COVID-19 Resource Center

COVID-19 Resource Center

February 21, 2020
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Researchers identify African countries at highest risk for COVID-19

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Tedros Adhanom Ghebreyesus
Tedros Adhanom Ghebreyesus

Researchers identified Egypt, Algeria and South Africa as the African countries at highest risk for imported cases of COVID-19 from China. However, they said countries found to be at moderate risk — including Nigeria and Ethiopia — are less prepared and more vulnerable to a potential outbreak, suggesting a need for support to handle future imported cases.

“Many countries in Africa are stepping up their preparedness to detect and cope with COVID-19 importations,” Vittoria Colizza, PhD, research director at Inserm and Sorbonne Universite in Paris, told Healio. “Our study was able to identify those countries that should be prioritized for resources, intensified surveillance and capacity building, as they have a moderate risk of importation of COVID-19 and may be otherwise ill prepared to detect imported cases and contain onward transmission.”

Colizza and colleagues used data on the volume of air travel from Chinese provinces with infections to Africa and the proportion of COVID-19 cases in Chinese provinces to estimate the risk of importing COVID-19 in African countries. They excluded air travel from Hubei province due to the travel ban introduced by China on Jan. 23 and Jan. 24.

To determine each country’s capacity to detect and respond to the virus, they used two WHO indicators — preparedness, measured using the WHO International Health Regulations Monitoring Framework State Parties Self-Assessment Annual Reporting Tool; and vulnerability, which was measured using the Infectious Disease Vulnerability Index. Their findings were published in The Lancet.

Egypt, Algeria and South Africa showed the highest risk for COVID-19 importation from China but had low vulnerability levels and moderate to high preparedness levels, the researchers found. Last week, Egypt was the first African country to confirm a case of the disease.

Moderate-risk African countries including Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana and Kenya showed varying levels of vulnerability and preparedness. Ethiopia and Nigeria showed moderate preparedness but high levels of vulnerability, whereas Sudan, Angola, Ghana, Tanzania and Kenya had similar importation risks, varying levels of preparedness and high levels of vulnerability.

Colizza noted that one of the study’s major limitations was the researcher’s inability to account for flight bans implemented by airlines, although the bans are not expected to prevent COVID-19 importation.

“Prior and current evidence indicates that realistic travel restrictions would have a limited effect in containing the epidemic and would delay by only a few weeks the risk that the outbreak extends to new countries,” Colizza said. “Travel or trade restrictions are indeed not currently recommended by WHO.”

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The United States has implemented mandatory 14-day quarantines for travelers returning from Hubei province to prevent spread of the novel coronavirus, and several U.S. airlines have delayed travel to mainland China. According to WHO, more than 74,000 cases and 2,121 deaths have been attributed to the virus in China since the beginning of the outbreak, with more than 1,000 confirmed cases and eight deaths occurring in 26 countries outside China.

“We’re partnering with the Africa CDC to coordinate our efforts to prepare African countries for the potential arrival of the virus,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said at a news conference on Thursday. “That’s where we believe that the virus could be a serious danger. That’s why we’re focusing on continents and countries where the health systems are weaker.”

Colizza emphasized that national health authorities should focus their attention on countries ill prepared to handle COVID-19 importation.

“Stepping up preparedness worldwide is critical for rapidly detecting and managing COVID-19 importations and avoiding chains of local transmission,” Colizza said. “National public health capabilities and infrastructures remain at the core of global health security, as they represent the first line of defense of infectious disease emergencies.”

“Particular attention should be focused on countries that have moderate to high risk of importation and weak health care systems,” Colizza added. “Crisis management plans should be ready in each African country.” – by Eamon Dreisbach

Disclosures: The authors report no relevant financial disclosures.