key: cord-0894709-rcztsrex
authors: Chitungo, Itai; Dzobo, Mathias; Hlongwa, Mbuzeleni; Dzinamarira, Tafadzwa
title: COVID-19: Unpacking the low number of cases in Africa
date: 2020-09-11
journal: Public health in practice
DOI: 10.1016/j.puhip.2020.100038
sha: 8d38ac76aeff6839dcd20b5757caea7eabe0d3d3
doc_id: 894709
cord_uid: rcztsrex

Coronavirus disease 2019 (COVID-19) has infected over nineteen million people globally with over 700 000 fatalities as of 9 August 2020. To date, Africa has recorded the least amount of COVID-19 confirmed cases. As of 9 August 2020, Africa has 1, 037, 135 cases compared to 10, 615, 855 in Americas and 3, 061, 264 in Europe. In this piece, the authors unpack the low numbers of laboratory confirmed COVID-19 cases in Africa - is it a case of limited testing capacity due to poor health systems or otherwise?

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections continues to threaten populations across the globe. While many clinical trials are currently underway, there is still no vaccine or effective antiviral treatment for COVID-19. Many countries have, appropriately, implemented lockdowns to reduce the rapid spread of COVID-19, as well as preparing healthcare systems to save lives. COVID-19 testing prompts vary from country to country based on local conditions and capacities. In South Africa, people who qualify to be tested for COVID-19 include hospitalized patients with respiratory conditions, contacts of known positive cases, health-care workers and returnee citizens. While in Nigeria testing is targeting travelers into the country with symptoms of fever, cough or breathing difficulties, and symptomatic persons with known contacts of positive cases or are resident in an area of high COVID-19 prevalence. Egypt has planned to offer COVID-19 testing in all general hospitals. The country has the most numbers of government designated testing sites, 320, compared to 26 and 17 in Nigeria and South Africa,

COVID-19 is a novel disease and as such diagnostic kits are being developed, validated and distributed. The lockdowns implemented has affected diagnostic kits productions and supply chains which has impacted availability of testing materials to scale up COVID-19 testing, and Africa is not spared. One of the main challenges faced by laboratories in the continent is that most of the diagnostic infrastructure requires the use of proprietary test materials, which includes reagents, consumables and cartridges 8 . Despite these challenges, the Centres for Disease Control and Prevention (Africa CDC) rolled out a new initiative to improve testing for COVID-19 response across the African continent 3 .

The WHO has recommended countries to ramp up testing capacity and availability as widespread accurate testing is essential to contain the virus spread. The efficacy of this strategy is dependent on resource availability (testing kits and healthcare staff) and functional health systems as this impacts the epidemic dynamics and mitigation plans 9 . The COVID-19 test gold J o u r n a l P r e -p r o o f standard is the nucleic acid -based real time quantitative PCR, which is expensive cumbersome and requires a high level of expertise 10 . The alternative serological tests are of low sensitivity and specificity and are mostly available in high-income countries 11 . Further, Africa still faces challenges such as low staffing levels and poor referrals systems that are slowing testing 8 In conclusion, we argue that it is not accurate to offer limited testing capacity, poor health systems and under-reporting as the only explanations for the lower numbers of COVID-19 cases reported in Africa. Africa's lower COVID-19 cases can be attributed to early mitigatory responses enhanced by leveraging existing infection control systems, warmer climate, and the general low risk of virus importation from Covid-19 hotspots. A recent surge in cases, in particular South Africa is a cause for concern and so is the winter season that much of Africa is experiencing. As lockdowns and restrictions are slowly being eased or lifted, there is a need to maintain vigilance in education, awareness, testing and resource mobilization for procurement of medical consumables to reduce the transmission of the virus. J o u r n a l P r e -p r o o f

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