Resurgence of COVID-19 in Africa

It was long expected that Africa, with its weak public health infrastructure and the impoverishment of its population, would face particular disaster with the outbreak of COVID-19. It arrived later than in other parts of the world, apparently mostly from Europe. The disease's earliest, high-profile victims were among those able to travel abroad, and South Africa—the country with probably the most extensive links to the rest of the world—early became the epicenter of the disease. Of the big African countries, it has the best public health infrastructure and the best statistics. Hence, there can be greater confidence in official statements about how pervasive the disease has become.

South Africa is once again the epicenter of the current wave of infections, driven, apparently, by a mutant strain of the virus. According to health experts cited by Western media, South Africa now accounts for an estimated 40 percent of COVID-19 cases in all of Africa. South African hospitals are overwhelmed. President Cyril Ramaphosa has responded by re-imposing strict restrictions on public behavior in an effort to "flatten the curve" of new infections.

Supported by a population terrified by what had happened elsewhere, when the first wave of the disease arrived, African governments moved quickly to apply the conventional methods to control the disease: closed borders, lockdowns, exhortations for mask wearing and hand washing, and social distancing. Economic ruin, however, led African governments to abandon most of the more draconian steps. Nevertheless, the disease appeared less deadly than elsewhere. That led to some research and more speculation about why Africa was doing better. Hypotheses included the swift action taken by African governments to the young population (COVID-19 is particularly fatal among the elderly) to speculation about the impact of earlier vaccination campaigns for other diseases might have had. 

But now the disease appears to be roaring back, with South Africa particularly hard-hit. But media treatment continues to be largely anecdotal, heart-rending stories of deaths caused by equipment shortages in overburdened public hospitals. There is new speculation that COVID-19 may be just as bad in Africa as it has been in the rest of the world.

Lack of hard information makes it hard to generalize about COVID-19 in Africa, nevertheless, here goes.

• There is significant variation from one country to another on a huge continent with more than fifty countries. For example, South Africa has the highest level of social and economic development in Africa. It also has a larger percentage of elderly people vulnerable to the disease. It also has a good statistics service. Both factors contribute to the country seeming to have a much higher level of infection than the rest of the continent. On the other hand, it is difficult to estimate the pervasiveness of the disease in countries such as the Democratic Republic of Congo that lack a strong statistics office and where the public health infrastructure is less developed.
• Even in good times and before COVID-19 arrived, the disease burden in Africa is heavier than in other parts of the world.
• Weak statistics make it hard to determine actual mortality rates and, not least, in some African cultures, people return home to die and their deaths are not counted officially. As elsewhere in the world, the poor are most of the victims.
• It remains to be seen when the coronavirus vaccine will become available. South Africa’s Ramaphosa says the government is negotiating with pharmaceutical companies.

That said, it also still appears likely that mortality rates from the disease are lower than in other parts of the world: for example, new, mass grave sites visible from the air are rare. Hence, the question remains: even if the disease in Africa is terrible, it appears less terrible than elsewhere. Why? The answer to that question is important, but it will require hard research and analysis rather than anecdotes.