World Health Organization tells Africa to ‘wake up’, as African researchers expect a ‘ticking time bomb’.

Just weeks ago, it seemed that Africa was mostly spared by the coronavirus outbreak — but that was never meant to last. The lag in cases was just that — a lag, not a permanent stop.

Even as the entire continent still has fewer than 1,000 cases, there are strong concerns that Africa is staring down the barrel of a disaster.

“Africa should wake up, my continent should wake up,” said the Ethiopian Tedros Adhanom Ghebreyesus, the first African head of the World Health Organization.

Many of the world’s most underdeveloped areas are in Africa, which translates into strained medical systems and oftentimes, lack of necessary infrastructure. Since the coronavirus pandemic seems to be a long-fought battle, the situation can quickly degenerate without adequate resources to keep it under control. This makes Africa a prime target for a coronavirus epicenter.

The continent is not unprepared. An African task force for coronavirus preparedness and response (AFTCOR) has been established, focusing on several workstreams which include laboratory diagnosis and infection prevention.

Should countries not be able to afford large-scale testing campaigns (which is likely), AFTCOR can increase this capacity in more than 40 African countries. Even so, the testing capacity is estimated to be substantially lower than what will be needed.

At the time of this writing, Africa has the least number of confirmed infections of all continents. However, this is likely to be owed to a relative economic isolation and a lack of testing rather than a true number of cases. The WHO expects cases in Africa to surge in the very near future.

The lack of sufficient intensive care unit (ICU) beds will also be challenging. What we have seen in China and we are now seeing in some parts of Europe is that the number of patients that required ventilatory support outnumbered the ventilators in ICU facilities. The hospitals in Lombardy (Italy), one of the richest areas in the world, were overrun. A lack of availability can drastically lower survival rates. It’s also unclear whether low and middle-income countries can afford to fund additional critical health care units.

“We really have no idea how COVID-19 will behave in Africa,” says pediatrician and HIV researcher Glenda Gray, president of the South African Medical Research Council. Last month, World Health Organization Director-General Tedros Adhanom Ghebreyesus, who is Ethiopian, said his “biggest concern” was COVID-19 spreading in countries with weak health systems.

Social isolation, a vital measure in suppressing the number of cases, is also most difficult to employ by those living in day to day poverty. Although Africa has taken remarkable strides, 422 million people on the continent still live below the global poverty line (accounting for 70% of the world’s poorest people). These vulnerable people, many of whom might simply not afford to self-isolate, are at great risk from the outbreak.

Many African nationals are also vulnerable to the disruption of stocks and supply chains, as we are already seeing in the effects of the pre-outbreak panic-buying. Several companies have stepped up and established pan-African supply networks, but as networks from all around the world are suffering, many African countries seem particularly vulnerable. The burden from the other diseases is also important and cannot be overlooked.

Africa’s fragile health system will undoubtedly be put under massive strain. But there are also positives. Several African countries, most notably South Africa, also have a wealth of expertise and infrastructure for running clinical trials.

The continent also had a bit more time to prepare: while the disease will almost certainly spread through Africa, it took a bit more time to get there — though whether or not that time was squandered is still an open question. We’ve also seen in the recent Ebola outbreak that African countries can rally with remarkable ability, but this will likely be a challenge like no other for many areas on the continent.

Mali, Libya, and Guinea-Bissau have just announced their first cases. Officially, 46 of the continent’s 54 countries now have the virus. In South Africa, there are 700 cases, and the country prepares for a lockdown. The rest of the continent is bracing.