African countries brace for coronavirus spread

NAIROBI — Across Africa, countries are ramping up airport screenings of passengers arriving from China, in efforts to prevent the spread of coronavirus on a continent already facing multiple outbreaks, including Ebola and measles.

This comes amid the 2019-nCoV outbreak, which was first reported in a cluster of individuals from Wuhan city, Hubei Province, in China in December 2019 and has since spread across the country and internationally.

While the World Health Organization has refrained from calling the outbreak a global emergency, it is a national emergency in China, with multiple cities shutting down public transportation including railway and airport stations in efforts to curb the spread of the virus which has now infected over 4,000 individuals across the country, and killed 106 people, according to the latest report by China’s National Health Commission.

Confirmed cases outside China are relatively small, at 73, but are spread across 17 countries and territories in Asia, Australia, Europe, and North America, as of this writing. Given the novelty of the virus, scientists are still uncertain about the virus’ transmission behavior, including its spread among asymptomatic cases, although it has been established the virus can transmit between humans among close contacts and health workers.

“This thing is big. I’ve not seen a rapidly evolving outbreak like the one we are dealing with,” said Dr. John Nkengasong, director at the Africa Centres for Disease Control during a press conference Tuesday in Addis Ababa, Ethiopia.

While there have not been any confirmed cases in Africa, he noted that there are “rumors of unconfirmed cases in several countries.” For example, health officials are investigating a potential case in Côte d’Ivoire, although they believe it is pneumonia. A student from China arrived at Jomo Kenyatta International Airport in Nairobi with coronavirus-like symptoms and has been isolated at a nearby hospital.

“There will continue to be rumors around suspected cases because the initial symptoms that people manifest will be very similar to those of the common cold,” he said.

There could also be active cases on the continent that have not yet been detected because of weak surveillance systems that exist in some nations across the continent, he said.

Heightening concerns about a spread to Africa are the high levels of movement between the two continents as commerce and trade increases between regions. Direct airline flights between China and Africa have increased over 600% in the past decade, according to Quartz.

“The risk of spread of this highly contagious virus to #Africa is very high given the large number of flights & people that fly through #Addis,” Senait Fisseha, chief adviser to WHO chief Tedros Adhanom Ghebreyesus, tweeted.

The Bill & Melinda Gates Foundation announced a commitment of $5 million to the Africa CDC to help African nations scale up preparedness for a potential spread of 2019-nCoV. This includes funding for “technical support to implement the screening and treatment of suspected cases, laboratory confirmation of 2019-nCoV diagnoses and the safe isolation and care of identified cases.”

On Tuesday, Africa CDC activated its incident management system for the virus. It has set up a weekly brief on the outbreak to inform countries about the latest news on the virus and is working with national public health institutes to coordinate in areas such as improving surveillance, laboratory support, and developing protocols for treatment, Nkengasong said.

Next week, Africa CDC, along with the Institut Pasteur de Dakar, is hosting a preparedness training for 15 African countries.

National governments across the continent have enhanced their screenings at airports, including screening for symptoms such as fever, flu, coughing, and difficulty breathing. Many African nations already had machines in place to screen for Ebola symptoms in travelers. Governments are also training health workers at airports and preparing areas for quarantine.

Passengers are also asked to fill out forms that have questions about the coronavirus, including asking passengers if they’ve been in areas that have been affected by coronavirus, or if they’ve been in close contact with someone who has been either suspected or confirmed to have the virus.  

In South Africa, the nation’s department of health and it’s National Institute for Communicable Diseases also distributed clinical guidelines and case definitions for health workers to assist in detecting, identifying and responding to any potential cases. The government said that its Emergency Operations Centre is currently in alert mode. The O.R.Tambo International Airport in Johannesburg is the busiest on the continent, followed by airports in Egypt, Ethiopia, and Kenya.

The Nigeria Centre for Disease Control has convened a technical working group aimed at assessing and managing the risk of a spread of the virus into the country.

“The NCDC is well positioned to handle any case of coronavirus that comes into the country. We are better prepared to manage coronavirus if it comes to Nigeria than we were during the Ebola outbreak. Our system has been tested by other infectious diseases over time, and lessons learnt from these outbreaks has further strengthened our capacity,” said Dr. Chinwe Lucia Och, head of research and knowledge management at NCDC during a live television address.

Ghana has increased surveillance of its land border with Côte d’Ivoire, in response to the potential case.

Governments are also distributing messaging on platforms such as social media around the symptoms of the virus and precautionary measures that citizens can take to avoid its spread, such as washing hands and avoiding contact with people who are sick.

