While South Africa was preparing to lock down in an effort to stop the spread of the coronavirus, World Health Organisation regional director for Africa Matshidiso Moeti warned that the “unwanted impacts” of such a move could be significant.

She said she could see countries surrounding South Africa adopting similar measures soon, as South Africa’s confirmed Covid-19 cases surpassed the 900-mark. By Thursday more than 3,000 confirmed cases had been reported in 46 African countries, with South Africa’s caseload the highest. Rwanda had already gone into a strict lockdown earlier in the week.

“Our expectation is that more and more countries will put in place these measures,” she said.

President Cyril Ramaphosa announced this week that South Africans have to stay home for the next three weeks, with only essential services still operating. Borders will be closed and movement between provinces will be limited.

Moeti told an online cross-continental, coronavirus-safe press conference organised by the World Economic Forum in Geneva that a lot of people are negatively impacted economically by a lockdown. To make it worthwhile, the lockdown should be accompanied by “a very rigorous implementation of key public health measures”. These include testing, tracing and following up with people who had contact with others who tested positive for Covid-19.

“We have seen more and more countries put in place these measures to minimise the transmission of the virus in various ways,” she said. “Many have closed borders or stopped flights from high-risk countries, and some to all countries.” She said the WHO emphasised the importance of keeping open “humanitarian corridors” to allow the necessary supplies and staff to move around. 

“I expect countries will take account of the due impact of the measures and assess what is the impact of these measures, because we thought that the unwanted impacts can be significant.” She noted that South Africa put into place “mitigation measures” to help the vulnerable.

For Africa, the good news for now is that there is still an opportunity to stop the spread. In about half of the affected countries, those who have Covid-19 are people who brought in the virus.

“We still have a window [to contain the virus], although it’s narrowing day to day,” she said. “If there is a really rigorous and systematic follow-up of these cases, identification, isolation, follow-up of the contacts, [this] is what could really make the difference. We could still contain the virus in these countries.”

The situation is evolving very quickly though, because only just over a month ago only one African country had reported a Covid-19 case. But she cautioned that many people in low-income urban areas and refugee camps might find it difficult to keep a distance from other people and to wash their hands regularly – two things that the WHO prescribes to prevent the spread of the virus. 

High-level political support and commitment are needed.

“We have seen a number of countries and a number of heads of state put in place the mechanisms at the most senior level,” she said, mentioning Kenya, Ghana, Uganda, Ethiopia and South Africa as examples of this. 

She said countries should channel all the expertise they have into fighting this disease.

“In the WHO, most of our staff no longer are doing their day jobs. They’ve been channelled into the response. Ministers of health must pull in their capacities and respond with what they have to prevent onward transmission.” 

Africa has been slow to report positive cases of the coronavirus, but Moeti said it’s unlikely that this was due to large numbers of infected people falling through the cracks. “There (have) been hundreds of alerts of people and contacts that have been tested in African countries, and many of them were discarded, found not to be positive,” she said. 

“We don’t believe there (is) a widespread number of people who are infected, because we have an influenza surveillance network in more than 23 countries and it has not reported having observed an uptick in the syndrome that is typical of this disease. While we recognise there are people who are asymptomatic, and therefore not tested, not counted, we don’t think there are hugely increased [numbers of] people walking around with the virus who are not detected.” 

In response to the difficulty of social distancing in African communities, where people often live close together, Dr John Nkengasong, director for the Africa Centres for Disease Control and Prevention in Ethiopia, said there was “not an easy answer to that”. 

He said: “Our communities are what they are, and we have to think through the issues of social distancing in the context of our own social and cultural living. Households are large and at the same time, we have to recognise this is an important measure that must be implemented if we have to have a chance to fight back against this enemy. We need to use all the tools we have including involving early on our social scientists to this fight.”

Dr Zabulon Yoti, WHO Medical Officer Epidemic and Pandemic Alert and Response, admitted there are “very significant gaps in all the countries” on the continent in responding to the coronavirus.

“No country has all the required capacities to adequately respond to this pandemic.” Countries where there are “armed conflicts with a massive displacement of the population” are in a particularly bad position, he said. 

In a report earlier this week, the International Crisis Group warned that in cases of active conflict it will be difficult to get medical and humanitarian help to the ill. Violent militias blocking access to some affected areas in 2019 made it difficult for the WHO and international NGOs to contain the Ebola outbreak, meaning it lasted longer and claimed more lives than it would have done in peacetime.

“At times, combatants targeted doctors and medical facilities themselves,” the report said. DM