COVID-19 in Africa: insights from our 2 April WHO media briefing

Dr Matshidiso Moeti, WHO Regional Director for Africa, who will speak on growing cases in the region, concerns and how countries can cope.

Lola Castro, Regional Director for Southern Africa, World Food Programme, who will speak on the impact of COVID-19 lockdowns and how this will impact vulnerable people who already a difficult time finding enough to eat and accessing other basic services.

Dr Zabulon Yoti, WHO Regional Emergencies Director for Africa

Dr Michel Yao, Emergency Operations Programme Manager, World Health Organization

Adrian Monck, Managing Director, World Economic Forum

As COVID-19 cases in Africa climb above 6,000, the World Economic Forum convened a question-and-answer session between journalists and senior officials from the World Health Organization and World Food Programme about how the continent’s response is likely to shape up over the coming days.

Why have relatively few governments introduced lockdown measures so far? Dr Matshidiso Moeti, WHO Regional Director for Africa, said the precautions were expanding as expected. “We are seeing an increasing number of African governments – including South Africa, Botswana and Nigeria – introduce these social distancing measures.” In the Congo, from which she was speaking alongside her colleague Dr Zabulon Yoti, WHO Regional Emergencies Director for Africa, a curfew had been in place “since yesterday”. The measures are expanding on a country-by-country basis, she said.

Joe Bavier of Thomson Reuters wondered whether economic restrictions were influencing government decisions over social distancing. “The economic impact [of COVID-19] is a great concern,” admitted Dr Moeti. She stressed that, due to a large number of people – including traders and casual workers – living in uncertain economic circumstances, governments would “need to put in mitigation measures” in the form of food or financial aid to allow people to stop working if necessary. Otherwise, many would find it difficult to observe the restrictions on movement.

“Many countries have closed schools already, and hundreds of millions of children are already not going to school in Africa,” Dr Moeti said. However, the reality that is conditions in some countries may make social distancing difficult. “[There is a] need to balance the feasibility of these social distancing measures in spaces where physical distances might be quite a challenge, and where people find it very difficult to stay indoors – where it’s hot, the space is small, or the number of people indoors is large,” she said. “But people are trying to do what they can.”

Lockdown measures would need to be addressed on a country-by-country basis, and must be accompanied by mitigation measures to ensure they are feasible. “Physical distancing is a very important component,” but government measures must be put in place to ensure people don’t suffer unduly, said Dr Moeti. Where water is scarce, for instance, “governments need to take this into account and provide water”, or the means of cleaning water.

Lola Castro, the World Food Programme’s Regional Director for Southern Africa, chimed in on the issue of food security. “In a normal year, we have 20-45 million people who are already food insecure.” The additional impact of COVID-19, and the reduction in production and transport, will affect the delivery of WFP relief “very much”. “We really need to keep the food moving across the region, from the goods-producing country to other countries, to prevent food insecurity,” she said.

School closures provide additional complications in the context of food: “Many children [in vulnerable areas] get their only meal of the day at school. Now we’re trying to find solutions as to how to do this in a different way.”

Simon Allison, Africa editor of the South African Mail and Guardian, wondered whether the apparent slowdown in infection rates in that country meant the lockdown measures were working. (The country began a three-week “total lockdown” on 27 March.)

With the measures only in place for a few days, it’s too early to tell, said Dr Moeti. “I think that infections and transmission slowdown will only show itself some days from now.” But did have some welcome words for those fearful of the country’s leap in infections prior to the lockdown. “We know there has been a backlog that needed confirming, so some of the dramatic recent increase might have been due to the confirmations coming in a group.”

Will the lockdown restrictions affect the movement of food aid across the continent? And how will these logistical challenges be overcome?

Lola Castro of the WFP stressed that food systems must continue functioning, and that produce must continue to move across borders. “The only way to do this is to get permission from governments,” she said. But early signs are encouraging. Before South Africa went into lockdown, the WFP requested that food cargoes continue to be allowed to move across borders, and so far food has been leaving South Africa bound for Zimbabwe, Namibia, Botswana and other countries with no problems whatsoever.

But Castro warned that in the future, depending on the effects of lockdown on smallholder farmers and their access to markets, we may see an increase in food prices and the number of people who require food assistance. The WFP is therefore requesting a figure of $413m (£333m) from its donors to ensure that the year’s harvests are distributed on time and effectively.

Testing was the next topic of conversation: what is the WHO doing to beef up testing for COVID-19 in Africa? At the moment, only 300 people have been tested in Zimbabwe – matter of grave concern in the nation.

Dr Moeti recognised the difficulties, but said that the WHO was working very hard with governments to expand their capacity for testing – a process that includes conducting training and helping to procure and distribute equipment and supplies.

