key: cord-0773327-xyamzl4w
authors: Maoujoud, Omar; Ahid, Samir
title: The COVID-19 pandemic in Africa: What can we expect?
date: 2020-06-07
journal: Value Health Reg Issues
DOI: 10.1016/j.vhri.2020.05.001
sha: 4bcefdcdd15fc64ad5b82d5d08396b21b0a10958
doc_id: 773327
cord_uid: xyamzl4w

In this paper we discuss the particularities of the COVID-19 pandemic in Africa, we comment on the first available data concerning the evolution of mortality rates. We think that our comments will help the decision-makers in Africa in their choices related to COVID-19 pandemic management.

In this paper we discuss the particularities of the COVID-19 pandemic in Africa, we comment on the first available data concerning the evolution of mortality rates. We think that our comments will help the decision-makers in Africa in their choices related to COVID-19 pandemic management.

Dear editor, As of April 27, 2 973 264 cases and 206 569 deaths due to coronavirus disease 2019 (COVID-19), had been reported worldwide. Africa was initially less affected; but the epidemiological situation has changed rapidly in the past few weeks, and the pandemic has spread almost to the whole continent in a very short time, leaving only Comoros and Lesotho with no reported cases to date. More than 32.000 confirmed cases and 1425 deaths, notably in South Africa, Egypt, Morocco and Algeria, respectively, countries with more than 3500 cases.

The rapid growth of the outbreak in Africa is a major health threat in the coming weeks and months, considering the weakness of public health ecosystem and the high prevalence of HIV, malaria, malnutrition and other comorbidities in many of the affected countries (1).

Experiences learnt in Italy, Spain, Iran and China are extremely valuable; nevertheless, COVID-19 pandemic would have a different impact on African countries, as the continent's demographic structure and health system constraints are different from other regions that have experienced COVID-19 earlier. The young age of the African population can be considered as a protective factor, as the median age of the 1·3 billion population is 19·7 years, which would limit the aged population exposed to severe and potentially fatal forms. However, this argument is offset by the poor capacity to provide intensive care for a large number of patients. Although the World Health Organization (WHO) has been supporting countries by providing thousands of COVID-19 testing kits, we admit a substantial under diagnosis in most African countries due to limitations in testing capabilities for the coronavirus. In this context, preliminary case fatality rate (CFR) (the percentage of individuals with symptomatic or confirmed disease who die from the disease) reported by some countries (Liberia 21%, Algeria 14·53%, Botswana 17%, Egypt 7·52 %) (2) are much higher compared to the reported CFR in China 1·38% (1·23-1·53) and from international cases 1·4% (0·4-3·5) (3).

Furthermore, the case fatality ratio is strongly influenced by the availability of intensive care units (ICU) facilities and beds; nevertheless, health3 systems in Africa before COVID-19 outbreak were limited in terms of supplies of ICU equipment and ventilators. In these circumstances, and based on the model developed by Robert verity and colleagues (3), we can estimate possible deaths in Africa as between 311.136 and 1.555.680, depending on the infection attack rate (10% and 50% respectively). This forecast is highly uncertain and these projections are still in early phase because it relies in part on many assumptions. Nevertheless, this number could be substantially higher if decisive action and mitigation -distancing policies are not implemented and enforced across all countries. Keeping infected population rate as low as possible should be the highest priority for all African countries; until an effective treatment or a vaccine is available to immunize the population. Our estimate of deaths in Africa over the next months is alarming, but the scenario could be substantially worse, and the impact could be hardest hit in terms of health as well as socioeconomically, in the case of excess demand for health system resources is not addressed, and if social distancing policies are not vigorously implemented and enforced across all regions. However, Africa still has the opportunity to flatten the curve, for this purpose, cooperation and coordination between countries at a regional level, to scale up the capacities in critical areas are highly needed, but given the global nature of the problem, international support with essential supplies and equipment to low -and middle-income countries, is required (4). Also, tailoring and adapting successful measures to local context and empowering communities to respond to outbreaks locally is greatly required. As the ancients used to say: "Nulla tenaci invia est via" No road is impassable.

Estimates of the severity of coronavirus disease 2019: a model-based analysis

Flattening the COVID-19 Curve in Developing Countries