key: cord-0699787-40v9qiuv authors: Blanton, Ronald E.; Mock, Nancy B.; Hiruy, Honelgn N.; Schieffelin, John S.; Doumbia, Seydou; Happi, Christian; Samuels, Robert J.; Oberhelman, Richard A. title: African Resources and the Promise of Resilience against COVID-19 date: 2020-06-03 journal: Am J Trop Med Hyg DOI: 10.4269/ajtmh.20-0470 sha: cd5d4adf5d8dece7d09f745264f9ab5c97363782 doc_id: 699787 cord_uid: 40v9qiuv African Resources and the Promise of Resilience against COVID-19. governments. Several countries have instituted national health insurance programs in an effort to achieve near-universal coverage. 6 Ethiopia aims to achieve universal coverage of primary care with new construction, equipment, and community-based health insurance for most of its population. Rwanda also provides near-universal health insurance through a community-based system. Finally, African countries have substantial experience in epidemic management and contact-tracing because of their experience with viral hemorrhagic fever epidemics, cyclical meningitis, outbreaks of cholera, and the high prevalence of HIV and tuberculosis. Regional economic communities: To partially offset their individual economic vulnerabilities, African countries excel in cooperative efforts that provide additional economic resilience. The African Union seeks to promote cooperation for development built on the foundation of eight regional institutions, covering all countries on the continent. Public health is a priority area, and, in the context of the pandemic, each of the regional institutions works to distribute personal protection equipment (PPE) and diagnostic kits, pool procurement services, monitor socioeconomic impact, provide daily updates, help member states adopt WHO guidelines and mobilization strategies, and exchange information through National Emergency Operations Centers. The West African Health Organization and the African CDC also facilitate information-sharing, training, and provision of personnel. Other public-private efforts include the contribution of PPE and test kits by China's Jack Ma Foundation and Ethiopia's Prime Minister Abiy Ahmed. 7 Nigeria's Private Sector Coalition Against COVID-19 (CACOVID 8 ) has contributed about US$100 million to support the Nigerian government's pandemic response. Biomedical capacity: Many countries in Africa have the intellectual resources and incipient infrastructure to conduct molecular surveillance, thanks to international cooperative programs led by the health and agricultural sectors. Benin, Burkina Faso, Cameroon, Ghana, Nigeria, Senegal, and Togo obtained large loans from the World Bank to establish the African Centers of Excellence Project. Some of these centers have been in the forefront of governmental response to outbreaks like Lassa fever, monkeypox, yellow fever, and, pres- Containment and mitigation: There is evidence that as the epidemic evolves in Africa, it may be following a different playbook than that in other regions, in the context of numerous demographic, cultural, and political differences that exist in this least developed continent. Still, African countries are at risk for catastrophic health system failures if even modest pressure is put on their healthcare resources. Rosenthal et al. 9 have pointed to many of the challenges to African countries facing the COVID-19 pandemic and steps that should be taken to mitigate its effect. The local resources pointed to here suggest that impacts will be less than what would have been expected even a decade ago. Given the resilience that exists in many of these countries, what needs to be done, and what is the role of the rest of the globe in this global emergency? African testing capacity is uneven across countries and should be supported with donations of kits and expertise. Testing and control efforts should be more decentralized and even made mobile to reach the largest number of people. Intensive care capacity needs support and expansion in facilities, equipment, and trained personnel to increase the overall quality of care. Lifesavers at all levels of care will be generators and renewable energy sources to supplement unreliable electricity. Lessons learned from specific experience with the COVID-19 epidemic should be gifted to Africa from more developed countries, where the experience has been longer and more intense to this point. In the long term, African societies will also need support to address the economic impacts of efforts to contain and mitigate the epidemic. COVID-19 pandemic in west Africa 10 African Countries Have No Ventilators Think 168,000 Ventilators Is Too Few? Try Three Obesity a risk factor for severe COVID-19 infection: multiple potential mechanisms Obesity in patients younger than 60 years is a TABLE 1 Characteristics that may influence COVID-19 outcomes of selected sub-Saharan countries risk factor for COVID-19 hospital admission It's Time to Rethink Medical Insurance Private Sector Coalition against COVID-19. Available at: www.cacovid.org COVID-19: shining the light on Africa Angola 31 2 5 24 55 3,432 114 40 80 22 41 Burkina Faso 20 2 7 20 40 715 44 40 40 9 88 Cotê d'Ivoire 84 3 2 29 66 1,716 70 47 40 23 60 DR Congo 25 3 6 22 29 562 19 41 80 7 111 Eq Guinea 1 2 6 25 44 10,262 301 45 210 40 50 Ethiopia 109 4 4 18 51 772 25 39 30 8 71 Ghana 30 3 3 29 72 2,202 67 47 90 14 235 Kenya 51 2 3 23 21 1,711 77 55 140 16 117 Liberia 5 3 2 28 56 677 57 39 80 4 53 Niger 22 3 2 20 27 414 29 37 30 4