Africa Turns to Home Care With Virus Cases Inundating Hospitals

(Bloomberg) -- As hopes fade that Africa will be spared the worst of the coronavirus pandemic and hospitals fill up, authorities are facing the grim reality that many severely ill patients will have to recover -- or die -- at home.

The continent accounts for less than 5% of the 7.6 million confirmed infections globally, but cases are rising rapidly as the disease takes hold in several cities where overcrowding makes physical distancing almost impossible. Spending on healthcare in Africa is about 1% of the global total, leaving hospitals ill-equipped to deal with the surge.

“It’s a very big challenge that we are stepping into,” said Allan Pamba, chief executive officer of The Nairobi Hospital, Kenya’s biggest private medical facility.

Data from South Africa shows about 10% of those diagnosed with the virus require hospitalization. The World Health Organization estimates as many as 190,000 of Africa’s 1.3 billion people could die in the pandemic’s first year if containment measures fail. It took 98 days to diagnose the first 100,000 cases in Africa and just 18 days to reach the 200,000 mark -- a surge that in part reflects an increase in testing.

Home-Care Policy

Kenya this week became the first on the continent to develop a home-care policy. The East African nation has 3,305 confirmed coronavirus cases and 96 deaths. President Uhuru Kenyatta warned on June 6 that spare hospital capacity is fast running out and planned expansions are a way off.

The government envisions all those displaying relatively mild coronavirus symptoms will be cared for at home, and that volunteers and health-care workers will be deployed to assess their living circumstances. While the guidelines specify that patients should have their own well-ventilated rooms, that’s a pipe dream for informal-settlement residents, who typically share a cramped home and bathroom facilities with several others.

“The reality is the majority of Kenyans will not have the comfort of going back to a private room in a home after getting the Covid test,” Pamba said in a June 9 interview. “They will probably also not have the discipline or luxury to stay in one place for 14 days.”

Nigeria, Africa’s most populous nation, is also preparing measures to avoid its hospitals becoming swamped.

It took an initial step of allowing facilities to discharge Covid-19 patients after 10 days in isolation and treatment, rather than the global standard of 14 days, and doesn’t require them to be tested to see if they are still infectious. The authorities are now studying home-care options, with a view to rolling out a program as soon as possible, said Emeka Oguanuo, a spokesman for the Nigeria Centre for Disease Control.

Inappropriate Response

Innocent Ujah, a professor who heads the Nigerian Medical Association, sees such a response as wholly inappropriate.

“We don’t have proper town planning and housing systems that would allow home care,” he said. ”What we suggest is that the government demarcate isolation wards, treatment wards, for cases of Covid-19. If their resources are overstretched, there are many hotels and public places that can be converted so it will not further increase community transmission.”

In South Africa, which has the continent’s best health-care system -- and the most confirmed coronavirus infections -- the government expects existing hospitals to be overrun when the disease peaks some time between late July and early September.

While it isn’t considering denying care to those who need it yet, and is instead focusing on establishing field hospitals to deal with patient overflow from regular facilities, it may have to rethink its strategy. Some experts predict the number of active cases in the country could reach 1.2 million.

‘Clouds Gathering’

“We can see that the clouds are gathering and we need to move pretty fast,” Health Minister Zweli Mkhize said on June 11. “We need to make sure we prepare for a situation where the numbers are higher.”

Intensive-care and high-care units in the Western Cape province, which is South Africa’s virus epicenter with 63% of the country’s almost 62,000 confirmed cases, are already struggling to cope.

The WHO urged African nations to remain focused on maintaining physical distancing as much as possible, improving hygiene standards and increasing testing and contact tracing.

“The pace of the spread is quickening,” Matshidiso Moeti, the WHO’s regional director for Africa, said in a June 11 statement. “Swift and early action by African countries has helped to keep the numbers low, but constant vigilance is needed to stop Covid-19 from overwhelming health facilities.”

©2020 Bloomberg L.P.