Omar Thiam is a doctor of economic sciences and director of the School of Management of the ISM Group.
The COVID-19 pandemic continues to gain ground. More than 184,066 people have died worldwide, including 1,246 in Africa so far. The Secretary General of the United Nations, Antonio Guterres, launched a few weeks ago, an appeal on RFI and France 24 for a global start in the fight against the spread of the virus in Africa. He said it was not too late to avoid "millions of deaths" . These “millions of deaths” can indeed be avoided if the measures adopted take into account the differences in contexts as well as socio-economic and especially cultural realities of African countries.
If we take the same path as the large developed countries, we will go straight to disaster.If we take the same path as the large developed countries, namely the United States, France, China and Italy - today overwhelmed despite their financial means and their impressive equipment - we will go straight to the catastrophic hypothesis mentioned by the Secretary General of the United Nations. The African continent, by its population and the health systems of the countries which compose it, is distinguished from other regions of the World contaminated by COVID-19.
It is important to take into account three factors that affect the African population.
First of all, the demographic structure of the continent is different from other regions of the world. The median age of the 1.3 billion Africans is 19.7 years. In contrast, the median age in China is 38.4 years, while it is 43.1 in Europe. Experiences in Asia and Europe have shown that people over the age of 60 and those with significant health conditions are the most vulnerable to severe cases of COVID-19. Although African youth can be seen as an important protective factor in the face of the pandemic, how the virus will evolve and manifest on the continent remains unknown.
The malaria peaks in 2020 could coincide with the ongoing COVID-19 pandemic.The second factor to take into account within the population is the high prevalence of malnutrition, anemia, malaria, AIDS and tuberculosis in certain countries. For example, Burundi and Liberia have some of the highest stunting rates in the world; one in three children under five is stunted. We can envisage an acceleration of this pandemic in sub-Saharan Africa due to a higher incidence of malnutrition in countries like Sudan. In addition, the rainy season has arrived in different areas, which means that malaria cases will increase rapidly and that the malaria peaks in 2020 could coincide with the ongoing COVID-19 pandemic.
We must therefore predict in Africa a higher incidence of severe forms of COVID-19 in young patients due to demography and associated endemic conditions which affect the immune system. Malnutrition, anemia, malaria, AIDS and tuberculosis are likely to increase the severity of COVID-19. The risk is indeed significant!
Third, social cohesion and social gatherings are of great importance in Africa. For example, weekly attendance at places of worship is high. Consequently, the measures aimed at imposing social and physical distancing may prove to be more difficult to implement, as demonstrated by certain challenges in Senegal following the closure of the mosques which themselves followed the appearance of the first cases of COVID-19. Since then, efforts have been made, in consultation with the authorities and religious associations. However, the situation differs from country to country. The Tanzanian head of state, during a mass last Sunday, proclaimed the refusal of his country to close places of worship because that is where we find "the real salvation" .
Africa's capacity to provide intensive care is the weakest in the world.Two major factors related to African health systems will also make the response to COVID-19 more difficult. First, the continent is experiencing the double burden of disease: in addition to coping with these endemic infectious diseases, African health systems cannot afford to absorb the COVID-19 pandemic. Second, Africa's capacity to provide intensive care is the weakest in the world. Severe forms of COVID-19 cause respiratory failure requiring ventilatory assistance. The ability to treat severe forms of COVID-19 will depend on the availability of ventilators, electricity, and oxygen. A recent analysis of the countries with the highest number of intensive care beds per capita does not include any country in Africa. For example in some African countries, like Liberia, there are no intensive care units with ventilators. Uganda has 0.1 intensive care beds per 100,000 population. In contrast, the United States has 34.7 beds per 100,000 population.
The lessons learned in Italy and China are extremely valuable. However, they cannot be directly applied to Africa because of the demographic differences and the constraints linked to the health system that we have mentioned. Health systems in Africa are struggling and have a very limited capacity to absorb the pandemic. The overall strategic approach will therefore have to focus on aggressive preventive measures and on highly targeted and limited containment. Indeed, the general confinement of the population, a privileged response in many countries of the world, is not adapted to sub-Saharan Africa. Indeed, on a continent where the majority of the population lives on less than two dollars a day, the weight of the informal economy is considerable. In 2018, the sector employed 85.8% of workers, according to a study by the International Labor Organization (ILO). In this context, it is therefore difficult to ask individuals to stay at home.
Youth leadership and commitment will be essential in prevention activities.Early and aggressive physical distancing and frequent hand washing will prevail as the most effective and affordable means of intervention for the continent, with parallel tests, contact tracing and case isolation. For aggressive preventive measures to work, full support will be needed. The support of the latter can only be obtained with a community commitment and a citizen start. In addition, the leadership and commitment of young people will be essential in prevention activities. Finally, given the importance of religious activities, the guides will have to actively participate in the response to COVID-19, by raising awareness and raising awareness. With regard to the health system, operating rooms and teams could be reorganized and reallocated to strengthen intensive care capacities in hospitals.
The African context is unique. There are differences in the structure of the population, a high prevalence of endemic diseases and the double burden of disease, with weakened health systems and limited capacity for critical care.
It is difficult to anticipate the future of Africa from a public health perspective.What can we say about the challenges ahead? It is difficult to anticipate the future from a public health perspective. An epidemic or pandemic can always emerge. Strong growth in population density, urbanization, overcrowding, poverty and climate change are important risk factors in this regard. In addition, other major challenges await Africa. The continent’s demographic growth is unprecedented in human history, both in size and pace: the continent’s population will double in less than three decades, from 1 billion to 2 billion here in 2050, while the African continent is the last on earth to begin its demographic transition. Finally, the economic and social consequences of migration phenomena inside and outside the continent do not seem to be anticipated in terms of food needs, education, care, health insurance, social protection and finally jobs.