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Disclosures: Nachega reports no relevant financial disclosures.
April 09, 2020
4 min read

COVID-19 in Africa: ‘Prepare for the worst, but hope for the best’

Disclosures: Nachega reports no relevant financial disclosures.
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Jean Nachega
Tedros Adhanom Ghebreyesus

In early April, the African region had fewer than 6,700 confirmed cases of COVID-19, a significantly lower count than the more than 112,000 cases reported in the Western Pacific and the more than 655,000 cases reported in Europe at that time. A study published in The Lancet in late February noted that the African continent “has remained relatively unaffected” by COVID-19 while highlighting a number of factors — including unstable health systems with limited ICUs and ventilators for possible severe cases of COVID-19 and travel to countries with high numbers of COVID-19 cases — that make the region vulnerable to further spread, including unstable health care systems with limited ICUs and ventilators for possible severe cases of COVID-19 and travel to countries with high numbers of COVID-19 cases.

Some experts are concerned that mitigation efforts would be hindered because of poverty-related social challenges that are prevalent in Africa, including limited access to running water and overcrowded households in shanty towns, should the disease begin to spread.

“Basic prevention measures such as hand-washing can be problematic when clean water, let alone soap, is scarce in some settings,” Jean Nachega, MD, PhD, MPH, FRCP, FAAS, associate professor of epidemiology, infectious diseases and microbiology at University of Pittsburgh and adjunct professor of medicine at Stellenbosch University in Cape Town, told Healio. “Alcohol-based sanitizers may help, but there remains a global shortage.”

In a viewpoint editorial published in Clinical Infectious Diseases, Nachega and colleagues outlined the importance of mitigating pan-continental spread of COVID-19 in Africa, citing “fragile health care systems” as a potential risk factor high morbidity and mortality due to COVID-19 cases on the continent. The researchers wrote that African countries with “unstable health systems” and travel history to hot spots such as China and Italy — which had 83,000 and nearly 129,000 cases, respectively, of the disease as of April 7 — are at particularly high risk for the outbreak.

In early April, the African region had less than 6,700 confirmed cases of COVID-19, a significantly lower count than the more than 112,000 cases reported in the western pacific and the more than 655,000 cases reported in Europe at that time.
Source: WHO

“Self-quarantine and self-isolation will be challenging to achieve in slums, townships and other communities where several people or members of a family share the same room,” Nachega added. “Many people in Africa live check to check or hand-to-mouth and they would rather die from the virus than see themselves or their family die from hunger.”

WHO representatives share similar concerns regarding the continent’s vulnerability to the virus.

“The African continent has the lowest number of cases so far, but that doesn't mean that the situation will not deteriorate. It may,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, said at a press briefing on April 6. “Africa should do everything to prevent this situation from getting worse. African leaders are doing their best.”


Inadequate capacity for PCR testing for the virus is a concern, according to the researchers, because a lack of testing may lead to undetected community transmission, which is similar to the outbreak in Seattle, Washington. The prevalence of HIV in sub-Saharan Africa, which currently accounts for 70% of the world’s HIV burden, may present an additional risk factor. Comorbidities such as cardiovascular disease, chronic lung disease, diabetes and cancer have been identified as risk factors for more severe disease and fatal outcomes in COVID-19, all of which are also present in aging patients with HIV.

Nachega believes that large-scale public information campaigns via social media, TV and radio may be useful for improving COVID-19 mitigation efforts throughout Africa.
Social distancing and hand-washing need to be reinforced as much as realistically possible in Africa, but there is a need for national governments, private sector organizations, philanthropic groups and others to support people who are vulnerable and who lost their jobs during confinement via an emergency solidarity fund,” Nachega said. “Africa needs to prepare for the worst but hope for the best.”

In the WHO briefing, Tedros emphasized the danger equipment shortages may pose to the virus’s burden throughout Africa.

“Business leaders in Africa are also coming together because Africa will need supplies. One of the major problems that has come up is the shortage of equipment — medical equipment, personal protective equipment (PPE), test kits and so on,” Tedros said. “The leaders have agreed to look for concrete solutions to address the problem. They also believe that, considering the number of cases we have on the continent, that testing cases, tracing contacts and isolating them, using the comprehensive approach, will actually help.”

Nachega also highlighted the “urgent need” to increase early detection of the virus through mass community point-of-care rapid testing, contact tracing of positive cases and self-quarantine, as well as the importance of reliable PPE for healthcare workers.

“Existing GeneXpert machines used for the rapid diagnosis of tuberculosis and HIV could be used for COVID-19 testing and could be a game-changer, as they can provide decentralized testing with fast results — in 45 minutes — in remote communities,” he told Healio.

In addition, there is a need for “national and international donor support to finance medical equipment such as personal protective equipment — masks, gloves, disinfectant products and such — for health care workers and to rehabilitate and provide health facilities with equipment such as ventilators so that they can operate at the standards needed to combat the pandemic and save lives,” Nachega said.


“Indeed, the World Bank Group recently approved nearly $50 million to help the Democratic Republic of Congo deal with the implementation of containment strategies, training of medical personnel and distribution of PPE to ensure timely testing and contacts tracing activities,” he continued.

In spite of the challenges, though, Nachega believes urgent action can make a difference.

“Proactive implementation of social distancing and confinement need to be reinforced as much as possible and whenever feasible to flatten the epidemic curve and hence prevent thousands to millions of deaths related to COVID-19 in Africa,” he told Healio. – by Eamon Dreisbach


COVID-19: World Bank approves nearly $50M for DR Congo. Available at:, accessed on April 06, 2020.

Nachega JB, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa353.

WHO. Coronavirus disease 2019 (COVID-19) Situation Report – 77. Accessed April 7, 2020.

Disclosure: Nachega reports no relevant financial disclosures.