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Corona in Africa: The silent infection

2021-10-20T05:17:21.240Z


In parts of Africa, about as many people were infected with the corona virus as were vaccinated in Europe - new figures show this. Experts are calling for a change in vaccination strategy.


Enlarge image

Vaccine delivery to Addis Ababa, Ethiopia: The deliveries often come too late for the initial immunization

Photo: Tiksa Negeri / REUTERS

About 112 million people live in Ethiopia.

Nobody really knows.

The landlocked country in the Horn of Africa is one of the poorest countries in the world, severe droughts repeatedly lead to famine and rob the many small farmers in the country from their livelihoods.

Armed conflicts make the situation even more difficult.

In this situation, the Sars-CoV-2 coronavirus has been spreading there for over a year and a half. So far there has been no humanitarian catastrophe. However, the consequences of the pandemic are largely unclear. This applies to almost all of Africa. According to official data, less than three percent of the Covid 19 diseases recorded worldwide and less than four percent of deaths occur on the continent. You can't believe that.

Most African countries do not systematically record illnesses and deaths.

Now it turns out that while the western world was discussing vaccine deliveries to the region for months - the first vaccination rate in poor countries worldwide is just three percent - the virus has largely infected people on the continent.

A study by the Tropical Institute at LMU Klinikum Munich and partners in Ethiopia highlights the extent to which the virus is spreading in the region.

Most have long been immune from infection

"When we talk about the low vaccination rate in African countries, the focus is often misguided," explains Michael Hoelscher, head of the Infection and Tropical Medicine Department at the LMU-Klinikum in an interview with SPIEGEL. “It is absolutely clear that the official numbers of infected people from the region are not correct. Most people have long had a certain immunity from infection. «The vaccination strategy for the region must therefore be reconsidered.

In cooperation with Hoelscher's employees Arne Kroidl and Andreas Wieser, experts in Ethiopia tested more than 2,300 people for antibodies against the coronavirus at various locations between August 2020 and April 2021.

In this way, at three different points in time, they checked what proportion of those examined had already been infected.

The study was published in the journal "The Lancet Global Health".

Around half of the test subjects were employees of two teaching hospitals, one in the city of Jimma in the south-west of the country, one in the capital and largest city of Addis Ababa in the center of Ethiopia.

The experts also examined the spread of the virus in rural and urban areas.

The tests coincided with the exact time that the second wave of infections had picked up speed in Africa.

Lots of infections in clinics and cities

As a result, the coronavirus apparently spread dramatically, especially among medical staff.

In the clinic in Addis Ababa, only around 11 percent of the employees examined had antibodies against the pathogen in their blood in August and September 2020.

About six months later, in the spring of 2021, it was around 54 percent - a fivefold increase.

In Jimma, around 31 percent of hospital staff were infected in November 2020.

By February 2021, the value rose to around 56 percent - the number of those already affected by the virus almost doubled in the short time.

It can be assumed that hospital staff come into contact with Covid 19 patients particularly frequently and thus have a higher risk of infection than the general population, but the number of infected people also increased significantly there.

In urban communities in Jimma and Addis Ababa, the experts recorded an increase in the proportion of the population that was already infected by around 40 percent.

In a district of Addis Ababa, 54 percent of the test subjects had antibodies against the virus in their blood when the test was first run there in January 2021.

By April the value rose to around 73 percent.

For comparison: According to official figures, around 360,000 corona infections have so far been detected in Ethiopia - with 112 million inhabitants, only 0.3 percent should actually have antibodies against the corona virus in their blood.

Even in rural areas, where the pathogen has so far spread less, the Ethiopian-German team led by Kroidl and Wieser was able to detect a corona infection in around 18 percent of the people examined in December and January; by February / March the value rose to 31 Percent.

The team fears that there is currently another large wave of infections in rural areas due to the comparatively low immunity.

We couldn't have afforded that in Germany

According to the experts, their study is the first to have coordinated the infection dynamics of the coronavirus in an African country over time.

Samples from other countries paint a similar picture: In the Democratic Republic of the Congo, for example, antibodies against the coronavirus were discovered in 41 percent of health care workers; they had apparently previously been infected with the pathogen, and in Nigeria a similar test came to a value of 45 percent.

"Other sporadic reports sometimes give even higher numbers, around 60 percent of blood donors in South Africa," the team writes.

"In this country we could never have afforded such a high search rate as in these states," says Hoelscher.

"The damage would have been immense." On the one hand, this is due to the significantly different age structure: In Ethiopia, estimates suggest that more than half of the population is younger than 20 years, while in Germany the median age is around 48.

On the other hand, diseases of civilization, such as obesity and high blood pressure, are much more common in the western world, according to Hoelscher.

"Since severe Covid-19 courses particularly affect older people and people with previous illnesses, the virus hits us harder than African countries."

"Some people die quietly there in the village"

But the second wave of infections also made itself felt in the clinics in Ethiopia.

"Our data coincide with national reports on the increased burden on critical patient care," says the study.

Kroidl confirms that there are more than enough Covid-19-associated deaths in Africa.

"Some people die quietly there in the village."

Just as for a long time no one had any idea how many people were actually infected in most African countries, the number of seriously ill and dead people is also in the dark.

"In Ethiopia and in many other countries there is neither a census nor a death statistic," says Wieser.

Morgues are also only found in the big cities.

"In the countryside, where the majority of the Ethiopian population lives, the funeral is the responsibility of the family and, for religious reasons, usually takes place within 48 hours," said the doctor. The cause of death usually remains unclear. Since only three percent of the people in Ethiopia are over 60 years old, it is often not even questioned if someone in that age group dies. However, unofficial information from the morgue in Addis Ababa indicated that a significant proportion of the dead were infected with the virus.

In some African countries, such as Kenya and Uganda, there were lockdowns, explains Kroidl.

In Ethiopia, too, public life was restricted in 2020, but the measures were lifted again in September of that year.

"They are particularly difficult to sustain in the region because the population is very dependent on close cooperation, markets and the exchange of goods."

Masks are also worn in African countries.

In the large hospitals, medical variants are available, but the population often falls back on self-sewn variants, report the experts.

"Nobody has to feel bad in Europe"

"We are dealing with a very high level of contamination in Africa, which is likely to increase even further," says Kroidl. The team is currently observing an increase in positive tests, which it cannot yet fully explain. One possibility is that another variant of the coronavirus is now spreading, which can bypass the immune protection of those who are already infected, and the immunity of some of those affected may also decline again.

"Vaccine is still scarce in African countries," says Kroidl. "The point now is to find out to what extent a vaccine dose protects against further disease progression in Africa after a previous infection and how vaccines can be used as efficiently as possible." test and do without the vaccination or the second vaccination dose if an infection has already existed.

"Vaccinations against Covid-19 are absolutely necessary in Africa," says Hoelscher.

"But if there is too little vaccine, it should be used sensibly and not just copying concepts from industrialized countries." The WHO is responsible for advising the countries on how they can vaccinate their vulnerable populations in a targeted manner.

"That is far too little happening at the moment."

In Africa, with an immunity rate of around 60 to 80 percent, the conditions are similar to those in industrialized countries.

Now it is important to regularly refresh the immune protection of people at risk.

"Building up a vaccine envy does not help us," says Hoelscher.

“Nobody in Europe has to feel bad when they get a third dose of an mRNA vaccine.

These means are currently impractical for Africa because of the extreme cooling requirements. "

Source: spiegel

All tech articles on 2021-10-20

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