She said that – as many of us will have seen from stories in the world’s media – obtaining testing kits was a big challenge at a global level. In her opinion, there were not presently large numbers of people in Africa who are asymptomatic and flying beneath the detection radar. Even still, she “would like to encourage large-scale testing of the sort seen in South Korea”, with additional measures including contact tracing and quarantine, but admitted there is “a real challenge” in the availability of test kits. “We are working with our partners to encourage the manufacture of these kits,” she said, but it remains “a recognised challenge and something we’re working with our partners every day to meet”.

Is there a lack of ventilators in Africa at present? Dr Yoti took the question to clarify that a small percentage of people who contract COVID-19, 1-2%, will need ventilators, while 15% may need treatment in an intensive care unit (ICU). “The health systems in Africa before COVID-19 were already a bit weak, with minimal supplies of these facilities,” he said. “We are at the moment working with this countries to meet this need, but we do recognise there are gaps in health systems, including ventilators and ICU beds.”

One correspondent wondered why there have been so few cases in Africa so far. Could it be to do with the age structure of the continent? (Two-fifths of Africa’s population under 15, while nearly a fifth is aged between 15 and 24.)

Dr Yoti warned against both complacency and jumping to conclusions. “Concerning mortality, we have seen our first 125 deaths. We have also noticed deaths occurring in people less than 40. We have also seen [as around the globe] people with comorbidities having higher mortality.”

However, in the last few days, Africa has also seen “a drastic increase in cases. We have seen this number [of cases] sometimes triple. Good surveillance contributes to this, but we think the real spread of this disease has been reflected in the increase in the number of cases.” So the threat of coronavirus is very real, and Africa’s young population is unlikely to provide a bulwark against infection or mortality

Esther Nakkazi, a freelance journalist from Uganda, wondered what the WHO take was on COVID-19 research in Africa. Dr Moeti said there was an effort to pool research and trials results in Africa and beyond. Nations are invited to join a platform called Solidarity, which is a multi-country clinical study testing potential treatments including medicines and combinations of medicines such as remdesivir and chloroquine. Argentina, Switzerland, France and Thailand are among the nations already participating.

“Having learned from Ebola experimental drugs and the Ebola vaccine [which was collaboratively produced by scientists across three continents], there’s an attempt to coordinate studies so that similar methodologies can be applied. It’s a case of putting information out there and asking governments and researchers to join this effort.”

Are there, asked freelance journalist Privilege Musvanhiri of Zimbabwe, any concerns that African governments are not being truthful on statistics? “On the whole, our country teams are working very closely with ministers of health on surveillance,” said Dr Moeti. All countries in the region are signatories of the international health regulations, which entail a responsibility to share information on infection rates as early and as fully as possible to help limit the spread. “They have an obligation under international health regulations to openly share information and this something we periodically remind them of,” said Dr Moeti.

A number of answers involved dispelling persistent but potentially damaging myths. Is it true that malaria-affected countries are less prone to COVID-19? “No, unfortunately,” said Dr Yoti. “We are making no such observation.” Some of the places where COVID-19 is expanding rapidly – including Nigeria, Senegal and Burkina Faso – are also prone to malaria. Do recent BCG immunisation programmes against tuberculosis mean large swathes of Africa are immune to COVID-19? Again, this belief is incorrect. “There’s a lot of information circulating on social media,” said Dr Yoti. “We would advise you to stick to credible sources of information, because some of this may divert attention from physical distancing, handwashing and the other recommended measures.”

Juanita Williams at AllAfrica.com wondered what governments can do to support small-scale farmers and food producers. “Most of the food produced in Africa,” said Castro of the WFP, “is produced by smallholder farmers – and most of them are women. Their livelihood depends on what they can bring to markets and sell. It’s critical those producers can continue producing to maintain supply chains.” The priority of the WFP is to “make sure that seeds are moving and can continue to be planted, that transports can move, and that some markets can remain open – obviously while respecting health restrictions”. The WFP will urge governments to focus on small farmers and keeping markets open where suitable, in order to feed Africa and areas of southern Africa, “where many vulnerable women will be unable to support their families if they can’t sell food”.

A very direct question came in from the New York Times: how many ventilators are there in the whole of Africa?

“At the moment, we are trying to find this information from our country-based colleagues,” said Dr Moeti. “We do not have the actual number, but what we can say without any doubt is that there’s an enormous gap in the numbers needed” as cases “begin to rise and increase in geographical spread”. She pointed out that the African growth in demand is happening “in the context of a global shortage, and lockdown conditions which will make transport of the ventilators a challenge”.

Though in most countries the numbers of patients requiring them are still small, Dr Moeti predicted that obtaining ventilators would become a challenge for Africa’s health systems – especially having seen problems it has caused for stronger health systems around the world.

Finally, a note of cautious optimism from Dr Yoti regarding the possibility of reinfection with the virus. “At present, we have no concrete evidence of reinfection in the African region.” But he warned that further observation and peer-reviewed studies were required before drawing any firm conclusions.