Authors : Katharine Houreld, David Lewis, Ryan McNeill and Samuel Granados
Affiliated organization : Reuters
Type of publication : Graphics
Date of publication : May 7, 2020
Africa has recorded over 51,000 cases of COVID-19, a fraction of the 3.76 million cases recorded globally, according to a Reuters tally. But the number of cases jumped nearly 38% in the past week. The United Nations Economic Commission for Africa (UNECA) has warned that even with intense social distancing, the continent of 1.3 billion could have nearly 123 million cases this year, and 300,000 people could die of the disease.
Low levels of testing make it impossible to know the true scale of infection. Africa has carried out a fraction of the COVID-19 testing that other regions have – around 685 tests per million people, although the rate of testing varies widely between countries. By comparison, European countries have carried out nearly 17 million tests, the equivalent of just under 23,000 per million people.
In many nations like Nigeria, South Sudan and Zimbabwe, electricity is extremely unreliable and hospitals depend on diesel-powered generators. Some health facilities in poorer, often rural, areas are unable to pay for the constant refueling and maintenance they need
Africa’s public health systems are notoriously ill-equipped, but there is also little public data on the resources they have to fight the virus.
The findings are stark. Most nations have severe shortages of medical personnel, especially critical care nurses and anaesthesia providers. The continent averages less than one intensive care bed and one ventilator per 100,000 people, Reuters found. This compares with 20-31 intensive care beds per 100,000 people in the United States, according to estimates in a 2012 survey for the U.S. National Institutes of Health.
Many African governments moved quickly to contain the pandemic, mounting high-profile public health campaigns, restricting movement and repurposing factories to produce protective equipment. Donations have poured in from a foundation set up by Chinese billionaire Jack Ma, and the World Bank is helping procure more than $1 billion worth of equipment for Africa.
Nevertheless, the Reuters survey and analysis of researchers’ projections showed that even in a best-case scenario, Africa could need at least 111,000 more intensive care beds and ventilators more than 10 times the number it has at present.
The East African nation of Tanzania, publicly criticised by the WHO for not restricting large gatherings, has sometimes gone for days without updating its coronavirus figures and has refused to tell donors anything about its public health resources, a diplomat told Reuters. A government spokesman said it was not true that Tanzania was not sharing information and referred Reuters to the health ministry for data, which did not respond.
Central African Republic’s Health Minister Pierre Somse was surprised to learn from an aid agency’s press release that the country had only three ventilators – he had no idea they had any, he said. Even where information is available, it is often hopelessly out of date. The WHO does not have the funds to carry out detailed surveys on a regular basis.
Not enough tests
So far, 868,227 COVID-19 tests have been carried out in Africa, according to a Reuters tally of official figures reported to the Africa CDC. That means around 685 tests have been carried out per million people – far below the 37,000 per million in Italy or 22,000 in the United States. “If you don’t test, you don’t find,” said John Nkengasong, director of the Africa CDC.
Africa could need at least 111,000 more intensive care beds and ventilators more than 10 times the number it has at present
South Africa accounts for 30% of Africa’s tests, although it has less than 5% of the population. Nigeria, which has 15% of the population, has carried out just 2% of testing; it began by testing strategically then broadened it out, Health Minister Osagie Ehanire said. Chad and Burundi have carried out fewer than 500 tests each. Chad said it didn’t have enough testing kits and staff after many of them had fallen ill; Burundi did not respond. Tanzania carried out 652 tests and identified 480 cases.
In January, only South Africa and Senegal could test for the new coronavirus, but now all African countries can perform tests apart from tiny Lesotho and the island nation of Sao Tome and Principe. But there is a global shortage of testing materials. Kenya has the capacity to carry out 37,000 tests per day, a Senate report based on information from the health ministry found, but has only carried out about 26,000 in all. It does not have enough laboratory personnel, sample collection kits or supplies, and has also received faulty test kits as donations.
The WHO estimates around 14% of COVID-19 patients will require hospitalization and oxygen support, and 5% will need a ventilator. Some countries are setting up extra beds for COVID-19 patients in places like sports stadiums or pop-up tent hospitals. The number of those beds can change rapidly, but that’s not intensive care.
Intensive care beds are expensive, difficult to run, and very unevenly distributed. Chad, an oil-rich but impoverished nation of 15 million people, has only 10, whereas the island nation of Mauritius, a financial hub home to 1.2 million, has 121.
