In the global coronavirus blind spot, fears of a silent outbreak
The global scramble to thwart the coronavirus has a vast blind spot: Sub-Saharan Africa.
In Tanzania, the government has banned coronavirus testing and declared its national epidemic defeated, even as hundreds of people die each month from unexplained respiratory problems. Last month in Zambia, 28 people died in their homes in a single day with Covid-19-like symptoms while waiting to be tested. In South Sudan, government forces barricaded thousands of people inside refugee camps, saying they were infected but refusing to test.
A lack of testing capacity, limited access to data and secretive governments across Africa have left the impression that many of the world’s poorest economies have avoided the worst effects of a disease that has killed at least 830,000 people worldwide. But the fate of much of sub-Saharan Africa’s one billion people is effectively invisible to global authorities trying to gauge the severity of the pandemic.
The paucity of data – combined with reports from several countries of spikes in deaths from respiratory disease – raises fears that a silent epidemic is raging in parts of the continent. Official coronavirus cases in sub-Saharan Africa have doubled in the past month to more than a million, but the official death rate – at 20,000 – remains significantly lower than those in less populated Europe and the United States. , according to data from the World Health Organization.
The World Bank says these unknowns could prevent the full reopening of African economies for years, deepening an economic emergency that the United Nations says is already pushing tens of millions into hunger and shrinking the continent’s new middle class. The risk is compounded by fears that African countries will be forced to wait for Covid-19 vaccines given production constraints and the rush between richer countries to secure their supplies.
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“We are fighting this disease in the dark,” said Stacey Mearns, senior technical adviser for emergency health at the International Rescue Committee. “The world really doesn’t know the extent of the disease on the continent.”
Data on the spread of the virus across Africa is woefully limited. The 46 countries in sub-Saharan Africa, with a population of one billion people, have carried out a total of 6.3 million coronavirus tests. New York State, with a population of 20 million, has conducted eight million tests.
African countries have an average of about 5,000 tests per million people, according to African Union data, compared to nearly 500,000 tests per million people in the United Arab Emirates and 200,000 in the United States. Three quarters of the tests in sub-Saharan Africa have been carried out. by four countries – South Africa, Kenya, Ghana and Ethiopia – meaning data from the rest of the continent is extremely sparse.
“There is a significant undercount of coronavirus cases in Africa due to insufficient testing,” said Farouk Umaru, director of global public health laboratory programs at the US Pharmacopeia, a Washington-based nongovernmental organization that advises the US government on medical standards and licensing. “Rapidly scaling up diagnostic testing is essential in response efforts to contain the pandemic.”
The most accurate data and proactive efforts to contain the virus on the continent are coming from a handful of democratic governments that have mobilized the public and private sectors to give a clearer picture of trends. South Africa led more than 3.5 million Covid-19 tests for its 60 million inhabitants. Trials to develop a $1 test kit that produces results in less than 10 minutes are underway in Senegal and Ghana, which have used 3D printers to produce ventilators.
But across swathes of the continent, the true scale of the virus is unknown. South Sudan has tested 15,000 of its 12 million people. Several countries, including Niger, Eritrea and Guinea, have each carried out fewer than 10,000 tests. Tanzania has carried out the fewest tests in the worldaccording to the World Health Organization, at 63 per million population, before it stopped providing international bodies with test data.
When the first suspected cases of coronavirus began to appear in Africa in early February, only two laboratories, one in South Africa and the other in Senegal, had the diagnostic capacity to test for the virus. It took nearly two months for the 46 countries south of the Sahara to set up testing capacity.
Some countries have gone to great lengths to ensure that coronavirus testing information is not shared. Equatorial Guinea’s government has expelled WHO officials, accusing them of falsifying new cases of the virus after announcing an end to its outbreak. When Burundi’s 55-year-old President Pierre Nkurunziza died in June, his autocratic government said the cause was a heart attackbut diplomats and medical professionals believe he was the first head of state in the world to die from Covid-19.
Tanzanian authorities have shut down a local newspaper after it published a photo of President John Magufuli at a crowded fish market in April, in violation of social distancing rules announced by his government. Another local TV channel had its license suspended in July after reporting an alert from the US Embassy warning of a high risk of coronavirus in the country. A law introduced last month prohibits citizens from discussing infectious diseases online without government approval, and dozens of Tanzanians, including prominent government critics, have been arrested for commenting on the virus on social media .
“Publishing information about the coronavirus pandemic is now considered unpatriotic,” said Muthoki Mumo, director for sub-Saharan Africa at the Committee to Protect Journalists.
Zambia began testing in late February, but the heavily indebted country has struggled to expand its facilities, according to interviews with Zambian officials and health experts. The country of 18 million people has carried out 100,000 tests, but appeals from the Treasury, which spends a third of its income on debt service, to lenders, including China and the International Monetary Fund, for financing of emergency have been largely rebuffed amid disputes over the country’s debt.
Economic chaos is visible in hospital wards across Zambia. Coronavirus testing capacity is so limited that people with respiratory symptoms often spend days searching for hospitals with test kits before they can be treated. Dozens of people died while waiting to be tested and others died before receiving test results, which could spread the disease to loved ones, medical officials say.
“We have a limited supply for testing due to the global shortage,” said Kakulubelwa Mulalelo, permanent secretary in the Zambian Ministry of Health. “Testing is done at the discretion of health officials.”
The chances of surviving the coronavirus for patients with pre-existing health conditions are significantly lower, and many families in Zambia have spoken of losing close relatives who are already sick with diseases such as diabetes and HIV/AIDS.
Unable to find hospital beds for sick relatives, some locals like Moreen Shabusale, a Zambian hairdresser, resorted to stockpiling antibiotics, hydroxychloroquine and painkillers. Ms Shabusale’s 52-year-old brother died earlier this month, three days after he was told to await the arrival of coronavirus test kits at a local hospital. A 21-year-old relative was recently battling a high fever, cough and night sweats.
“They don’t admit any patient to a Covid-19 ward without test results, but they turn people away without treatment,” she said. “It is pathetic.”
The situation is even less clear in Somalia, Burkina Faso, Nigeria and the Democratic Republic of Congo, where raging insurgencies make mass testing impossible and weak health systems are already struggling to contain other medical emergencies, including HIV/AIDS, measles and Ebola .
The testing shortage goes beyond the state’s limited capacity. Covid-19 stigma prevents people from getting tested, health officials say. In Somalia, the number of people seeking treatment in health facilities has fallen by a third since March, according to Care International, an NGO, as more people suspected of being infected are cut off from communities.
Shabir Madhi, professor of vaccinology at the University of the Witwatersrand in Johannesburg, said the testing figures across Africa were so incomplete they made no sense.
“It doesn’t quantify the true extent of virus circulation,” he said.
Corrections & Amplifications
US Pharmacopeia is a non-governmental organization based in Washington, DC. It was incorrectly called Pharmacopeia in an earlier version of this article. (Corrected September 10) New York State has a population of 20 million. An earlier version of this article incorrectly stated that it had a population of 8.3 million. (Corrected August 31)
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