Africa: Don't Let Guard Down, We Must Be Ready for Long Fight - WHO's Moeti

East Africa Lab Network.
29 May 2020

Cape Town — It took 36 days to reach 1,000 reported cases of COVID-19 on the continent. In 62 days, 100,000 cases were reported, Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa, said during an online media briefing hosted by the World Economic Forum.

"We are seeing some rapid increases compared to two weeks ago. Reported cases have tripled in five countries and doubled in ten countries, noting that most countries still have fewer than 1,000 reported cases."

So far, a number of countries have begun easing their lockdowns, and, according to WHO's initial analysis, the impact on doubling time - the number of days for case numbers to double in a given country - appears to be varying depending on the timing and duration of the confinement measures.  For example, Burkina Faso started implementing a partial lockdown of 17 days after the notification of its first confirmed case and recorded an increase in the number of cases during the lockdown period by 253%. The confinement measures were implemented for 38 days and resulted in a significant reduction of daily new cases.

Thirteen countries in sub-Saharan Africa have implemented lockdowns along with other public health and social measures nationwide, while ten more instigated partial lockdowns in hotspots. Moeti emphasised the importance of strong public health measures to curb the spread of the virus. "Yesterday marked the three months since the first COVID-19 case was reported in sub-Saharan Africa in Nigeria," Moeti said. "In this time, governments have been working day and night in partnership with the WHO to contain this virus." Moeti said that the disruption to access to supplies like test kits and personal protection equipment (PPEs) have made the global body's efforts against the virus more difficult.

The WHO has issued interim guidance to Member States, which encourage a gradual adjustment of public health and social measures, while constantly assessing risks. Beginning with the re-opening of international airports, with a mandatory 14-day quarantine of all travelers, the guidelines progress through a series of steps for countries to take to regain some normalcy. Cases in Africa remain lower than in some parts of the world, according to Moeti.

"However, we are not letting our guard down and we cannot be complacent," she added. "We all have roles to play and must be ready for a long fight against COVID-19." Moeti called for solidarity and a strong focus against the prevention of the virus through social distancing and sanitation.

Mauritius

Kailesh Kumar Singh Jagutpal, Minister of Health and Wellness in Mauritius, shared how his country has fared against the spread of the virus. "Mauritius registered the first cases of COVID-19 in March. Our monitoring, preparedness and action plan has been in place since mid-January," he said. The Prime Minister of Mauritius, Pravind Jugnauth, holds a daily meeting with a high-level committee in order to regularly gauge the progress of the pandemic in the island nation and allows safety measures to be implemented accordingly, Jagutpal said. "The government of Mauritius decided to impose a sanitary curfew, which should remain in force until the 1st of June."

Jagutpal also said that economic activity was starting to resume in a controlled manner. However, passenger flights have been temporarily canceled and the government is actively trying to repatriate citizens stranded abroad. Those that return are placed into quarantine for 14 days. Contact tracing efforts have been reinforced as well, Jagutpal said.

"Testing capacities have allowed us to have a better picture of the evolution of the situation within the community."

To date, Mauritius has recorded 334 cases and 10 deaths - 322 patients have recovered from the virus. "We have not recorded any positive cases in the local community for more than one month," Jagutpal said. "We have, however, registered two imported cases recently and those were from passengers who traveled abroad and are now in quarantine."

South Africa

After recording the first case of COVID-19 in the nation on 5 March, South Africa has seen over 25,000 positive cases. "We have noticed a change in the pattern," of Health for South Africa Zwelini Mkhize said. "For the first three weeks, we had a doubling time of two days and we imposed a lockdown, after which we saw a reduction in the doubling time to 15 days."

Mkhize said that this merited an easing of lockdown measures in South Africa. "As we do so, we take a risk-adjusted approach. However, we have noticed that in certain parts of the country, the outbreak has come out in clusters and this has driven up numbers."

Mkhize said that the number of deaths in South Africa to date stands at 552 people, representing a 2% mortality rate. Recoveries stand at over 13,000, representing roughly 52% of cases, according to Mkhize.

Testing has been a primary focus to curb the spread of the virus in communities, Mkhize said.  "We have done over 634,000 tests; during this period, we have identified that most of the country is stable except for 13 areas - districts and metropoles - we have declared to be hotspots where additional restrictions will be allocated."

Mkhize emphasised the importance of social distancing and masks and welcomed the support of Cuban doctors who were brought into the country to assist local health workers.

"Two-hundred-and-seventeen were brought in to strengthen our ground teams and we have increased the number of intensive care unit (ICU) beds," Mkhize said.

Currently, 1,000 COVID-19 patients in South Africa are in hospital with fewer than 200 requiring ICU care. "All in all, we believe in the future that we will see more of these clusters arising in areas as we return to normality and we hope to contain them."

