How has Africa been so resilient against COVID-19?

When the COVID-19 pandemic swept across the world in March and forced dozens of countries into lockdown, there were fears that Africa would be its next victim, and that the continent’s relatively fragile healthcare systems would collapse under pressure.

As Europe frantically built makeshift hospitals and imposed lockdown measures, they looked on at their neighbouring continent, wondering how, if the worst were to happen, its infrastructure may cope.

The wave was imminent. It could be more devastating than anywhere else. And then…

Well, it never really happened.

Since the start of the pandemic, Africa has recorded just over 29,000 of the world’s 1.13 million COVID-related deaths. The UK alone has recorded 44,000 deaths, and, to put that into greater context, the UK’s population is 67 million and Africa’s is one billion.

So why hasn’t coronavirus caused the devastation so many predicted? It initially puzzled experts , but a clearer picture is emerging.

Age and Demography

According to data, the virus seems to disproportionately affect the elderly and those with underlying health conditions. In the UK, for example, the average age of COVID fatalities is 82.

Europe and North America have ageing populations, and account for the highest number of deaths overall per capita. In contrast, Africa has the lowest number of deaths per capita, but its population is significantly younger – 60% of Africans are under the age of 25.

If you look more closely, Kenya’s median age is just 20, whilst the UK’s is 40.

COVID-19 is also known to pose a higher risk to those with type-2 diabetes and obesity – both conditions which are far less common in Ghana, Kenya and Tanzania (where African Adventures operates) than in richer countries.

Whilst Africa is home to lots of densely-populated cities – which have been the epicentre of its outbreaks – it remains a sparsely populated continent, and a higher proportion of Africans live in rural areas than citizens in other continents. Generally, the younger, and thus more COVID-resilient, citizens live in cities whilst older people live in smaller villages where the virus is less likely to spread. 

Recent studies have shown there is evidence to support the theory that Africans have greater genetic resilience against COVID-19 than their European or American counterparts.

Response

For all its demographic advantages, Africa is far more adept at dealing with health crises than many believe , and it has recent experience of dealing with something far more deadly than COVID-19.

Ebola’s mortality rate during 2013-2016 was 40% – COVID-19’s hovers around 4%.

Worse still, Ebola did not discriminate against age or health. In the summer of 2014, at the height of the epidemic, Ebola decimated communities in Guinea, Sierra Leone and Liberia in a way that COVID-19 has not and, unless it drastically mutates to affect a wider age group, will not.

As part of a multi-faceted and targeted campaign to slow the spread of the disease, however, the worst-affected countries implemented successful contact tracing systems and community outreach campaigns that were so successful that the disease was largely defeated by the following Easter.

Whilst special praise should be reserved for these nations that turned such a catastrophic outbreak around so quickly, its West African neighbours deserve credit too for avoiding one. Nigeria, Mali and Senegal all reported cases, but each shut Ebola down before it had a chance to cause any serious problems.

Neighbouring countries also implemented what proved to be highly effective testing systems at border entry points. Nearby Cote d’Ivoire, Burkina Faso and Ghana reported no cases at all, which is all the more impressive given that many parts of West Africa have relatively transient populations.

Many African nations acted quickly then, and they have acted quickly now.

At the start of the COVID-19 pandemic, most African countries enacted wide-reaching social restrictions far earlier than many other countries around the world. In fact, Lesotho, the landlocked country surrounded by South Africa, shut schools and businesses before recording a single case.

Further, Ghana adopted one of the earliest contact tracing systems back in April, and an innovative strategy to use community or ‘pool’ testing. Each pool has 10 samples, and 100 pools are tested at a time. Instead of testing one person at a time, samples from multiple individuals are put together and tested as one pool. If the pooled test comes back negative, everyone in the pool is declared negative. If, however, it is positive, then everybody from the pool must take a test so the infected person(s) can be identified.

Are the figures correct?

It is reasonable to assume that many COVID-19 cases in Africa have gone undiagnosed because significantly fewer tests are being conducted. In fact, just 10 countries – including Ghana and Kenya – have carried out 80% of tests in Africa.

Some countries have reported poor quality data and other countries, including Tanzania, are barely carrying out any testing at all.

So, could some countries in Africa be masking the true number of cases and, worse still, deaths?

Well, it certainly seems unlikely. There have been no substantial reports of any countries’ hospitals being full of COVID-19 patients, let alone overwhelmed.

Tanzania, which has been referred to as the Sweden of Africa, given its relaxed response to COVID-19 (it never imposed a lockdown on its citizens, and reopened schools and businesses within a matter of weeks) is largely operating as normal.

But what if deaths are not being recorded correctly? Are the true figures being missed? Or could there be something more sinister happening? The data would suggest not, because one would expect there to be a material increase in the overall mortality rates, especially in the colder months.

There hasn’t been one.

So why is travel to Africa banned?

The UK government’s ‘travel corridor’ policy, which has attracted fierce criticism from the travel industry, was set up in July to enable Britons to travel freely – at least without quarantine on arrival or return – to foreign destinations.  

It required any approved destination on the travel corridor list to have no more than 20 cases of COVID-19 per 100,000 people. The constant chopping and changing of countries on and off the list has subsequently all but shut down leisure travel. If the figure of 20 cases per 100,000 figure appeared questionable at the time of inception, its continued use as the benchmark is beginning to look a little ridiculous, considering the UK’s current rate of infection is 373 per 100,000.

The Foreign, Commonwealth & Development Office (FCDO) adopts an outdated two-tier travel advice system that either allows for restriction-free travel abroad or advises against all but essential travel. Its website even says that it typically enforces the latter to prevent Britons from travelling to countries with high threat levels of terrorism or political instability.

In a period where countries like Belgium and Czech Republic, which have 1019 and 1148 cases per 100,000 people respectively, are treated the same way as Ghana and Kenya – where both have less than 10 cases per 100,000 people – there must be a serious rethink in order to create a fairer, more nuanced approach to travel.

Kenya and Tanzania’s economies rely heavily on tourism and both have been damaged significantly by the lack of international visitors this year. Hundreds of thousands of jobs rely directly or indirectly on the sector, and both populations have suffered disproportionately as a result. Ghana relies less on international tourism but is trying to grow its inbound market. All three countries have reopened their borders and are allowing Britons to visit without the need to quarantine – if they arrive with proof of a negative COVID test.

So, with some of the lowest rates of COVID-19 in the world, why is the UK government banning all but essential travel to the whole African continent? Can you imagine Europe, or the US being treated in the same way?