the “beginning of a return to normal” for Africa

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Sampling of a saliva sample at a Covid-19 screening unit in Cairo on June 21, 2020.

One month to the day after having passed its epidemic peak, Africa continues to see the coronavirus pandemic rapidly diminishing on its soil. She would even be living the “Beginning of a return to normal”, according to Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, invited to speak during an exchange, Thursday, September 24, organized by the Africa office of the World Health Organization (WHO) .

If the situation is more engaging than elsewhere, the director of the UN regional agency, Matshidiso Moeti, nevertheless posed a caveat, believing that “Even though everyone is hoping for a vaccine for 2021, the continent is not immune from a second wave and the road to definitively emerges from the crisis is still long.” It is indeed, at present, still impossible to say whether the fifty-four countries will be able to end, or even relax, by the end of the year the restrictions that they impose on themselves.

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However, with 34,836 deaths due to Covid-19 and 1.43 million infections for 1.2 billion inhabitants, Africa was the most spared from the pandemic alongside Oceania. Even South Africa and Egypt, which account for two-thirds of the continent’s deaths, account for “only” 22,000 deaths. This is less than France and its 31,447 dead when the two countries together weigh 2.3 times the population of France.

This toll, even provisional, is a long way from Western alerts of the start of the pandemic predicting Africans that they would be “Decimated”, wanted to remind the doctor Ugandan Sam Agatre Okuonzi, from Arua Regional Hospital, also guest speaker. A fear that was based on the fragility of health systems that could not withstand the strong pressure of powerful epidemic centers.

Huge awareness work

During the rise of the pandemic, “The models were also complicated on the continent by the fact that few patients were hospitalized, traces the head of the WHO Africa office. Because of the youth of the population and the very high rate of asymptomatic cases – nearly 80% against an average of 40% in Western countries. Everyone lacked information to make accurate forecasts “, she wanted to clarify.

“We have been working on new models throughout the pandemic by collecting as much data as possible and drawing lessons from our Ebola experience, complemented by Francisca Mutapi, professor of global health, infection and immunity at the University of Edinburgh. Over the months, we have conducted a comparative analysis of the different responses to come out the best. “

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The four doctors agree in praising the enormous awareness-raising work carried out with communities on barrier gestures, wearing a mask, hygiene, social distancing and traffic restrictions.

But beyond this summary X-ray, these public health specialists wished to question further the specificities of this continent to identify what has protected Africans from the major sources of contamination that the countries of the North have known and still know.

Readiness to respond

In their eyes, the speed to react is the first point to underline. As soon as the first case was discovered on February 14 in Egypt, “African leaders very early on closed all international air links and their internal borders. And the health instructions were well received by the populations ”, insists Dr. Moeti.

Obviously, the youth of a continent where only 3% of the African population is over 65, has counted. All the more so as the practitioners were keen to observe that a country like Algeria, in full demographic transition with already more than 10% of people over 65, was more affected than others with nearly 1,700 death.

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The social structure of families has also been advanced, since the very old, who represent only 1% of the African population, do not live in reception structures (of the nursing home type) which have been so fatal to them in the West. In addition, the large proportion of the population still living in rural areas, where daily life takes place outdoors, could also have been a protective element, such as the low use of transport in these areas.

Conversely, for countries like South Africa or Egypt, the urban density, even overpopulation in certain areas, have largely favored the spread of the virus. There could also be the possibility of cross-immunity for populations already exposed to other types of coronavirus, also insisted Professor Francisca Maputi. Suffice to say, the specialists concluded, that the continent’s resistance factors have been multiple and that it will take months, even years, to analyze them in more detail.

Increased vigilance

This situation, for the time being much less gloomy than imagined, does not prevent increased vigilance on the evolution of the virus in the fifty-four countries, none of which has been spared. This is why the WHO and the African Centers for Disease Control and Prevention (Africa CDC) announced two weeks ago the launch of a network of twelve laboratories, including ten African ones, to strengthen the sequencing of the genome of the severe acute respiratory syndrome (SARS-CoV-2). While several countries, like Senegal and Morocco, are now producing their own Covid tests.

“It is essential to be able not only to follow the evolution of the virus, but also to assess its possible mutation in order to put in place an effective response”, explained Mme Moeti. And for that no less than 2,016 virus sequences, coming from eighteen countries (Algeria, Benin, Cameroon, DRC, Egypt, Gambia, Ghana, Kenya, Madagascar, Mali, Morocco, Nigeria, Senegal, Sierra Leone, South Africa. South, Tunisia, Uganda, Zambia) have already been generated and are being analyzed. Which even makes him say that “Thanks to this new network, we are in a better position to develop vaccines and treatments adapted to African populations and, ultimately, to control Covid-19”.

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So far, sequencing has already revealed that most versions of the coronavirus that have circulated on the continent come from the lineage that emerged in Europe. In other words, the coronavirus has largely been imported. This confirms that the Pan-African strategy of restricting movement on land, sea and in the air has indeed been the right one. But this collection is also very valuable for understanding how the virus circulates while transforming.

Ten lineages on the continent were thus identified and their grouping by lineage or subline reveals the links or imports of SARS-CoV-2 from one African country to another. “Thanks to genomic sequencing, we can better understand the pandemic by more precisely identifying the transmission groups”, explained Dr John Nkengasong, director of the Africa CDC.

As a side effect, the coronavirus crisis will therefore also have advanced partnerships between countries on the continent and the expertise of its scientists, whom the Ebola episodes had already well armed. But “We need more African researchers, Francisca Mutapi concluded. Researchers who can dialogue with national and continental institutions to build, whatever the virus, the most relevant response possible. “ And the Ugandan Sam Agatre Okuonzi to add: “And learn the lessons of an African epidemic that is far from the disaster announced. “

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