Mkhize added that the level of COVID-19's impact on the country is increasing, however, this is within the scope of the country's health services. "Our major challenges remain the availability of diagnostic kits and PPEs. Nevertheless, working with partners around the continent, we aim to procure more."

Uganda

Ugandan Minister of Health Jane Aceng compared the spread of COVID-19 with outbreaks of Ebola. "At the time the pandemic was declared, Uganda was responding to the threat of ebola from the Democratic Republic of Congo and so this pandemic had Uganda on high alert. I must say, with the experience we have had in responding to ebola, we were ready to propel ourselves forward," Aceng said.

Aceng praised Uganda's leadership in responding to the pandemic at the speed it did with President Yoweri Museveni having addressed the nation 15 times, issuing 36 guidelines on the prevention of contracting the virus and the introduction of a national lockdown. "Initially, our response was based on preventing importation but once the virus gained presence in the country, we had to change our strategy to suppress transmission," Aceng  said.

Minister Aceng said that the national lockdown - which saw the closure of schools, businesses and churches - was helpful in giving the government the opportunity to follow directives from the World Health Organisation. "We have had a very strong multi-sectoral response," Aceng, said. "We also mobilised our scientists to be able to give advice and so we have a scientific advisory committee comprising 16 scientists with varied expertise to help guide response."

Aceng also noted collaboration with academic institutions which, together with the scientific advisory committee, allowed the nation to strategise a phased lifting of the national lockdown. "We have also embraced a number of IT solutions," Aceng  said. "This allows us to track people who test positive. We have also prioritised local production of PPEs, hand sanitiser and medication so that we are able to access these materials quickly."

Questions and answers

Uganda has yet to report any COVID-19 deaths. Why is that?

Aceng: "We have 317 confirmed cases, we have discharged a total of 69 and we have 217 active cases. Because of the relatively small numbers, it gives health workers the opportunity to focus more on patients and treat them well. We have over 16 treatment centres in the country and these, along with close observation, allow us to focus closely on patients."

What was the motivation for South Africa to ease its national lockdown to level 3 and allowing places of worship to reopen after seeing countries like Germany seeing a rise in infections from church services?

Mkhize: "I should indicate that the response to COVID-19 is led by the president and ministers. There have been many consultations with the business and religious sectors, traditional leaders, civil society, and various political parties. At the end of the day it has become clear that we are likely to have this pandemic for more than a year, maybe even two years, and therefore it is important to us to understand that there is a degree of ease that has to be brought into the approach, so the president has called for a risk-adjusted easing of restrictions. We have charged all sectors with the responsibility of teaching their constituencies and members about behavioral change in the use of masks, sanitation, and social distancing. In this case, the consultation with churches has indicated their willingness to change how they conduct church services like increasing the distance between church members and restricting numbers at a service to 50."

When looking at Rwanda and Uganda's low death rates, what are these two east African countries doing differently that benefits them compared to their neighbours like Kenya?

Moeti: "These countries (Rwanda and Uganda) have health systems that were already performing relatively well. If we look at the WHO's index that evaluates countries' health system performance, Uganda and Rwanda are among the best in terms of coverage and quality. Secondly, these are countries that surround the DRC where a great degree of effort had been invested in preparedness for outbreaks like ebola."

Aceng: "As I said earlier, Uganda has had experience with outbreaks in the past. Since 2000, we have had six Ebola outbreaks and about five Marburg outbreaks and these have given us the opportunity to not only build capacity but also to put systems in place which can easily be activated to respond to epidemics as they occur."

Is Africa at a lower risk given the higher mortality in older age groups and the continent's relatively young population?

Aceng: "From our analysis, our average affected age group is 33 years old which indicates that even younger age groups can be affected by COVID-19, and are also prone to succumbing. We have not seen many cases in older age groups, perhaps because we instituted measures to handle the outbreak early."

Mkhize: "I think the pattern of mortality in our case has been evolving; we had no deaths for the first three weeks but after that, given our current death rate of about 550, 50% of those happened in the past two weeks. Now, given the profile of the patients, we have very few that are under 20 years old with most being between 20 and 50 years old. The mortality rate starts rising in patients that are between 50 and 69 years old, so we believe that mortality is affected by age and comorbidities, which is also a factor across all age groups. There is also a large number of young people that are asymptomatic who tend to recover more easily from infections."

Moeti: "In terms of those affected, younger people tend to be the majority, mostly between the ages of 25 and 45. We have observed that among people who are severely ill and who die tend to be concentrated in the older age groups if we look across regions and at people over the age of 60. If one looks at comorbidities in Africa in general,  we've observed in our data from non-communicable diseases - cardiovascular disease, hypertension and obesity - that African people, in general, tend to be affected earlier, tend to be more seriously affected and tend to die earlier of these non-communicable diseases which constitute the majority of these comorbidities."

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