Looming threat of COVID-19 infection in Africa: act collectively, and fast

Abstract

Because of the high volume of air traffic and trade between China and Africa, Africa is at a high risk for the introduction and spread of the novel coronavirus disease 2019 (COVID-19); although only Egypt has reported the first case, from a non-national. The greatest concern for public health experts is whether COVID-19 will become a pandemic, with sustained year-round transmission, similar to influenza, as is now being observed in several countries. What might happen to Africa—where most countries have weak health-care systems, including inadequate surveillance and laboratory capacity, scarcity of public health human resources, and limited financial means— if a pandemic occurs? With neither treatment nor vaccines, and without pre-existing immunity, the effect might be devastating because of the multiple health challenges the continent already faces: rapid population growth and increased movement of people; existing endemic diseases, such as human immunodeficiency virus, tuberculosis, and malaria; remerging and emerging infectious pathogens such as Ebola virus disease, Lassa haemorrhagic fever, and others; and increasing incidence of non-communicable diseases. Models that enable the continent to better allocate scarce resources to better prepare and respond to the COVID-19 epidemic are crucial. The modelling study by Marius Gilbert and colleagues in The Lancet identifies each African country’s risk of importation of COVID-19 from China, using data on the volume of air travel from three airports in provinces in China to African countries. Gilbert and colleagues use two indicators to determine the capacity of countries to detect and respond to cases: preparedness, using the WHO International Health Regulations Moni toring and Evaluation Framework; and vulnerability, using the Infectious Disease Vulnerability Index. Based on their analysis, Egypt, Algeria, and South Africa had the highest importation risk, and a moderate to high capacity to respond to outbreaks. Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya had moderate risk with variable capacity and high vulnerability. In the model, the risk mainly originates from Guangdong, Fujian, and Beijing. The study provides a valuable tool that can help countries in Africa prioritise and allocate resources as they prepare to respond to the potential introduction and spread of COVID-19. The study should also be interpreted in light of the fast-evolving nature of the COVID-19 outbreak. First, with the exception of Ethiopian airlines, all African airlines have suspended flights to China. Although these measures might delay, but not stop, the importation risk of COVID-19 into Africa, their implementation is still worthwhile. Second, although Beijing, Shanghai, and Fujian do not report the highest number of cases of COVID-19 in China, the volume of travel from these cities to Africa is high, which might increase the risk of exporting cases to Africa. Lastly, almost half of the flights from Africa to China are operated by Ethiopian Airlines, so it is possible that cases might pass through Ethiopia and affect destination countries. The report by Gilbert and colleagues provides an important tool to map out the continental risk for the spread of COVID-19 in Africa, which should be used to inform a framework of action to prepare the continent for any potential importation and spread of COVID-19. First, collectively, Africa needs a unified continentwide strategy for preparedness and response. The strategy must be comprehensive, and member states, Published Online February 27, 2020 https://doi.org/10.1016/ S0140-6736(20)30464-5