Coronavirus Africa: Health Systems collapse in containing the covid-19 pandemic

While information continues to arrive on the number of deaths from covid-19 in European countries such as Italy and Spain, or the abrupt increase in infections in the United States, there is a continent of which little is known, but the health authorities are especially concerned: Africa.

The high population density and poor hygiene conditions in some parts of Africa make it even more difficult to contain the pandemic.
The alarm was triggered a few days ago by the President of the World Health Organization (WHO), Tedros Adhanom, when he stated that this continent must prepare for ‘the worst’.
Africa must wake up
Similar warnings have been issued by authorities from other international institutions, who have pointed out that the ‘disaster is imminent’ on the continent and that it can turn into a ‘brutal storm’ if urgent measures are not taken.
According to official figures, as of Wednesday, April 1, there were 5,849 confirmed positive cases of covid-19 and 201 deaths across Africa. Compared to, for example, Europe, the number does not seem overwhelming.
Experts and international authorities have warned that insufficient tests are being carried out to trace infected people in Africa.
So why is there so much fear of the pandemic arriving on the continent?

Precarious health system

According to various expert projections, Africa is two or three weeks away from catching up with Asia and Europe in terms of virus transmission.
Consequently, different NGOs and international institutions have called on African governments to apply measures such as confinement or the closure of their borders.
Some African countries have taken measures such as confinement and blocking of borders. However, authorities say this will not be enough to deal with the outbreak in the region.
Some of them have: South Africa, for example, has implemented mandatory quarantine and announced that it will begin doing thousands of house-to-house tests.
Likewise, Nigeria put the inhabitants of its two most populous cities in confinement, while The Gambia closed its borders. And in Kenya there is a curfew.
However, none of this seems sufficient.
‘Cases are increasing very, very fast,’ says Nigerian Mary Stephen, WHO representative in Africa.
Lack of respirators is one of the problems of the health systems of African countries in this pandemic.
‘We have to break the transmission chain and the more cases we have, the more difficult it will be,’ she said.
‘We must prevent deaths from escalating and for this we need to be more proactive and implement preventive and control measures urgently,’ she adds.
The doctor explains that one of the great problems that Africa has in facing the pandemic is its precarious health system, with its lack of beds, intensive care units (ICU), specialist doctors and the rest of the essential equipment to face the virus, like artificial respirators.
This is why, says Stephen, it is so important to break the chain of transmission ‘before it is too late.’
There are countries that are already taking preventive measures against Coronavirus in Africa.
A similar opinion is held by the epidemiologist Anna Roca, who has lived in Africa for ten years working for the Gambia Unit of the University of London School of Hygiene and Tropical Medicine (LSHTM).
‘Strategies to deal with the pandemic, such as flattening the contagion curve, have been designed in Europe or in high-income countries and it is very difficult to think that they can be implemented in these countries,’ she said.
‘Here the system is going to be saturated much earlier than in those countries; it will collapse very quickly,’ she adds.
‘Collateral damage’
Just to give an example, the researcher states that in the Gambia there are no intensive care units.
About 100 beds are now being accommodated across the country to combat the pandemic, but it is estimated that more than 1,000 will be needed.
‘That is, we are behind on everything,’ she says.
Thus, it is feared that the spread of the pandemic could have devastating effects on one of the weakest health systems in the world, also leaving millions of patients suffering from other diseases such as tuberculosis, HIV, malaria or malnutrition unattended.
 ‘The expected collateral damage in Africa is much greater than in Europe,’ says Roca.
‘Here it is clear that women will not take their children to vaccination programs, therefore, there may be outbreaks of other diseases,’ she says.
And ‘it is also expected that hospitals will not be able to care for other patients; there is even fear that women will have their children at home, which can lead to increased mortality in newborns,’ he adds.
Poor hygiene conditions and lack of water
The picture is even bleaker in Africa when you consider that there are areas where you cannot access something as basic as hand washing.
According to the United Nations Children's Fund (Unicef), in the sub-Saharan region, 63% of people living in urban areas (or 258 million people) do not have access to handwashing.
n West and Central Africa, meanwhile, more than a third of all people still do not have access to clean water.  This generates that the hygiene conditions are extremely fragile.  ‘To get water in the Gambia you have to leave your house and go to general taps. Hygiene, therefore, is not a priority because there is no water to continuously wash your hands,’ explains researcher Anna Roca.
Washing hands with soap and water is not easy for many in Africa.
Washing hands with soap and water is not easy for many in Africa.
In West and Central Africa, meanwhile, more than a third of all people still do not have access to clean water.
This generates that the hygiene conditions are extremely fragile.
‘To get water in the Gambia you have to leave your house and go to general taps. Hygiene, therefore, is not a priority because there is no water to continuously wash your hands,’ explains researcher Anna Roca.
Furthermore, the high population density of some areas of this continent makes it even more difficult to contain the pandemic.
For example, in the capital of Kenya, Nairobi, there are slums - such as the so-called Mukuru - where more than half a million people live in overcrowding.
There, the houses are made of cardboard or plastic, they do not have ventilation or drainage, nor do they collect waste: the perfect formula for the spread of disease.
‘It is not possible for us to separate one child from another in case of infection. We do not have space. There are no rooms here,’ one of the inhabitants of this place, Celestine Adhiambo, told the news reporter.
Likewise, there are deep-rooted cultural traditions in some African societies that also do not help to stop contagion.
‘Here Europe's programs to isolate vulnerable people are very difficult to implement as many families live together, in the same house and all eat from the same plate,’ explains Anna Roca.
In addition, in many cases governments are not transmitting the correct information to prevent the transmission of the disease.
‘We need to make sure that people are being properly informed of what is happening in their countries and how they can take care of themselves, for example, social distancing, or how to cough and sneeze, hand washing, etc.,’ he explains. Mary Stephen of WHO.
‘There is a lot of panic and, because people are panicking, there are countries that are taking action without scientific evidence,’ she adds.
Dramatic impact on the economy
The coronavirus crisis will expose other problems that plague many African countries: tremendous social inequality.
‘We are going to see the gap, the divide between the rich and poor’
‘We already see it in South Africa, with the differences in the private and public health systems. And, as always, the poor will suffer the most,’ she adds.

