Since COVID-19 was declared a pandemic by the World Health Organization, Africans have been told to stay put and “prepare for the worst.” Even though Africa is at a less advanced stage, WHO director-general Tedros Ghebreyesus indicates Africa, in particular, may suffer direct effects of the disease itself and indirect effects on the economy.
Considering the fragile health care system in Africa, options to tackle the pandemic are not the same as developed nations, which can mitigate lockdowns with income replacement, provide testing and containment and build equipped isolation and treatment centers. With far fewer health care workers and poor hospital setups, Africa is left with lockdowns with or without income replacement and working aggressively towards surveillance, testing, and containment to curb the spread so as not to overwhelm our health care system.
The competitive global demand for hospital equipment, personal protective equipment or PPE (aprons, gloves, face masks, face shields, google glasses, boots), testing kits, mechanical ventilators, and medications will further disrupt the economy because we don’t have the basics, to begin with.
Africa has suffered significant deaths in previous pandemics; in western Africa, Ebola took around 11,000, contained by health professionals’ heroic work, the nature of transmission, and the joined hands of the international community. But uncontained health issues like HIV/AIDS, TB and more, will, coupled with COVID-19, increase the risk of deaths. If the golden time for containing transmission is already past, as Ghebreyesus has stated, then I fear Africa will suffer the worst.
A COVID-related economic plunge will impose greater difficulty in fighting the novel coronavirus. Most affected will be tourism, oil, agricultural exports, and air transport. Even though fewer cases in Africa can be attributed to international travelers and migrants compared to Asia, Europe, and North America, air transport holds the pillar of the economy in my home of Ethiopia. Our airlines have lost around $550 million after decreasing 90% of external flights, which will lead to high unemployment and worse living conditions for poor urban neighborhoods without regular access to water and food at the best of times. For rural people already living on the edge, this will lead to greater hunger and have a reverse impact on efforts to control disease transmission. Additionally, economic losses will decrease the capacity to acquire hospital equipment and PPE and to train health care workers.
Beyond Africa’s already poor health care situation, an unstable political situation, hunger, and violence make fighting this pandemic even more difficult. UN Secretary-General Antonio Guterres said immigrants and populations in war zones have double the risk of contracting the virus. Libya, South Sudan, and Nigeria top that list. Also on that list is Ethiopia, which cut off the internet to around 15 million people as a “security measure,” later lifted following domestic and international pressure. Also, at heightened risk are communities with high numbers of population with internal displacement. Such challenges impede health care workers from addressing health needs and providing basic necessities for these populations.
The pandemic’s socioeconomic fallout will affect people throughout the world, but likely more seriously in Africa, which already had poor resources and exacerbating factors. Since this pandemic can be halted by slowing down transmission, preventing infection, and by mitigating effects, joining arms will strengthen us. “No country could do it alone,” said Antonio Guterres, “and we should cooperate and address people at risk, including women who often shoulder a disproportionate burden of care work.”
My hospital, with already a struggling financial and laboratory setup, is preparing to become a COVID-19 treatment center and isolate suspect cases. Making changes to the physical structure or building new facilities would be prohibitively costly and take too long. So we must work with the present hospital setup, taking strict infection prevention and control (IPC) measures, eliminating non-emergency cases, decreasing in-patient visitors, and implementing WHO hospital preparedness checklists to our capacity.
A COVID-19 task force, led by hospital officials representing every aspect of the profession needed to fight this pandemic, has been increasing preparedness: triaging and monitoring everyone entering the facility, swapping in-patient wards to make room for isolation and treatment, installing hand washing basins and other IPC measures.
Early detection has not begun because we lack testing kits; the central lab must come and test suspected cases. Containment and mitigation will be a challenge once we start receiving COVID-19 patients. Unfortunately, advance preparation is extremely limited, beginning with providing PPE for health care personnel, because PPE is limited in the hospital and nationwide. Our hospital also suffers from poor ICU setup: only 4-6 functional mechanical ventilators and very few critical care professionals.
Sadly, things considered simple elsewhere are a struggle here in Ethiopia; we already have difficulty providing isolated home service and transportation for health care workers. Many have been forced to stay in the hospital because they fear infecting the community and their loved ones; some have even been expelled from the homes they rented.
The pandemic will undoubtedly undermine care for patients with diseases and conditions other than COVID-19, accounting for significant mortality and morbidity at the best of times. Confronted with a global health crisis, health care professionals in already stressed nations must bear a greater burden. Our leaders must listen to us as the inadequacies of our health care infrastructure become even more evident, as CNN noted: “Africa’s leaders forced to confront health care systems they neglected for years.”
Above all, dedicated health care workers, upon who everyone else will rely should the worst come to pass here in Africa, must be supplied with what they need to provide care and protect themselves, paying attention to the psychological impact resulting from their service on the frontlines.
Yohannes Mengistu is a physician in Ethiopia.
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