NAIROBI — Vulnerable populations, including the poor and displaced, are at high risk of being affected by the potential spread of the coronavirus to Africa, the World Health Organization has warned.
Recognizing the fact that high-density areas such as slums and displacement camps could serve as breeding grounds for the spread of the virus, WHO is helping countries prepare for a response. In doing so, it is also facing challenges such as limited laboratory capacity and existing outbreaks.
The United Nations health body is focusing much of its efforts on 13 high priority countries on the continent.
“You can easily have a huge number of cases and the system can easily be overwhelmed. This is why early detection is critical.”— Dr. Michel Yao, emergency operations program manager, WHO Africa Office
The 2019-nCoV outbreak, first reported in China in December 2019, has since spread across the country and internationally. There are over 6,000 cases and over 130 deaths reported — and the numbers continue to rise exponentially.
Containing the virus has been complicated by all of the unknowns about the new virus — including the ways in which it spreads — and that there is no vaccine or specific antiviral treatment recommended for the virus.
Concerns are heightened across Africa about the potential spread of the virus to the continent, in light of increased trade relations between the regions in the past decade — leading to more frequent travel between China and Africa.
African nations have set up airport screenings to effectively manage a potential spread of 2019-nCoV to the continent, while the Gates Foundation has committed $5 million for preparedness efforts.
The outbreak would occur at a time when resources are already stretched thin, as national governments and the humanitarian sector juggle the responses to existing multiple health crises in Africa, including an Ebola outbreak that has persisted over a year and the world’s largest measles outbreak.
Devex spoke with Dr. Michel Yao, emergency operations program manager for WHO’s Africa Office, about preparedness measures to prevent a spread of 2019-nCoV, as well as vulnerabilities across the continent that could complicate efforts to squash the potential outbreak.
In its efforts to help African countries prepare, WHO is emphasizing the need to detect any cases early. With this outbreak — where the epicenter of the crisis is in China — it is highly likely that a country’s first case would enter through an arriving airline passenger from China, Yao said.
In efforts to prevent a spread into wider society, across the African continent countries have enhanced health screening of passengers from China — including screening for symptoms such as fever or coughing, as well as asking passengers for information about their exposure to individuals with the virus. The Bill & Melinda Gates Foundation announced a commitment of $5 million on Monday to assist the Africa Centres for Disease Control with efforts to increase capacity to prevent the spread of the virus. The next day, Africa CDC activated its incident management system for 2019-nCoV.
WHO has created a list of high priority countries in which it is focusing much of its energy, which includes countries that either have a direct flight to China or have large amounts of travelers from China, Yao said. This includes Algeria, Angola, Côte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia.
The growth of novel coronavirus in a Melbourne-based laboratory has been described as “a piece in the puzzle” to developing tests and vaccines to combat its rapid spread.
While there have not been any confirmed cases of the virus in Africa, there have been suspected cases in countries including Kenya and Mauritania, he said. Suspected cases in Ethiopia and Côte d'Ivoire have tested negative.
If the virus does enter the continent, there is concern about it infiltrating high-density areas across the continent, such as slums and displacement camps.
“In Africa we have many factors that can easily increase the number of cases, such as if cases enter these highly dense communities,” Yao said. “This is actually our main concern.”
Laboratory capacity, influenza networks
In order to prevent a major spread of the virus in Africa, countries need to have mechanisms in place to detect people with symptoms, isolate them, collect viral samples, send those samples to laboratories, and then provide any confirmed cases with treatment, he said. Health workers and lab technicians also need to be trained on protocols for dealing with this virus, as well as provided with protective equipment.
Weak laboratory capacity is an issue in many countries across the continent and there is not yet a commercially available diagnostic test.
“Labs have to be updated urgently so that we can increase the detection capacity,” Yao said.
Where lab capacity is lacking, countries need to send samples to WHO referral labs in other countries. When a country needs to send a test to a capable lab in another country, the process can take a few days, he said, for reasons such as some countries don’t have a regular flight connection to a country with a referral lab.
“In Africa we have many factors that can easily increase the number of cases, such as if cases enter these highly dense communities. This is actually our main concern.”— Dr. Michel Yao, emergency operations program manager, WHO Africa Office
But existing networks that have been built up around the need to respond to influenza across the continent could provide a basis for countries to respond, Yao said. There are existing networks of labs that monitor new strains of influenza and regularly exchange information amongst themselves. Every year the influenza vaccine needs to adjust based on the prevailing virus.
WHO has about 28 referral labs on the continent. These labs were used for influenza, but are now receiving help to upgrade in order to build the capacity to respond to 2019-nCoV, he said.
According to a WHO press release, there are currently only two referral laboratories in Africa with the reagents needed to conduct tests to confirm a case of 2019-nCoV. WHO is shipping reagent kits to more than 20 other countries in the region, meaning "diagnostic capacity is expected to increase over the coming days."
For example, Dr. Lia Tadesse, state minister of health in Ethiopia, tweeted on Tuesday that the country had isolated four suspected cases, which tested negative, but the tests were sent for confirmation to South Africa.
“In Africa, most of the countries are more or less at the same level except maybe countries that have a strong lab capacity, like South Africa,” Yao said. “Most of the countries remain quite vulnerable and … most of them need to be supported.”
Tapping into Ebola preparedness, flexible guidelines
Countries also need to create contingency plans, Yao said. This includes examining the potential number of 2019-nCoV cases that could occur in a country and ensuring there is enough capacity to deal with that caseload.
“For example, at a treatment center there may be only a few specific rooms for communicable diseases, but they can easily be overwhelmed. The plan is then to ensure that you can set up quickly treatment centers like what we do in the case of Ebola, with our partners,” he said.
With the 2014 outbreak of Ebola in West Africa and the ongoing outbreak in DRC, countries across the continent have either experienced Ebola outbreaks or have prepared their health systems for a future Ebola outbreak. These preparations could offer a slight advantage to these countries in terms of knowing how to respond to a 2019-nCoV outbreak, Yao said, because much of the protocols are similar. This includes setting up treatment centers, isolating cases, protecting health workers, tracking down contacts and communicating with communities about the outbreak.
If there was a large-scale outbreak of 2019-nCoV, labs may not test each suspected case, he said. If this were to happen, suspected cases could be moved into case management after detection, based on the presence of symptoms, and then there would be efforts to track down the person’s contacts.
“As long as you have the capacity to test few of the cases, if the number of cases increases, then you can still go ahead with control measures,” he said.
But the response system can still be overwhelmed, he said, as has been seen in the case of Ebola with DRC, where responders have worked tirelessly to quell an outbreak that has lasted almost a year and a half.
“You can easily have a huge number of cases and the system can easily be overwhelmed. This is why early detection is critical. We are strongly advising African countries to have this early detection process … to easily control it before it becomes a large community contamination,” Yao said.
There is also a need to remain flexible, he said. One of the unknowns of the new virus is whether it’s possible to transmit the virus if a person has no symptoms. This could mean that a traveler arriving in a country can appear to be healthy — but is actually spreading the virus to the passengers next to them, as well as the broader community once they leave the airport.
If it is confirmed that this is the case, the current system would have to be reinforced, Yao said. This could include governments working with airlines to follow-up with people who are coming from high-risk zones.
“In the case of this new virus, the guidance will evolve based on evidence that is made available,” he said. “The guidance for today can easily change tomorrow.”
Update, Jan. 31, 2020: This article has been updated to reflect that there are currently only two referral laboratories in Africa with the reagents needed to conduct tests to confirm a case of 2019-nCoV.