The following is a guest post by Dr. Bertha Serwa Ayi
China has been courting African nations for years. Chinese investment and infrastructure include the $200 million African Union headquarters in Addis Ababa, Ethiopia as well as a glistening medical school nestled in greenery of the Volta Region of Ghana. With the volume of Chinese traffic into Africa, concerns on the potential for widespread infection and transmission of COVID-19 to Africa were understandable surprise, all the more so as direct flights to and from mainland China continued unabated into Kenya. As the disease unleashed its fury in Asia with cases topping over 80,000 in China, sub-Saharan Africa paradoxically seemed unscathed with no smell of smoke or singing of hair as the embers waxed and waned in China. This baffled Africans and international journalists.
China neighbor South Korea expanded its testing capacity to about 10,000 a day with and has detected 7500 confirmed cases. Its healthcare system is overwhelmed to the point that some sick patients die at home while waiting for a hospital bed to become available. Africa was still quiet. The first drop to ripple its calm surface was a Chinese national who traveled to Egypt on Feb.14. This as soon followed by an infected Italian traveler who came to Nigeria on a Turkish airline on Feb. 28 and was reported ill after he had stayed at an airport hotel and traveled through two states. He was placed in a special infectious disease hospital for evaluation. He was found to have more than 100 contacts. One tested positive this week confirming human-to-human transmission on the continent and debunking some of the myths circulating among African social media that Africans were somehow immune to infection with SARS-CoV-2, the virus which causes COVID-19.
In Europe it has been tumultuous as Italy faced a surge of cases, and France, Germany and Spani faced a sudden increase. Spain reported 435 cases on March 10 alone. An exhausted Italy imposed a mandatory quarantine on Northern Italy and ultimately imposed a national quarantine on its 62 million population surpassing the quarantine in Hubei province in China in numbers. Italian healthcare workers were having to make heart wrenching decisions of who should get a critical care bed, and who should be asked to go home. This was not until Africa had felt a substantial spillover from Italy as its confirmed cases in Africa gradually increased from single digits into the teens more than half of which were initally directly related to travel from Italy, with another handful related to travel to France. To date these are the cases being managed on the continent.
- Nigeria: Two cases. The first patient was a returning traveler from Italy. The second was a contact of this index patient.
- Senegal: 10 cases, One was a traveler from France.
- Burkina Faso: Two cases returned from a trip in France.
- Egypt: 67 cases
- Tunisia: Seven cases. The first five cases had all traveled from Italy.
- Algeria: 24 cases and one death. First case was a traveler from Italy who was later sent back to Italy. The next group was a family who received a guest from France
- South Africa: 17 cases. First was a traveler from Italy
- Cameroon: Two cases. The second was a contact of the first, a French citizen who had arrived on Feb. 24.
- Togo: One. A patient who arrived by land and had traveled to Benin, Germany, France and Turkey.
- Democratic Republic of Congo: One case. A Belgian citiizen who had been in the country for several days.
- Morocco: six cases and one death. The first case was a citizen who had returned from Italy.
- Cote d’Ivoire: One case reported March 11 from a returning traveler from Italy on March 11.
- Gabon: One case. A Gabonese citizen who returned from a trip to France.
So far no sustained transmission has been reported in any of these African countries. In the meanwhile most African countries, keenly aware of the dearth of their hospital capacities have kicked into full gear their attempts at detection and isolation as critical piece of their preparedness plan supplemented by modified travel restrictions. Kenya recently discontinued direct flights from China.
Ghana is is located just north of the equator along the Gulf of Guinea. It is surrounded by nations with confirmed cases. It is bordered on the north by Burkina Faso on the east by Togo, and on the west by Cote d’Ivoire. To date according to personal communication with Dr. Anthony Nsiah Asare, current advisor to the President of the country on health and former Director General of the Ghana Health Service, all 57 tests run by the Noguchi Memorial Institute for Medical Research in Accra and another six run by the Kumasi Center for Collaborative Research on Tropical Medicine in Kumasi on suspected patients have all been negative. This quickly debunked an initial erroneous report from the BBC news in the early hours of March 11, 2020 that the nation has one positive test result.