The International Federation of Red Cross and Red Crescent Societies is coordinating with its national Red Cross societies giving them the relevant updates on the virus and helping them to strengthen their preparedness efforts, such as developing risk communications for communities. It is also encouraging them to partake in preparedness meetings organized at the national level with ministries of health, so that they can support the ministries with a unified response.

IFRC has community pandemic preparedness projects in seven African countries.

“The key message at the moment is there are so many unknowns about the transmission of this virus, so there needs to be a high level of alertness and readiness,” said Dr. Ben Adinoyi, health and care coordinator at IFRC. “The success of any response to this coronavirus, and to stop it’s spreading, is the ability to detect it early, the moment it gets into a country.”

One of the challenges facing the continent in the event of its spread, according to Nkengasong, is that diagnostic tests for the virus are not yet commercially available, but he said that conversations with manufacturers to make this happen are ongoing.

A series of tweets, published this week by Tom Inglesby, director of the Johns Hopkins Center for Health Security, made recommendations for global and national planning efforts on what should be done in the event that the virus can’t be contained.

This includes a scale-up of vaccine development efforts, an expansion of diagnostic development capacity globally, and expediting clinical trials for antivirals.

He also called for a major expansion of personal protective gear for health care workers, hospital infection control plans, and the need for governments to provide transparent, comprehensive, and rapid communications on the spread of the virus. He also urged that travel and trade remain open, even if the virus spreads widely.

Balancing outbreaks

The global 2019-nCoV outbreak is taking place in the midst of an ongoing Ebola outbreak in the eastern Democratic Republic of the Congo that started in August 2018 and has been declared as a public health emergency of international concern by WHO. National and international response has helped keep Ebola from spilling beyond DRC’s borders, but containing the outbreak within DRC has been a challenge, due to repeated incidents of insecurity and community distrust of the response.

Experts acknowledge the current global interest in the 2019-nCoV, but also underscore the need for continued attention and maintain support until the end of the Ebola outbreak.

While aid officials acknowledge improvements in the response in the past few weeks, with a weekly average of 14 cases, they note the insecurity and community trust remain issues that can delay containment. “We all know the road to zero will be bumpy" Emanuele Capobianco, director of health and care at the IFRC, told Devex.

“It’s important to mention — [we need to] finish the job. Everybody is now interested with the new coronavirus, but we still have work on Ebola,” Dr. Ibrahima Socé Fall, WHO assistant director-general for emergency response, said.

There doesn’t seem much concern at the moment that the 2019-nCoV outbreak might take away resources for the Ebola response. Capobianco said there has been strong support from a number of donors toward the response, including the U.S., U.K. and the World Bank. Their support has allowed organizations like IFRC to operate effectively, he said.

However, he acknowledged the importance of keeping media attention on the Ebola outbreak, and ensuring donor financing “will continue until the end.”

What’s more concerning is if the 2019-nCoV enters DRC.

While there have been no confirmed cases in the African continent to date, Capobianco, echoing ACDC’s Nkengasong, said no reported cases doesn’t mean there are no cases.

One of the positive effects of having a long outbreak in a country is it boosts the country’s capacity to respond to future similar events. However, in the face of a new virus, like the 2019-nCoV, the capacity of all countries to handle an outbreak will be tested, Capobianco said.

In addition, any new virus — such as the 2019-nCoV — is a concern, and countries need to start preparing now, WHO’s Fall said.

Meanwhile, Jeremy Farrar, director of the Wellcome Trust, warned against the new outbreak detracting from the Ebola response.

“If that happens, Ebola in the DRC will take off,” Farrar told Devex at the World Economic Forum in Davos, Switzerland, adding that he has raised the issue with WHO and is hopeful that it won’t happen.

The fact that much of the response is now led by DRC and neighboring countries may protect against a shift of international resources leaving the country in a lurch. If the response was largely international there would be more of a risk, he said.

The way donors have funded Ebola has largely been through aid budgets, but as coronavirus threatens countries such as the U.K., funding for the response is likely to come from the “domestic health pot” of money, “so hopefully there won’t be competition for funding,” he added.

“This is a real test,” Farrar said, adding that it was the first time that the world has had to fight two major epidemics. “I hope we have the infrastructure, people, and global networks that allow us to do it.”

Senior Reporter Adva Saldinger contributed to this article.

Update, Feb. 12, 2020: This article has been updated to clarify Farrar’s comments about funding Ebola and the novel coronavirus.