It is because Africa's populations rely on street trade to make a living and whose poor health infrastructure is burdened with tackling a string of other diseases, Dr. Coenie Louw, the founder of the Gateway Health Institute charity in Pretoria, said.
The doctor warned that the challenge was too big even for South Africa, the most developed country in Sub-Saharan Africa. The country, which has conducted over 12,000 tests, accounts for most of the confirmed COVID-19 cases on the continent. After recording a steep rise from 554 to 709 cases on Wednesday, it still expects further growth.
The World Health Organization has already expressed concern about Africa, which has only registered a total of 2,746 cases as of Thursday, according to the African Union's data, and urged the authorities to more aggressively contain the disease, and test and trace contacts.
South Africa, meanwhile, is headed for a 21-lockdown that starts at midnight. The 56 million-strong population, except for those who provide essential services, is required to stay home. People will only be allowed to go to shops and pharmacies, and all restaurants, bars and cafes will be shut down.
The problem is that South Africa, which can afford a lockdown and other anti-coronavirus measures, is only a small piece of the continent. According to Louw, the rest of Africa has very little chance of properly tackling the global health crisis.
Lockdown ‘Only Hope’ To Slow Down Spread
According to Louw, measures like those introduced in South Africa, namely the declaration of a national state of emergency and a three-week lockdown, are the only hope for the continent to slow down the spread of the disease, which is expected to directly affect at least six to seven out of every 10 South Africans. However, even the lockdown is unlikely to affect the number of sick people, but it will help the health system prepare and might reduce the number of deaths.
"The lockdown now is not going to change the numbers, it is just going to slow down the numbers. But slowing down the numbers will bring down the deaths, because at least there will be a hospital bed for you, or there might be a respirator for you. But if we suddenly have a million sick people, and they all need to go to the hospital, we are in trouble … This lockdown is our only chance of slowing down," Louw said.
He praised the South African government’s move to impose a lockdown and help small businesses that will lose out. However, the government will need to ask for help to be able to survive the pandemic, he said.
"I think South Africa is a good example of following lessons from Italy and China, from South Korea and so on, and hopefully other countries in Africa will follow our model so to speak … Our response, even if it is maybe a bit late, is guided by real science … Yes, we are going to beg the Chinese for machines, and ventilators, and respirators; yes, we are going to probably beg money from the World Bank or whatever to survive this. But I think our governments’ approach is not bad," Louw said.
Situation Desperate For Poorer Countries
While countries that are doing better economically, like South Africa, can ask organizations like the World Bank for help and hope to survive this pandemic, others are left alone with little chance of fighting the disease. Louw explained that practices used by countries in Europe and Asia, like social distancing and border closures — the main and only ways to stop the fast spread of the virus — just cannot be implemented in Africa.
"In South Africa a lot of people are poor. It is very difficult to practice social distancing because they are living in very crowded situations, informal settlements, they have to travel to work in crowded buses and taxis and trains … Africa relies a lot on informal trading. A lot of people make their living by selling vegetables on the streets. That will not be able to continue — how will those people make their living if you enforce lockdowns everywhere?" Louw said.
He added that it would also be difficult to isolate people who are already sick, as in the poor neighborhoods people live in horrendous conditions, where 10 people could easily be sharing one room.
"You cannot isolate old people in those circumstances, because there are only one or two rooms available. That is our big issue. I know the government is making plans to provide isolation facilities and quarantine places, but on the ground, it will be very difficult to practice social distancing or isolation in the poor areas. That is where our big problem lies," the doctor explained.
No Border Control Makes Tracking Impossible
Another issue in Africa is the lack of border control. People living in a poor country often go to a richer neighbour every day to work or simply buy food and do not always use official border posts to cross. According to Louw, "everybody is expecting" a dramatic scenario for Africa, as not many countries can afford to close the borders to stop the spread of the disease.
"South Africa is one of the better economies, so we can afford to implement measures like that. If you go up to the west, to places like Niger, or Sudan, or Burundi — there is no way that they could close borders and stem the tide of people crossing borders," Louw said.
He also drew attention to the dangerous situation in the countries hosting large numbers of refugees who live in packed camps, calling it "a disaster waiting to happen."
"I am thinking about countries like Kenya, for example, and other countries where there is a huge amount of refugees living in tainted camps. Even in South Africa, we have around 2 million refugees and some of them are on the streets ... It is a disaster waiting to happen," the charity founder said.
Limited Testing Capacity vs. Large Numbers Of People at Risk
Most African countries have a weak, undeveloped health infrastructure, with people taking long journeys to get to the nearest hospital or living in war for long periods of time. Therefore, even if some countries have so far reported a relatively small number of COVID-19 cases, they still do not have the means to track the spread of the virus.
"We also do not have the money in Africa to test widely. I read an article that said Mozambique only has enough tests to do ten tests a day. How can you curb the spread of this virus if you only can do ten tests a day? … Nigeria has reported very few cases — 40 cases up till now, and I can tell you that anybody who has a clear idea about how this virus is spreading will know that those numbers are not accurate," Louw argued.
Another risk area for Africa is the high percentage of vulnerable people — those infected with HIV, or have diabetes or other health conditions.
"As you know, South Africa is the country with the highest number of HIV cases in the world; we are probably second or third in terms of people who have tuberculosis in the world. And if you are on treatment it seems that you will be okay, but there are just as many people that have not been tested for HIV or TB, and that is one of our big risk areas," Louw warned.
Cultural Peculiarities, Lack Of Awareness
The charity founder also mentioned yet another peculiarity of the African population that makes it difficult for people to comply with restrictions on public gatherings — many of them are strong believers, and going to church is a basic need for them. He recalled the course of the outbreak in Malaysia, where a spike in contamination was due to a religious gathering, the same as in Iran. He added that the same practice is typical in Nigeria and Zimbabwe.
"Our government has managed to stop that [large religious gatherings] — but you can imagine in other African countries where religion plays a big role, like Uganda, Nigeria, Kenya, Zimbabwe, where people just defy the regulations and flock into churches," Louw said.
According to the doctor, it is also difficult to inform people about the pandemic and make them understand its seriousness. Many people simply do not have access to information, and some do not believe it.
"It is difficult to get the message across to people ... They do not have smartphones, they do not have television, do not have access to the internet … There are millions of people out there who do not know how to practice basic hand hygiene, what social distancing is and why they should do it, what it means to flatten the curve … It is also the main issue — to reach people and to educate them about COVID and the steps they can take," he said.
Africa Cannot Do Without Help
Taking into account all these issues, Louw concluded that Africa would need international assistance to be able to fight the COVID-19 pandemic. The continent is in drastic need of medical supplies and expertise to treat patients.
"Africa needs everything. We need testing kits, software, hardware, they need disposables like gloves and masks and protective equipment and they definitely need respirators and oxygen. Africa needs a total strengthening of the health system … we hope that China will come here to help as well. There is nothing in Africa that is not needed," he concluded.
The Gateway Health Institute is currently carrying out two projects to help the population. One pertains to raising awareness of the disease through the distribution of mobile phones and updating the population on the outbreak, and the second seeks to secure food supply for children after the schools have closed.
