical of such settlements greatly facilitates the spread of any infection once it is introduced. Eighty-five percent of Africa's 25 million forcibly displaced persons are concentrated in 8 countries: the Democratic Republic of the Congo (DRC), South Sudan, Somalia, Ethiopia, Sudan, Nigeria, the Central African Republic (CAR), and Cameroon."
The full study, including a table of vulnerabilities and maps of risk factors in each nation, can be accessed here >> Mapping Risk Factors for the Spread of COVID-19 in Africa.