Coronavirus test kits boost for Africa, but have large numbers of cases already been missed?
- Years of conflict have left some African nations with minimal health provision and poorly equipped to handle an outbreak
- As donations and purchases of testing kits arrive, there is concern that the numbers diagnosed remain relatively low
More worrying, according to experts, is that several countries, including Somalia, South Sudan and the Central African Republic, have suffered years of conflicts that have left them with extremely weak health care systems that cannot cope with Covid-19, the disease caused by the coronavirus.
Most pressing is their capacity to test people. Somalia said on Friday it had tested 47 people for the coronavirus and 36 had tested positive. By the next day, 19 of the 25 tested were positive – a confirmation rate that observers considered shocking.
That took the country’s total cases as of Sunday to 164, with seven deaths. The cases included 15 health workers.
The numbers were still low compared with countries such as Egypt, South Africa and Morocco, which had by then recorded more than 3,000 coronavirus cases each, but it could mean that many cases had gone undetected, given the country’s limited testing capacity.
“There is an increased risk that cases may go undetected or undiagnosed if community transmission begins and becomes widespread,” said the Somalia branch of the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), which coordinates international responses to emergencies and natural disasters.
“In the past week there has been a 51 per cent increase in the number of reported cases in my continent, Africa, and a 60 per cent increase in the number of reported deaths,” Tedros, who is from Ethiopia, said.
The challenge of obtaining testing kits meant it was “likely that the real numbers are higher than reported”, he said.
Somalia confirmed its first case on March 16. With its barely functioning health system, it has been sending its specimens to be tested at the Kenya Medical Research Institute in Nairobi, and other laboratories in the region.
However, Somalia will this week start conducting its own testing, after the WHO funded three Covid-19 diagnostic and testing facilities, in Mogadishu, Garowe and Hargeisa.
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Dr Mamunur Rahman Malik, the WHO representative in Somalia, said that, as the Somali government scales up testing, “we expect that more cases would be detected in the coming days”.
“Our concern is the [already] weak and fragile health system in the country – the outbreak will place a heavy burden on it,” Malik said. “Some cases have probably been missed, but that is probably happening in every country.”
OCHA has warned of a significant impact on the 2.6 million internally displaced people who live in more than 2,000 crowded settlements with limited access to health care, water, sanitation and hygiene services.
To prevent the virus spreading, the Somali government has suspended all international flights other than humanitarian ones, declared a dusk-to-dawn curfew in Mogadishu, the capital, closed schools and banned large gatherings to ensure social distancing.
Humanitarian agency CARE International has said that Covid-19 was likely to have an even more extreme and long-lasting economic impact on the country than the decades of civil war from which it is still recovering.
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Somalia typifies many African countries that lack the capacity to test a large number of people, including South Sudan, which also ships its samples to Nairobi for testing. It too has suffered years of civil war since seceding from the Republic of Sudan in 2011.
South Sudan has four confirmed cases, all of them United Nations staff. To contain the disease, it has suspended international flights, closed land borders, closed non-essential shops and imposed a night curfew.
John Nkengasong, director of the Africa Centres for Disease Control and Prevention (Africa CDC), said that South Sudan was receiving testing kits and medical equipment donated by the WHO and the Jack Ma Foundation. Ma is the founder of Alibaba, which owns the South China Morning Post.
“We are very concerned with the ability to cope with [Covid-19],” said Nkengasong. “They are doing their testing in Kenya and we hope with time they will build their capacity in South Sudan.”
To help countries such as Somalia, South Sudan, the Central African Republic and the Democratic Republic of Congo scale up their testing, the Africa CDC and the African Union Commission are distributing 1 million tests in four weeks, rising to 10 million tests in 24 weeks. The kits are being bought from Germany and other countries outside Africa.
“There is a big gap in testing in the continent,” Nkengasong said. South Africa had been the most aggressive in its detection, with more than 120,000 tests conducted as of Monday, of which 3,300 were positive, while 58 people had died, he said. Ghana had done the second-most tests, with 68,591, from which it had diagnosed 1,042 people with the coronavirus and suffered nine deaths.
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“We have 1 million tests that we have ordered from Germany to support countries,” he said. “It is difficult and challenging that countries have not been able to scale up testing. Even 1 million tests will go a long way in boosting this.”
