COVID-19 in Africa: insights from our 30 April WHO media briefing

This week’s WHO briefing took place at 11:00 Geneva time with the below speakers.

Dr Matshidiso Moeti, World Health Organization Regional Director for Africa

Dr Zwelini Mkhize, Minister of Health of South Africa

Professor Kojo Ansah Koram, Epidemiologist, Former Director, Noguchi Memorial Research Institute, Ghana

Dr Joe Phaahla, Deputy Minister of Health of South Africa

Dr Michel Yao, World Health Organization Emergency Operations Programme Manager

Adrian Monck, Managing Director, World Economic Forum

In today’s COVID-19 in Africa briefing, topics ranged from the continent’s current low mortality rate and infection in conflict zones to balancing lives and livelihoods.

Dr Matshidiso Moeti, the World Health Organization’s Regional Director for Africa, on the three-month anniversary of the WHO declaring the coronavirus outbreak a global health emergency, kicked off the briefing with a summary of the regional situation: 34,000 cases across the continent, with 1,500 deaths.

She was encouraged by a handful of small countries, including Namibia, Mauritania and the Seychelles, that had not reported any cases at all for a fortnight. She also noted positive results in South Africa, Ghana, Mauritius, Botswana, Mauritania and Niger, with three-week lockdowns producing a decline in new cases.

But she was “very concerned” about significant community spread now occurring in several West African countries.

Politicians faced difficult decisions as the need to balance “lives and livelihoods” comes into play, as countries looked to ease restrictions and kickstart their economies. “In doing so, we are encouraging countries to adjust measures slowly and in line with the evidence,” Moeti said.

Stopping the transmission of the virus remains the priority, which would mean establishing a “new normal” in public health.

Large-scale testing was a key pillar of this process, as is “decentralising” the response to ensure healthcare centres do not become a vector of transmission. “Health facilities should have dual-track capacities for continuing the provision of essential services, so all staff take droplet precautions and know what to do if a person presents themselves with Covid-19-like symptoms,” she said.

Nor should education be neglected, Moeti said: “Communities must be informed and empowered to adhere to the preventive measures, like good hand hygiene, cleaning surfaces in the house, and also to practice community-based surveillance by recognizing those who might be ill.”

Finally, the day before International Labour Day, she thanked all healthcare workers risking their lives on the frontline.

Dr Zwelini Mkhize, South Africa’s Minister of Health, outlined the country’s continent-leading containment strategy on COVID-19. The total number of cases stands at 5,350, with 2,073 recoveries and 103 death (a 1.2% mortality rate).

Dr Mkhize stressed this so-far impressive outcome had the result of a “whole nation” effort, across party lines, that had aimed at “one message” to get the country to respond as a “coherent unit”.

After initial research revealed a possible “avalanche” of hospital admissions, the government had chosen to act proactively, he said, by testing upstream in communities. Sixty thousand field workers had screened nearly 6 million people for body temperature and other symptoms, allowing better management of the virus in the country’s densely packed urban neighbourhoods.

In terms of testing individuals specifically for the virus, around 195,000 tests had been performed, with 5,000 turning out positive – a 3% rate.

The country’s so-far five-week lockdown, imposed to stop the virus entering from abroad and being transmitted at public gathering, had changed the curve of transmission, said Dr Mkhize. “It has assisted to deflect the exponential rise and flattened it a little bit. We are seeing a slightly different trajectory that has pushed the peak of the epidemic to around September in the best-case scenario, or July in the worst case.”

The eventual shape of the epidemic would depend on the government’s strategy to exit lockdown, which would grade different parts of the country based on a five-stage system of how prepared they were to deal with the crisis.

Professor Kojo Ansah Koram, epidemiologist and former Director of the Noguchi Memorial Research Institute, Ghana, revealed the country had currently seen 1,671 cases, 190 recoveries and 16 deaths, giving a 1% mortality rate.

He commended his country’s early decision to test travelers and isolate positive cases: around 1,000 individuals were quarantined and screened, and more than 10% had the virus.

“That was a good [idea] – because at that one point we were not so sure what was happening. And all of them turned out to be asymptomatic, so these would have been thrown into the population and contributed to the transmission pool,” said Professor Koram.

This early success solidified a policy of testing and tracing infected people in order to promptly remove them from contact with others – something assisted by the country’s three-week lockdown. After some initial difficulties, the country has currently performed between 110,000 and 120,000 tests.

“What that means is that instead of us waiting at hospitals and health facilities to get suspected cases to test, we’ve actually gone into the population and try to find out who are those carrying the virus, and then get them out,” he said.

Of the 1,483 cases currently under observation, 80% were in the capital, Accra, either at home or in isolation centres. Kumasi was another hotspot for infection.

In response to a question from Nigerian journalist Paul Adepoju about South Africa’s seemingly low mortality rate, Dr Mkhize emphasized it was still early to draw firm conclusions, but the country’s youthful demographics could be a factor.

“We have noticed that many people are younger and healthier, therefore they tend to handle the infection better. Most of the patients who have succumbed have got underlying co-morbidities – this is a major factor – and most of them have been above 60,” he said.

With regard to lessons going forward, Dr Mkhize emphasized better organization: “Our preparation should be in terms of creating triage systems in hospitals, so patients with respiratory systems are separated from the rest of the patients.”

Bryan Pearson, from Africa Confidential, asked how concerned the WHO were about the situation unfolding in Dar es Salaam in Tanzania. “We are observing countries taking an approach to responding at different speeds,” replied Dr Moeti.

Tanzania had lagged on fully implementing physical distancing, she noted – places of worship were still open while schools were closed, for example. The government had also taken time to prevent travel out of the capital once it was acknowledged to be an infection hub.

“Through our country team and working with technical partners on the ground, we are continuing to advise the government in order to have those policy decisions taken based on data that will enable the government to get on top of the situation,” she said.

Kenya’s Alphonse Shiundu, of Africa Check, asked Dr Koram about the practicalities of advising political leaders about epidemiological matters.

“You work from a position of strength and you base your recommendations and suggestions on the data that is known,” said Dr Koram.

But he emphasized that the situation on the ground often imposed practical limits. “If you are in a place like Accra, where there are a large majority of people in the informal sector, then your advice has to be weighed against the consideration of what happens to that daily population that has to go out on a daily basis and earn their bread. Your advice has to be managed in the context of all the other things.”

Expecting an extension to the three-week lockdown in Ghana, he had been forced to “recalibrate” his recommendations, he said.

The WHO team reiterated the vulnerability of displaced people and others in conflict zones to the coronavirus – such as in the Sahel, the Central African Republic and South Sudan.

“Access is a critical area for our team on the ground to structure the response,” said Dr Michel Yao, World Health Organization Emergency Operations Programme Manager. Partnership with humanitarian organizations and other agencies was crucial to putting healthcare operations into place – often in remote areas far from capital cities.

Bloomberg Live’s Janice Kew asked if the COVID-19 response in South Africa might accelerate the country’s transition to universal health coverage (UHC).

Dr Mkhize confirmed that the current crisis was causing sweeping changes in how the country’s healthcare operated: “We have agreed that we need to face the outbreak as a health sector – which mean we make decisions with private and public.”

The initial wave of cases had been tested and treated privately, he said – and the government was continuing to negotiate “terms of engagement” with the private sector as the epidemic unfolded. “COVID-19 will make the collaboration much closer,” he said.

But UHC would have to wait until the coronavirus was dealt with, in order to attempt to align the interests of both public and private players, he stressed.