Low number of COVID-19 cases in Africa

South Africa appears to be over the COVID-19 surge, with death and infection rates mercifully lower than initially feared, however scientists and politicians caution that now is not the time to become complacent.

While experts predicted South Africa and the rest of the continent would be totally overwhelmed by the coronavirus, this has apparently not happened. And numbers were relatively low, as was the death rate, despite the poor health infrastructure across the continent.

The number of new daily confirmed cases overall has been dropping, although some countries are still seeing a rise in cases. At the time of going to press, South Africa had 640 441 confirmed cases and 15 086 deaths.

Hatzolah’s Lance Abramson told the SA Jewish Report: “Things have settled but the virus has not gone away. The number of cases are fewer but we are still seeing new infections and new patients signing up to our programme daily.”

Experts agree the surprisingly low death rate could be partly because of the comparatively young population in Africa, with COVID-19 being known to have a higher mortality rate for older age groups.

Africa has recorded more than a million confirmed cases, although the true extent of the pandemic in the continent is not known. “Testing rates are reported to be low, which could affect official numbers,” said Professor Lucille Blumberg, deputy director of the National Institute for Communicable Diseases. “It is difficult to compare the numbers because the degree of testing is quite low in many parts of Africa especially outside major cities.”

She said patients in rural areas presenting with respiratory illnesses and things like pneumonia were also not always tested for COVID-19 so it was difficult to know the exact numbers.

South Africa and Egypt have seen the largest recorded outbreaks so far, with South Africa one of only nine countries in the world to record more than 500 000 confirmed cases.

Initially, global authorities were highly concerned about the spread of COVID-19 in Africa.

“The first concern was that the virus would spread particularly rapidly and extensively in the African milieu. Urban conglomerates on the African continent are notorious for being overcrowded with poor sanitation and control measures, such as social distancing, would have been very difficult to implement,” said retired virologist Professor Barry Schoub, one of the medical experts advising the community.

“Secondly, the extent of underlying diseases, including tropical infectious diseases, tuberculosis, and HIV, as well as malnutrition, in much of the continent was an additional source of worry.”

However, he said observations to date of the epidemic on the continent have been “surprisingly positive”.

“The extent and severity of COVID-19 appears to have been far less than anticipated and considerably less than the earlier epidemic in European countries and the Americas,” he said.

Why this has been so is still being studied extensively. Several factors could explain this much unexpected outcome.

“Firstly, the age spectrum of the population on the continent is skewed to a much younger age than in developed countries, and advanced age is known to be a major risk factor for severe disease. This will probably turn out to be the major reason.

“Secondly, the widespread presence of infections and tropical diseases may, in fact, turn out to have played a positive role through the theoretical possibility of ‘training’ the immune system to protect against infection or serious disease from the coronavirus more effectively. This is purely speculative and evidence remains to be forthcoming.”

Thirdly, he said, tests, although extensive in some countries, may have underestimated the extent of the disease in many other countries.

“There may well be a complexity of factors contributing to the lower burden of disease in the African continent. It does indeed make for interesting medical science and valuable public health knowledge,” he added.

As at Wednesday, South Africa’s recovery rate was at 88%.

South Africa’s Health Minister Dr Zweli Mkhize said this week that the country had recently ranked fifth in the number of positive cases globally, but had since dropped to eighth and could drop further if the infection rate continued to drop. Despite this, he urged South Africans to remain cautious.

“We are at a point where our numbers are steadily coming down, hospitalisation numbers have reduced, and people in intensive care units are reducing. We must be very optimistic, but still very cautious. We are not seeing the end of the disease yet,” he said.