When the coronavirus first spread around the world, there was near-general concern among experts that countries in Africa could be particularly hard hit, with high transmission rates that could quickly overwhelm healthcare systems.
But about nine months after the pandemic, which left over 31 million people sick and caused more than 950,000 deaths worldwide, most African countries have fared significantly better than other parts of the world. The reasons are still a mystery – more research is needed, and some studies aimed at answering the questions are only just beginning – but scientists said the success of many African countries so far offers crucial lessons for the rest of the world and shine a light on how inherent prejudices can skew scientific research.
“The first models of disease prediction painted a very bleak picture of the severe destruction of life and the economy in Africa,” said Dr. Sam Agatre Okuonzi, who works at the Arua Regional Referral Hospital in northern Uganda, at a World Health Organization press conference on Thursday. “In Uganda, it was predicted that there would be 600,000 cases of Covid-19 and 30,000 deaths by September. But the reality is completely different.”
Uganda has 7,064 reported coronavirus cases and 70 deaths. According to a review by Johns Hopkins University. South Africa, the hardest-hit country on the continent, recorded more than 665,000 cases and 16,206 deaths. This equates to about 28 deaths per 100,000 people compared to more than 61 deaths per 100,000 people in the United States.
Although other countries like Ethiopia, Algeria and Nigeria have struggled with major outbreaks, most countries on the continent have so far managed to contain the spread of the virus.
Part of that success can be attributed to aggressive measures taken at the start of the pandemic to restrict people’s movements and slow down transmission within communities, said Dr. Matshidiso Moeti, WHO Regional Director for Africa.
“The governments took drastic measures early on to burden their economies with high costs,” said Moeti at the press conference. “That bought us some time.”
She said there were concerns that the number of new infections could rise in the coming weeks as restrictions are relaxed and many African countries slowly return to normal. Moeti said there are already upward movements in South Africa, Algeria, Mauritania and Ghana, likely as a direct result of the cities reopening in May and June.
The WHO has emphasized that the next few months – in Africa, but also elsewhere – will be very important in warding off an expected second wave of infections.
Moeti said African countries should emphasize preparedness and “establish public health capacity to contain the spread so that the spread does not repeat itself in cycles”.
As efforts begin to prepare for a possible second wave, scientists are also trying to figure out what African countries did right during the first phase of the pandemic.
More research is needed, but some early theories have emerged, Okuonzi said.
He said it is possible that some African countries are better equipped to respond to infectious disease outbreaks “because we have a lot of experience with Ebola and other diseases.”
Shaun Truelove, assistant scientist and modeling expert at the Johns Hopkins Bloomberg School of Public Health, said it was also possible that some populations in Africa could have “cross-reactive immunities” from exposure to other circulating coronaviruses.
There’s no solid evidence for this yet, but it’s something researchers are actively investigating. Francisca Mutapi, Professor of Global Health Infections and Immunity at the University of Edinburgh in Scotland, is involved in research in Zimbabwe to determine people’s immunity to six other known coronaviruses. Mutapi said she expected to learn more about possible cross protection measures in the next four months.
Mutapi suggested that differences in culture and lifestyle might play a role. “One of the factors about the virus is that it doesn’t spread very well outdoors,” she said. “Africa has a significant rural population who spend a lot of time outdoors. This is one of the factors we have found from our own work.”
Moeti said it was also likely that demographics could explain why many African countries have had fewer Covid-19 deaths.
“Most African countries have around 3 percent of the population over the age of 65,” she said, adding that research has shown that young people are at lower risk of developing the coronavirus seriously.
Trends in Africa are in stark contrast to the experience of African Americans, who are at disproportionate risk of becoming seriously ill from the coronavirus due to a number of other socio-economic factors. Researchers have no reason to believe that blacks have natural immunity to the coronavirus, despite some pseudoscience that has been spread about blacks in the United States. However, the United States has historically had racial and socioeconomic health differences.
Some researchers have raised the possibility that low numbers in Africa could be due to underreporting, but Truelove said it likely isn’t.
“That doesn’t fully explain it because we would see health systems overwhelmed if an outbreak really did happen,” he said.
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Scientists like Truelove are desperate to learn more about what has so far kept African countries from realizing the dire predictions from the beginning of the pandemic.
“It’s really not clear why and if it’s a combination of all of these theories or other things,” he said. “It’s going to be an interesting discovery process.”
Epidemiological concerns aside, the divide between early projections for what might happen in Africa and most of the continent’s real-world experiences reveals the limits of conventional infectious disease modeling, Okuonzi said.
Most models are “based on European populations, not African populations, and they are also informed by very ingrained prejudices about Africa that Africa, for example, is susceptible to disease,” he said. “Covid-19 has destroyed many prejudices about the disease in general.”