This week, our attention is on rising cases and spreading variants. The continent is experiencing the third-consecutive week of climbing infections, with daily new cases increasing 19 per cent week on week. Since 17 May, average new cases have jumped by nearly 60 per cent daily. In the past two weeks alone, 21 countries have seen cases increase by at least 20 per cent while 13 countries are experiencing surges in mortality.
Eight countries – Democratic Republic of Congo (DRC), Namibia, Nigeria, Rwanda, Senegal, Somalia, Uganda and Zambia – are experiencing both rising cases and deaths. Yet new daily tests have actually been declining for the past two weeks, indicating that actual case numbers are likely to be significantly higher than what is currently being reported.
Of the four variants of concern (VOC) globally, three have now been identified in Africa: Alpha, Beta and Delta. In total, 44 countries have identified the presence of at least one of these variants. Alpha has been confirmed in 34 countries – making it the most common variant on the continent – Beta in 31 countries and Delta in 13 countries to date. Six countries – DRC, Ghana, Kenya, Mauritania, South Africa and Uganda – have reported all three but the geographic range of these nations suggests a wider spread of the variants.
Variants are a grave concern for Africa, particularly Delta – which may be even more transmissible than the other VOCs. In late April, the Director of the Africa Centres for Disease Control and Prevention (CDC), Dr John Nkengasong, warned that if the continent experienced a surge in cases like that seen in India, it would be severely overwhelmed due to its fragile health systems, specifically insufficient numbers of health-care workers, limited hospital beds and ICU equipment, and low oxygen supplies.
Although Africa has so far experienced lower clinical manifestations in terms of hospitalisation and death relative to the rest of the world (attributable to several probable factors including age demographics), each new mutation of the virus carries the risk that these factors will no longer help to protect the population. Moreover, each brings with it the possibility of existing vaccination, therapeutic or public-health regimes (including diagnostics) being rendered less effective.
The recent exponential growth, especially when accompanied by an increase in mortality, indicates the likely presence of a variant. However, there are challenges in directly attributing variants to surges in Africa. The continent’s low testing and surveillance and limited genomic-sequencing capacity affect the speed at which a variant can be identified. As a result, variant cases are both unidentified and under-reported. This makes it difficult to determine with certainty whether case growth is caused by a mutated strain or a reduction in public-health precautions and pandemic fatigue – or both.
In light of rising cases and the under-detection of variants, governments must act fast to slow the spread of the virus. Governments need to approach this new wave as they treated the first cases of Covid-19 by enhancing surveillance and testing, increasing contact tracing and isolation of probable cases, and introducing localised restrictions on movement in combination with other public-health measures. Border closures, curfews and limits on gatherings, like those now imposed in South Africa and Uganda, should be enforced wherever case numbers are climbing exponentially.
Hospitals, clinics and health-care workers should be preparing for a surge, including by arranging for overflow capacity, accumulating surplus oxygen and ICU supplies, and ensuring there is sufficient PPE. Effective therapeutics need to be procured and stored. Vaccines should continue to be among the top priorities for governments, with administration rates stepped up wherever possible – but vaccines cannot be relied on to slow the viral spread in the short run. African governments must continue to deploy these other measures to protect their populations.
If governments do not take an immediate and proactive approach to reduce transmission rates, Covid-19 and its more concerning variants will continue to spread. The more the virus is allowed to spread, the more opportunity for mutations and the higher the risk that a more dangerous variant will emerge.