After months of slow burn, Africa is now roaring towards one million coronavirus cases.
Many officials are looking anxiously to South Africa, where the virus is surging through densely packed urban areas, overwhelming some of the best equipped public hospitals on the continent and forcing authorities to dig mass burial sites.
“The continent is at a pivotal point,” Dr Matshidiso Moeti, the World Health Organization’s Africa Director said last week. “The virus has spilled out of major cities and spread into distant hinterland.”
“We can still stop Covid-19 from reaching full momentum, but the time to act is now,” Dr Moeti warned.
The region’s health sector has suffered decades of underinvestment by elites who prefer to be treated abroad in private clinics in Europe and many feared hospitals would soon be overwhelmed.
But over the last few months, the virus has spread far slower through the continent than many anticipated. Experts say the central reason for this is the quick action taken by the vast majority of African leaders.
As early as February, countries like Mali were screening the temperatures of people arriving by plane and handing out hand sanitiser, measures which are yet to be implemented in many richer countries like the UK.
By mid-March, most governments began to lock their countries down, stopping international air travel when there were just a handful of cases within their borders. Experts say these measures have helped to dramatically slow the spread of the virus through the continent.
Moreover, the fact that Africa’s population has a median age of about 19, has helped to keep death rates lower than in Europe where the median age is about 43.
So far there have been about 20,000 deaths directly linked to the virus, according to the Africa Centre for Disease Control (Africa CDC) in Addis Ababa.
While the pandemic has prompted governments around the world to retreat from multilateralism and implement protectionist policies, the virus has actually driven more international cooperation in Africa, say Landry Signé and Mary Treacy at the Brookings Institute in Washington DC.
They point to the many continent-wide responses to the crisis, like a medical supplies platform the African Union created in June to help African governments get what they need in a crowded international market filled with powerful players like the US and the European Union.
But now the virus has spread to every country on the continent and after months of economically damaging lockdowns, governments are being forced to loosen regulations and open their borders to trade and tourism.
As they do the virus is beginning to gain momentum from Kenya and Ethiopia to Zimbabwe and South Africa.
One major concern is a dire lack of testing. One analysis found that by July 7, Africa had only carried out 4,200 coronavirus tests per million people, almost 18 times less than Europe had carried out.
Even then, testing coverage varies significantly from country to country, leaving major gaps in the data. For example, South Africa has carried out some three millions tests on its 59m people, more than 10 times what Nigeria has done on its 200m population.
The dire lack of testing has prompted fears that a silent epidemic may be spreading through the continent.
South Africa currently has the lion’s share of African coronavirus cases. After two months of one of the most draconian lockdowns in the world, the government was forced to lift the measures because of catastrophic economic damage.
Covid-19 is now galloping through the continent’s most industrialised nation. Last week, South Africa hit 500,000 recorded cases, about half of Africa’s total and the fifth-highest tally in the world.
The pandemic is exposing the brutal inequality of South Africa’s densely packed townships and informal settlements, a legacy of apartheid-era housing policies where non-white people were only allowed to live in certain areas.
“We are seeing townships become virus hotspots because we haven’t dismantled the apartheid city,” Edward Molopi, a researcher at the Socio-Economic Research Institute in Johannesburg, told Reuters News Agency.
At the same time, South African doctors say the virus is exposing the endemic corruption and mismanagement which has left many public hospitals and clinics underequipped, understaffed and underfunded.
South Africa has a slightly older population than the rest of Sub-Saharan Africa, with a median age of 28 and so far, the rainbow nation has officially recorded some 8,300 deaths from the virus.
But the death count could be higher. Researchers at South African Medical Research Council, calculated that there had been more than 17,000 excess deaths in the country between the first week of May and the middle of July.
“Our epidemic did not grow dramatically in March because of the early intervention. The epidemic stalled [and] we bought ourselves six to eight weeks [with the national lockdown]. In that time, we constructed field hospitals to avoid the Italy situation,” Professor Salim Abdool Karim, who chairs the South African Ministerial Advisory Committee on Covid-19, told the Telegraph.
However, Professor Karim said that with the national lockdown now over cases were jumping by more than 7,000 every 24 hours.
He added that while his country had initially had “unity and common purpose”, widespread economic hardship and hunger meant that many people had lost confidence in the government’s response.
“We have lost our unity of purpose,” Professor Karim says “People are irritated, fed up, angry and don’t understand what happened. They look out the window and say, ‘but we stayed at home’.”
“Across Africa, many countries took swift and decisive action to contain transmission of the virus and prevent their epidemics reaching the tragic scale seen across Europe and the Americas,” says Charlie Whittaker, an infectious disease epidemiologist at Imperial College London.
“But the events in South Africa highlights the real and continued threat that Covid-19 poses to African nations, and just how fragile these initial gains can be as control measures are relaxed.”
Additional reporting by Peta Thornycroft in Johannesburg.
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