PORT ELIZABETH, South Africa,:Dec 26:
When the pandemic began, global public health officials raised grave concerns about the vulnerabilities of Africa. But its countries overall appeared to fare far better than those in Europe or the Americas, upending scientists’ expectations. Now, the coronavirus is on the rise again in swaths of the continent, posing a new, possibly deadlier threat.
In South Africa, a crush of new cases that spread from Port Elizabeth is growing exponentially across the nation, with deaths mounting. Eight countries, including Nigeria, Uganda and Mali, recently recorded their highest daily case counts all year. “The second wave is here,” John N. Nkengasong, the head of the Africa Centers for Disease Control and Prevention, has declared.
When the virus was first detected, many African countries were considered particularly at risk because they had weak medical, laboratory and disease-surveillance systems and were already battling other contagions. Some were riven by armed conflict, limiting health workers’ access. In March, Tedros Adhanom Ghebreyesus, the first African director-general of the World Health Organization, cautioned, “We have to prepare for the worst.”
But many African governments pursued swift, severe lockdowns that — while financially ruinous, especially for their poorest citizens — slowed the rate of infection. Some deployed networks of community health workers.
The Africa C.D.C., the W.H.O. and other agencies helped expand testing and moved in protective gear, medical equipment and pharmaceuticals.
The reported toll of the pandemic on the continent — 2.6 million cases and 61,000 deaths, according to the Africa C.D.C. — is lower than what the United States alone currently experiences in three weeks.
But that accounting is almost certainly incomplete. Evidence is growing that many cases were missed, according to an analysis of new studies, visits to nearly a dozen medical institutions and interviews with more than 100 public health officials, scientists, government leaders and medical providers on the continent.
“It is possible and very likely that the rate of exposure is much more than what has been reported,” Dr. Nkengasong said in an interview.Now, as they battle new outbreaks, doctors are convinced that deaths have also gone uncounted. Dr. John Black, the only infectious-disease specialist for adults in Port Elizabeth, said he and other physicians feared that many people were dying at home. Indeed, a government analysis showed that there had been more than twice as many excess deaths as could be explained by confirmed cases in South Africa. “We don’t know what the real number is,” he said.
Scientists are also considering other explanations for the continent’s outcome. These range from the asymptomatic or mild infections more common in youth — the median age in Africa is just 19.7, about half that of the United States — to unproven factors including pre-existing immunity, patterns of mobility and climate. If those conditions helped protect against the virus earlier, officials ask, will they do so now?
In South Africa, the continent’s leader by far in coronavirus cases and deaths, the growing devastation in its medical system has led to the rationing of care for older adults. Last week, officials announced that a new variant of the virus that may be associated with faster transmission has become dominant. With stricter control measures lifted and many people no longer seeing the virus as a threat, public health officials fear that Africa’s second wave could be far worse than its first.
“The risk perception has gone from something very scary at the beginning to now something people are not worried about anymore,” said Dr. Chikwe Ihekweazu, director-general of the Nigeria Center for Disease Control.
Some Africans view Covid-19 as an affliction of Westerners and wealthy travelers. In a classroom in a Somali community displaced by drought and war, a fourth grader readily identified the United States as having the most cases. “Donald Trump was Covid-19-positive,” he said.Determining the death toll is especially challenging. Only a third of the nations on the continent record and report annual deaths, according to the U.N. Economic Commission for Africa, many not meeting international standards.
But South Africa offers clues.
An estimated 60,000 more people have died there than would normally be expected; fewer than half have been attributed to Covid-19. Disrupted health services may account for some of them, but researchers believe that many fatal Covid cases have gone undetected.
Older adults, people with chronic health conditions and those admitted to public, rather than private, institutions are more likely to die, according to the country’s National Institute for Communicable Diseases. White South Africans have been hospitalized for the coronavirus at higher rates than their share of the population, probably because of their higher average age. But the institute found that when controlling for age, Black, Indian and mixed-race South Africans were more likely than white South Africans to die of the disease in hospitals.
Still, experts generally believe that fatalities on the continent are far lower than in the West, potentially for reasons beyond demographics. For instance, countries that regularly immunize babies with a tuberculosis vaccine also tend to have lower coronavirus mortality, though a causative link has yet to be proved.
To achieve widespread immunity, more targeted vaccines are needed, like those now rolling out in the United States and Europe. Most African countries have not struck direct deals with Western vaccine makers, though some are importing Chinese-made vaccines not yet vetted by stringent regulators.
The continent itself has little vaccine-manufacturing capacity. Biovac, a company in Cape Town, was trying to find a partner and would need up to a year to begin filling vials.