This is the third article in a series about the ongoing COVID-19 pandemic. Read articles one and two. 

COVID-19 in Africa will be an unfolding human disaster of monumental proportions, the likes of which we have never seen and whose body count will only be estimable and not actually countable.

The prevention mantras for COVID-19 are hand hygiene and social distancing. But a substantial proportion of Africans lack sufficient water to wash their hands and have no soap. For many families, housing is limited and social distancing is simply impossible. In 2015, the United Nations estimated that only 15% of sub-Saharan Africans had access to basic hand-washing facilities. Matters are even worse in some countries. In Liberia for example, 97% of homes lacked clean water and soap in 2017.

Furthermore, apart from these basics, 15% of all infected individuals will require hospitalisation. This may be for oxygen or for intravenous fluids or for antibiotics for bacterial pneumonia after viral pneumonia due to COVID-19.

However, chronic shortages of all sorts of things will make such treatments very difficult to obtain, and these are relatively simple pieces of kit such as oxygen masks. Indeed the state of public health systems in many African countries is so low that many refuse to attend hospital, viewing it only as a place of very last resort. In Sierra Leone for example, many people go to a hospital when they have almost reached the end of their disease, whatever it might be, to die.

An attendant at a supermarket in Burkina Faso distributes hand sanitiser to shoppers as they enter. Photo: AFP

For the more critically ill, the situation is even direr. Around 4% of those stricken by COVID-19 require intensive care including ventilation, assisted breathing. The World Health Organization has estimated that there are fewer than 5,000 intensive care beds across 43 of Africa’s 55 countries. This works out at five beds per million people. The equivalent average statistic across Europe is 4,000 beds per million. There are no more than 2,000 working ventilators in 41 African countries – compare that with 170,000 ventilators in the United States alone. Indeed 10 African countries have no ventilators at all. Africans are therefore literally steeling themselves for a deadly debacle that will completely overwhelm already struggling healthcare systems.

Donors are trying to help. Chinese billionaire Jack Ma, for example, will donate 500 ventilators to the continent. But this will not suffice. Highly trained medical personnel are also needed to run these high-tech machines in addition to a reliable electricity supply and piped oxygen. These are taken for granted in developed countries but are frequently absent in health facilities in Africa. The grim prospects have led many African governments to enforce serious measures which have included curfews and travel restrictions.

Sadly, this was not the way it should have been. At a UN conference on Primary Health Care in 1978, the Health for All initiative was launched and one goal was to attempt to level the gross inequality in global health, particularly between developed and developing nations. The rise of free market capitalism in the 1980s, however, put paid to the notion that States should be responsible for providing health care for every citizen.

A military official closes off access to a wealthy residential commune in Kinshasa, DR Congo on April 6, 2020. Photo: AFP

The upshot? If Africa (total population circa 1,216,130,000) has an 80% infection rate with an asymptomatic rate of 80% (972,904,000 total infected), with an optimistic 10% mortality due to health care services being overwhelmed, the mortality may approach 20,290,400. Matters may be compounded in Africa as the relatively high prevalence of HIV, tuberculosis and other pathogens might not only serve as additional co-morbidities for COVID-19 infected individuals, but also contribute to diagnostic uncertainty. The situation is grim indeed.

Sadly, as the philanthropist Petra Němcová averred, “we cannot stop natural disasters but we can arm ourselves with knowledge: so many lives wouldn't have to be lost if there was enough disaster preparedness.”

Victor Grech is a consultant paediatrician (Cardiology) at Mater Dei Hospital.