Since my last post examining preparedness in Ghana, the nation has identified treatment centers at all of its 16 administrative regions. On March 11, Ghana joined Kenya and Gabon in restricting all international travel for all public health officials effective immediately. The screening at the airport is so meticulous that a British crew member of an unidentified airline called in to London’s radio station Leading Britain’s Conversation a popular network in Britain. In the call to the host of LBC 97.3, the crew member praised Ghana for their stringent screening methods. He describes his experience at the Kotok International Airport as follows, “When I got to Ghana, they had everything laid out. I mean I thought I was in a surgical ward, and that was in a third world country. They had people dressed up like surgeons who took our temperature. They did everything.” He bemoaned how he had no screening procedures and no officials mandated to ask any screening questions on arrival at London’s Heathrow airport. He expected more from Britain. Kotoka International Airport was awarded “the most improved airport” and the best in Africa by the Airport Council International on March 11.
In Rwanda, emergency water faucets had been placed outside bus stations for passengers to wash their hands and feet prior to boarding the city buses in Kigali.
Myths also abound. Videos of a woman proclaiming eating garlic (She proudly pronounces it as “guyric”) would ward away COVID-19 diseases floats freely on social media. A charlatan prophet claims he has found the oil that will destroy “colloravirus”. Some charlatan preachers vowed to purchase tickets to Wuhan city to confront the virus. Meanwhile an online report of one Cameroonian who recovered from the disease in Wuhan city has got many believing that African genes are immune. One recovered patient is a testament to the progression of the disease in healthy young people. Less than 2% of COVID-19 cases have occurred in patients less than 20 and so far no one below the age of 10 has died despite evidence of high viral loads. The Cameroonian patient is proof that Africans are as susceptible to the infection as any other race. One of the patients in a Maryland Hospital is a Nigerian male. A colleague of mine who works in London is on home quarantine after a patient of Nigerian descent who was profoundly ill had a positive test results. Africans do not have a natural immunity to SARS-CoV-2
Then there is the myth of the weather effect. Some Africans erroneously believe that the virus will not survive in the warm weather of sub-Saharan Africa. However multiple studies of coronaviruses in bats and in patients who present with acute respiratory illnesses have shown that coronaviruses are present in bats in Ghana and Kenya, where studies have been done, and likely in most African countries. In Ghana about 2-3% of patients with respiratory illness evaluated at select sentinel sites have been attributable to coronaviruses. African Health Care sectors have side stepped all these floating myths that will lull them into a false sense of security and continue to tirelessly ramp up their preparedness plans. This disease has shown us by carefully observing the surge of cases in Italy, Iran and in the United States that when the surge occurs from an initial handful of cases it will quickly overwhelm and disrupt all laid out plans. US cases just went over 1100 after only 4500 tests had been performed outside of commercial labs. South Korea is now running 10,000 tests a day some through drive-through testing site. Germany has followed suit. If the United States implements the same massive roll out of testing it may be quite revealing how its hospitals will handle the surge and how many will actually test positive. In the meanwhile African countries do not want to wait for a surge of cases, they want to stop them at the points of entry with a modest insight of their limited hospital capabilities.
Addendum: Since this article was first published March 12, Ghana reported its first two cases. Two unrelated travelers, a Nortwegian citizen and a Ghanaian diplomat who had traveled through Turkey. These are the first two positive tests out of the 65 per the Ghana Health Service.
Bertha Serwa Ayi, MD, FACP, FIDSA, MBA is an adjunct Assistant Professor of Medicine at the Kansas Health Sciences Center, USA and an adjunct lecturer at the University of Development Studies, Ghana. She is a graduate of the University Of Ghana Medical School (UGMS Class of 1996) where she graduated with honors and received the Alcon/Paracelsus Award in Ophthalmology. She completed her Internal Medicine Residency training at Good Samaritan Hospital Inc., affiliated with Johns Hopkins University School of Medicine in Baltimore Maryland in 2002. Furthermore, In 2004, she completed fellowship training in Infectious Diseases at a combined training program at Creighton University Medical Center, University of Nebraska Medical Center and the Veterans Administration Hospital in Omaha, Nebraska. She is a Board Certified Infectious Disease Specialist and a fellow of the American College of Physicians (FACP) and the Infectious Disease Society of America, which produces this blog. She is in private practice.