Will Africa be Devastated by Covid-19 as Many Predicted? Perspective and Prospective
INTRODUCTION Since the novel coronavirus disease 2019 (Covid-19 or SARS CoV-2 infection) has been declared as pandemic, several mathematicians and statisticians have developed different trajectory curves for Africa, with the assumption that the virus can have an exponential pattern of transmission. According to Economic Commission for Africa, 300k-3.3 million COVID-19 related deaths may occur in Africa (1). A large body of literature and international media have also predicted that Africa is going to be flooded, much higher than Europe and the United States of America (USA). For Ethiopia alone, some estimated 28-33 million with full mitigation and 70-107 million people without mitigation actions can get infected. When the author of this perspective sees such an easy to do, but hard to conceive figures, he likes to join the closed loop forum and express what his thought is.As of 21st April 2020, close to 23k confirmed cases and 1000+ deaths are reported from 55 African countries, while the global figure climbs to more than two and a half million and individual countries in the West are reporting the highest ever cases (200k-700k+) and deaths (24k-42k+) in less than three months (2). The hardest hit countries being the most capable to tackle such kind of infectious outbreak, and the extremely contagious nature of this virus is the puzzle and unprecedented phenomenon.Virtually, countries of the globe do not look like they are ordered by the burden of this infection; the actual magnitude of case and death load in each looks as if they are ordered by their economic power and financial muscle. The bottom line is that this infection has been exponentially spreading, and becoming highly prevalent and fatal in the richest countries. That is not yet happening in countries within the tropical climate zone. Will it be like that in the weeks or months to come is the core question of this perspective.Some may argue that the developed countries testing capacity is what has inflated the case load, citing USA and Germany as an example. Yes, the high test uptake has helped the developed countries to identify as many cases as possible in a short period of time. However, the testing capacity alone could not explain the whole picture of the reality on the ground. What has been disproportionately rising in the last three months in the Western countries of the temperate climate zone was not only case load, but also the staggering mortality figure and the severely morbid cases (hospitalization for pneumonia, ICU care, dialysis, and blood transfusion), which are the two key measurements to show how severe the actual magnitude of the Covid-19 is. A very important argument is; had the Covid-19 transmission been as contagious as in Europe and USA, by this time, every health facility in Africa and other tropical countries could have been flooded with severely ill patients and deaths. But, that is not the case in any of African and tropical countries. The other side of the coin is; the overwhelming cases and deaths experienced in Europe and USA is despite the fact that they started to report Covid-19 confirmed cases almost same time or later than many of the countries in the tropical climate zone.Up to now, the proportion of mortality in the majority of Covid-19 reporting countries is in the lower range (<10%) (2). The relatively high case fatality rates among countries with larger case load are reported from Europe and one North African country (Algeria). This observation may lead to pose questions on the predilection of the transmission and the survival of the virus particle outside the human body at different climate zone, as discussed below. On blanket view of the global distribution of the infection, relatively low case and death load is observed across Africa, South Middle East, South and Southeast Asia and Latin America. Since the beginning, the epicenter has moved from East to West along the temperate climate zone, and causes incomparably massive casualties.Even in Africa, the relatively hardest hit countries are still outside the tropical zone (Algeria, Egypt, Morocco and South Africa). Countries in the tropical zone of Asia and Latin America, with relatively high case load, are not yet as hot spot as Western countries in the temperate zone, despite the proportional duration of exposure; the cumulative number of deaths is incomparably low. The mathematical modeling result for the stated period using hypothetical numbers and the reported data from several tropical countries is far apart. Brazil looks an exception, probably due to the rainy season or high tourist flow just around the outbreak.Further, this is despite the fact that some African countries has started reporting Covid-19 cases even earlier than some Western countries with high case load. Many authors have underscored the high mobility of the global population for the rapid spread of Covid-19 in hot spot areas. But, the number of cases in many of the African countries is large enough to result in exponential transmission of the virus and be able to make hot spot. Age and sex strata are some of the factors determining the prognosis, but not that much strong to justify the exponential transmission. Hereunder, some more critical appraisal is presented.