The continent’s three giants – Nigeria, Ethiopia and Egypt – have 1,920 intensive care beds between them for more than 400 million people. Nigeria’s health minister said the country had not had to use most of its equipment yet, but it had still ordered more.
So far, 868,227 COVID-19 tests have been carried out in Africa, according to a Reuters tally of official figures reported to the Africa CDC. That means around 685 tests have been carried out per million people – far below the 37,000 per million in Italy or 22,000 in the United States
There are discrepancies between official figures and the experience of frontline medical staff, Reuters found. Uganda said it has 268 ICU beds in public hospitals. But only about 70 ICU beds countrywide have the necessary staff and equipment to function, said Arthur Kwizera, a lecturer in anaesthesia and intensive care at Makerere University College of Health Sciences whose team carried out a study on intensive care capacity late last year. The government did not respond to requests for comment on that point.
How much will be needed ?
Under a best-case scenario – what Imperial College researcher Charlie Whittaker described as a complete lockdown for an indefinite time – at least 121,000 critical care beds will be needed at the peak of the pandemic on the continent, Reuters found. That compares with 9,800 at present, according to the Reuters survey.
Some nations, such as Guinea Bissau, have no ventilators at all. Mauritania has one; Liberia said it has six; Somalia has 19. South Africa has 3,300, but about two-thirds are in private hospitals, which the majority of the population cannot afford. The health ministry said the state has the right to use private facilities in an emergency.
Africa has no history of building ventilators. South Africa’s state-owned defence company Denel plans to begin making them, and institutions in Kenya and Senegal have developed prototypes. But authorities in Senegal say they’ve only certified imports before; it could take months to get a prototype certified and mass-produced.
In many nations like Nigeria, South Sudan and Zimbabwe, electricity is extremely unreliable and hospitals depend on diesel-powered generators. Some health facilities in poorer, often rural, areas are unable to pay for the constant refueling and maintenance they need.
Doctors, critical care nurses, anaesthesiologists and biotechnicians – essential for maintaining equipment – are in short supply, although data from many countries dates back years. Continent-wide, one doctor serves an average of 80,000 people, World Bank data shows. There are more in wealthy Mauritius – 2 doctors per 1,000 – but countries like Liberia, Malawi or Burundi have far fewer.
Anaesthetists run critical care units in many African nations. But only nine countries have one or more physicians qualified to administer anaesthetics per 100,000 people, according to the World Federation of Societies of Anaesthesiologists. Most have staffing levels comparable to Afghanistan or Haiti.
Equipment and personnel are arriving: For example, the World Bank is helping more than 30 African nations source medical supplies. South Sudan recently received a donation of five ventilators, bringing its total to nine.
Doctors, critical care nurses, anaesthesiologists and biotechnicians – essential for maintaining equipment – are in short supply, although data from many countries dates back years
Private hospitals are generally better staffed, but their revenues have dropped by an average of 40% since March, mostly due to a decline in elective surgeries and regular outpatient chronic treatment, said the Africa Healthcare Federation, an umbrella organisation for the private healthcare sector.
Some governments on the continent are trying to negotiate access to private hospitals for patients who can’t afford the fees. But most hospitals say they will need some form of payment and – mindful of governments that pay bills late or not at all – some would prefer that an internationally administered independent fund handle the payments.
Les Wathinotes sont soit des résumés de publications sélectionnées par WATHI, conformes aux résumés originaux, soit des versions modifiées des résumés originaux, soit des extraits choisis par WATHI compte tenu de leur pertinence par rapport au thème du Débat. Lorsque les publications et leurs résumés ne sont disponibles qu’en français ou en anglais, WATHI se charge de la traduction des extraits choisis dans l’autre langue. Toutes les Wathinotes renvoient aux publications originales et intégrales qui ne sont pas hébergées par le site de WATHI, et sont destinées à promouvoir la lecture de ces documents, fruit du travail de recherche d’universitaires et d’experts.
The Wathinotes are either original abstracts of publications selected by WATHI, modified original summaries or publication quotes selected for their relevance for the theme of the Debate. When publications and abstracts are only available either in French or in English, the translation is done by WATHI. All the Wathinotes link to the original and integral publications that are not hosted on the WATHI website. WATHI participates to the promotion of these documents that have been written by university professors and experts.