Social inequality is another factor why experts foresee the arrival of the pandemic will be a disaster.

And, in unstable economies like that of many African countries, the possibility of creating economic packages that help people cope with the crisis is seen as a very remote possibility.
Consequently, many people will not be able to stop working because they will not have anything to eat.
‘In countries where people live to the day where there is no capacity to save, where most currency exchange is informal, the impact can be very large and fast’, explains Anna Roca.
In this way, some measures are already affecting certain countries.
For example, The Gambia closed its borders with Senegal, but this is going to bring a blow to its economy as it depends largely on this country.
For BBC Africa correspondent Andrew Hardwing, ‘There is no doubt that this can turn into a disaster.’
‘The economic impact in Africa is going to be enormous because we have very vulnerable economies, and even in the most sophisticated ones, such as South Africa, the blow is going to be very hard,’ she explains.
Furthermore, it is very difficult to think that nations with stable economic situations are going to be able to help them because, this time, the crisis is hitting the whole world.

Experts believe that it will be difficult for aid to come from other countries, because everyone is being affected by the pandemic.

‘Here we are used to the fact that, when catastrophes happen, high-income countries send us resources. But at the moment it is very difficult to think that help will come to us,’ says Roca.
For now, the only hope that remains is that the outbreak will take time to reach Africa, so that when it does, there are already countries with their crises overcomed and can send reinforcements.
‘The data indicates that the outbreak here will be as strong as in Europe and we are not prepared. I hope that by the time they are emerging from the pandemic, they will react quickly to help Africa,’ says the researcher.


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