World and continental experts are racing against time to find ways to slow the internal spread of Covid-19 in Africa, where it’s often difficult for people to physically distance themselves from others, and where soap and water aren’t always readily available.

“I don’t think anyone has a magic bullet,” the director of the Africa Centres for Disease Control, John Nkengasong, said during a remote briefing yesterday (Thursday 2 April).

Infections in Africa stand at over 6,000 almost 40 days after the first case was reported on the continent. The number of infected people has doubled over the past seven days, and Covid-19 cases have been reported in more remote regions such as the easternmost regions of the Democratic Republic of the Congo, which only recently saw its last Ebola patient cured. In Burkina Faso, Cameroon and Senegal, the virus has started spreading outside capital cities and all of South Africa’s nine provinces have reported cases. 

“Social distancing is a proven method for controlling this kind of pandemic and outbreak, but the question is the process of how do you do that in communities that are challenged,” Nkengasong said.

“That is everyone’s fear and concern.” 

For now, community leaders and champions should help spread the message that social distancing is the most effective method in the absence of a vaccine and proven treatment for coronavirus, he said. 

“We have to use everyone’s cooperation. That’s all I can say at this point.” 

With an increasing number of countries on the continent going into lockdown, Nkengasong has warned against slapping travel restrictions on the whole country when the virus is only being transmitted in an area or a city. 

“It’s not necessary to lock down the entire country if transmission is not happening in certain areas, but you do want to do it in areas where transmission is becoming extensive. But engage your community ahead of time,” he warned. 

Lockdowns are in effect, among others, in Rwanda, Kenya, Uganda, the Republic of the Congo, Botswana, South Africa and in Abuja and Lagos in Nigeria. 

World Health Organisation regional director for Africa, Dr Matshidiso Moeti, said it was too early to say whether the lockdown in South Africa, which has the highest number of cases on the continent, has been effective. 

“The lockdown has been in place for a few days and I think the infections, the transmission that will start to be slowed down, will only show itself in a reduction of cases a few days from now,” she said. There was a backlog of a few days in testing, and South Africa was additionally burdened by having to help neighbouring countries with their tests.

Almost a week into South Africa’s lockdown, Health Minister Zweli Mkhize was, however, slightly more optimistic but nevertheless warned it could be the “calm before the storm”. 

At a briefing last night he announced that the number of positive cases in the country had climbed to 1,462, an increase of 82 from the day before.

“There is a restraint in the numbers which we think is the impact of the lockdown, the fact that we have closed the borders and the fact that there is not a lot of movement and people coming in from the outside,” he said. 

Moeti cautioned that lockdowns could have a serious impact on Africans, as many people work in the informal sector. 

“Some work in markets and need to earn money every day,” she said, adding that a lot of children are out of school, where they often receive free meals. The World Food Programme has stepped in to help provide for those who have no money for food.

Health authorities are working to put in place plans for what to do when the worst wave of the pandemic hits the continent. 

Moeti admitted the WHO does not know how many ventilators are available across the continent, but said experts are working on projections of the probable number of cases in different countries to estimate “what kind of gap there will be”. 

“At the same time, we work with partners on trying to find a way to source this type of equipment, and, very importantly, also plan for how to have transportation for the procured ventilators for these countries and to get the permission needed from governments to allow these deliveries to happen.” 

Even European countries with comparatively good health systems have struggled to get enough ventilators for those worst affected by coronavirus. 

Last week Moeti said there was a narrowing window for containing the spread in certain African countries, as the virus was brought in by travellers who were easy to contact-trace. Yesterday, however, there was a sense from her that this window might be closing soon. Moeti still advocated for “rigorous, meticulous application of public health measures” such as testing, immediate contact-tracing and quarantining and isolation to limit the spread, but community engagement is now starting to play a bigger role. 

People should be made to feel “empowered and confident on how they can take actions to protect themselves as opposed to being subjects of impositions of rules by government,” she said. DM