Africa’s Struggling Health-Care Systems Brace for Coronavirus

(Bloomberg Businessweek) -- In a red-roofed building at the edge of the University of Abuja Teaching Hospital campus, the walls are freshly painted, a crew is laying pipes for refurbished bathrooms, and others are hauling in furniture. The single-story concrete structure, meant for trauma victims at the largest health-care facility in the Nigerian capital, is being rapidly repurposed to quarantine patients diagnosed with the coronavirus, putting it on the front lines of Nigeria’s—and Africa’s—efforts to contain the illness. “We are moving, we are going to get there,” Yunusa Thairu, the leader of the hospital’s coronavirus response team, tells staff crowded into an auditorium next door. “Let’s be confident. This is not a death sentence.”

Across Africa, officials are bracing for a rapid spread of the pathogen. The worry is an outbreak could devastate the region, which accounts for 16% of the global population but just 1% of health-care spending. There’s little money for ventilators and other life-support equipment needed for severe cases of Covid-19, and any sustained fight against the coronavirus would steer resources away from malaria and HIV, which kill hundreds of thousands every year. If Italy, with 41 doctors per 10,000 people, is struggling to contain the disease, virus trackers fear what would happen if it were to sweep across Africa, where there are just two doctors per 10,000. “It will be worse in an African setting,” says Nathalie MacDermott, an infectious disease specialist at King’s College London.

Nigeria is where the virus first made landfall in sub-Saharan Africa, on Feb. 27, when an Italian businessman tested positive in Lagos, the country’s sprawling, congested commercial capital. It has appeared in at least 10 other African nations, sparking a flurry of responses. On March 2, Senegal reported a French national had been infected. A few days later, Egypt said it had 48 cases, most linked to a Nile River cruise ship. Kenya has set up isolation facilities in Nairobi, activated an emergency operations center, and secured extra protective gear. “A lot still needs to be done,” says Isaac Ngere, a member of Kenya’s national coronavirus task force. “Our schools are crowded. Our living areas are crowded. Our public transport is crowded. That’s a good environment for the disease to spread.”

The International Monetary Fund on March 4 pledged to make $10 billion available at zero interest to help poor countries, especially in Africa, tackle the virus. The World Health Organization has supplied testing equipment and training throughout the continent while focusing on 13 countries with strong links to China, the region’s top trading partner. Muhammad Ali Pate, a former Nigerian health minister now with the World Bank, fears the virus could devastate “the crevices of society” where health systems are weak. “If you look at a map, you will see areas where cases have not been detected,” Pate says. “That may reflect that the virus isn’t there. But it may be telling us something else: that they may not have the capability to test.”

• Does Ebola offer any lessons?

Health authorities fret that efforts to fight the coronavirus will indirectly contribute to an increase in deaths from illnesses such as malaria, which kills about 400,000 Africans a year. The 2014-16 Ebola epidemic, which left more than 11,000 dead, highlights the risk of overwhelming health-care systems. Across West Africa, the Ebola crisis disrupted treatment of malaria, HIV, and tuberculosis: Many clinics shut down, and patients with other ailments avoided doctors for fear of contracting Ebola. “More people died from a lack of general health services than from Ebola,” says Jimmy Whitworth, a professor of public health at the London School of Hygiene & Tropical Medicine. “We must make sure we don’t neglect those services while we fight the coronavirus.”

With 60% of Africans under 25, the disease may not be as deadly there as it is in European or Asian countries with older populations. Unlike in the West, with its nursing homes, the elderly in Africa usually stay with their families, reducing clusters of vulnerable people. And Ebola may have given Africa a better sense of how to deal with outbreaks. As the disease—far more virulent than coronavirus, but less communicable—spread across Africa in 2014, Nigeria avoided an epidemic by tracking and isolating potential cases. “The structures and emergency response strategies that worked well for Ebola are being reactivated,” says Niniola Williams, head of a nonprofit that battles infectious diseases in Nigeria.

Chikwe Ihekweazu, who leads Nigeria’s Center for Disease Control, is overseeing the country’s response. In February the German-trained epidemiologist joined a WHO mission on a visit to Wuhan, the epicenter of the outbreak in China. Since his return two weeks ago, he’s been in voluntary isolation, working from a cramped studio at his home in an upscale neighborhood in Abuja. While places such as the university hospital, with clean wards dating from the 1980s oil bonanza, are preparing, he says Nigeria is ill-equipped for an outbreak. Clinics in smaller cities and the countryside lack everything from bandages to beds to physicians, and he has a staff of just 250, with five laboratories to test new infections in a country of 200 million. The U.S. Centers for Disease Control and Prevention, by contrast, has 11,000 employees and hundreds of labs.

Ihekweazu fears the prevalence of malaria in Africa could make it hard to trace cases, as the ailments’ early symptoms are similar, and the widespread incidence of HIV has left many vulnerable to Covid-19. “It’s a challenge around diagnoses, a challenge around care,” he says, hunkered in his home office, as two assistants work at the table in the adjacent dining room. “My nightmare scenario is a situation like Italy, in which significant transmission has already started by the time you have a chance to control it.”
 
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To contact the editor responsible for this story: David Rocks at drocks1@bloomberg.net

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