By Azu Ishiekwene
In one of his bestsellers, The Zahir, Paulo Coelho said there are two major problems in life: knowing when to begin and knowing when to stop.
If, for example, Nigeria had closed its borders early on and enforced quarantine for all returning Nigerians, whoever they are, things might have been different today. I’m sure many others would say the same for their own countries as well.
In between knowing when to begin and knowing when to stop, however, an agency of the United Nations, which ought to help Africa find its way out of the present crisis, is bandying figures about COVID-19 that can only compound the continent’s collective misery.
The Economic Commission for Africa (ECA) said between 300,000 and 3.3 million Africans may die from coronavirus.
The commission gave five different possible scenarios (from no-intervention to suppression using intense social distancing) that could lead to – or mitigate – this catastrophic outcome. It, however, failed disastrously to show the basis for its model on a country-specific basis. That’s unforgivable because no disease impacts a country the same way, much less a continent.
Africa is not a country.
How did the ECA arrive at its apocalyptic figures for a continent of 58 countries and a population of 600-750 million people, with all its nuances, diversity and complexity, without providing details on a country-by-country basis of how its forecast might happen?
When experts in the US predicted that between 200,000 to 1.7 million people could die from coronavirus it was based largely on 1) the impact and profile of previous epidemics, especially the viral ones; 2) how quickly and effectively people respond to precautions, adjust and iterate, and 3) the capacity of the medical healthcare system to respond to the ongoing crisis.
That, obviously, was what the ECA wanted to do with Africa: to sound a warning that we cannot treat with levity a virus that the world is yet to fully understand, much less tame.
But the commission goofed, and we’re not obliged to be led by the nose. Its report, COVID-19 in Africa: Protecting Lives and Economies, showed little respect for the continent’s diversity or evidence about how it arrived at its far-reaching conclusions, at least for the potential hotspots. Yet, this is the same commission that should have been on the frontline with fact-based evidence, harnessing original thinking about how to help the continent find its way out.
To be sure, the report highlighted the serious deficiencies in healthcare systems across the continent, which we know.
It highlighted the fragile state of the economies, the danger posed by the pandemic and suggested that the continent’s growth may not only recess by nearly 2.6 percent, Africa may also need $200 billion (for its healthcare systems and forbearance) to plug the hole. Again, not surprising.
It reminded us that large segments of the continent’s populations reside in overcrowded urban areas, which increases the risk of transmission, and added that general poverty compounded by poor access to basic sanitary infrastructure and a broken global medical supply chain, could make the continent the world’s capital of COVID-19.
Maybe? Improbable. Africa is not a country. According to WHO, parasite and vector-borne diseases, diarrhea, lower respiratory tract infections, HIV, and Ischaemic heart diseases claim three million African lives yearly. If ECA thinks that coronavirus alone would kill more Africans than the combined forces of these five top killers, then it is vitally important to show us country-specific data how this would happen, at least in the hotspots.
A one-size-fits-all picture may indulge mortality modelling, which has become the in-thing, but it’s simply not good enough.
Interestingly, at about the same time the ECA was releasing its 48-page report, the situation in some of the most populous countries on the continent did not show any significant divergence in the ratio between reported/confirmed and recorded deaths in these countries, and what is being recorded in other parts of the world.
As of April 21, Nigeria and Ethiopia, whose combined populations is roughly half of the continent’s and which also have significant poor urban populations, had only recorded 665 and 114 confirmed cases respectively with combined deaths of 25, well below the current world average of three to four percent, with impressive rates of recovery in both countries.
South Africa and Kenya which are not just among the continent’s top 10 populous countries but are also reasonably integrated into the global supply chain have, so far, managed to contain the spread of the virus with total confirmed cases of 3,761 (mostly from South Africa) as of April 21, 72 deaths, and 1,127 recoveries.
Also, as of April 21, Africanarguments.org said the total confirmed cases in Africa were 23,720; recoveries 6,159; and deaths, 1,162.
Egypt, Morocco and Algeria, which the report said have less crowded urban areas and therefore are potentially less vulnerable, constituted over 45 percent of the confirmed cases in Africa as of April 21, with higher than average mortality. That is precisely why a report that fails to supply the basis for a worst-case scenario for the continent’s hotspots, is quite frankly, irresponsible.
I should not be mistaken. I know that it’s still early days and depending on how the pandemic is managed, things might get grim in some countries, with Nigeria still being a country of concern.
I’m also not suggesting, for a moment, that Africa’s job is done, that the worst is over, or that the challenge of COVID-19 is not a clear and present danger to the continent. There is a need for better co-ordination and information sharing among countries.
Research centres, scientists and universities must also step up to the plate. Two years ago, WHO held a simulation of a response to “a deadly global flu pandemic” involving 40 countries including 10 from Africa. Have the lessons from that simulation been any use in helping countries respond to COVID-19?
The public deserves more from ECA. I simply refuse to accept data that treats the continent as a country just because such data is coming from experts who assume they would not be questioned.
As more countries around the world embark on aggressive and rapid testing, while easing restrictions, it would be particularly helpful to look at steps barely mentioned in the ECA’s report that could be modified from country to country.
Mandatory use of face masks; greater transparency about results from community testing; more information about how and where to get help by those who present symptoms; redefinition and expansion of “essential services” to include more of the informal sector, may help.
Also, smart curfews and continued restrictions on large gatherings; greater honesty about what is working, some humility about what is not and what is still unknown, might also be useful in the days ahead.
It’s still a long, long road and the ECA should shine the light instead of beating us over the head with apocalyptic data. Perhaps it’s not the commission’s fault that the continent began late, but it’s time to stop mortality modelling not based on country-specific evidence.