North Africa Is Becoming a Pandemic Hotspot
WHY YOU SHOULD CARE
Proximity to Europe has long helped this region. Now it could be backfiring.
On Valentine’s Day this year, Egypt won a race nobody wanted to win: It announced the African continent’s first confirmed case of COVID-19. Shortly afterward, WHO Regional Director for Africa Matshidiso Moeti warned that “the window of opportunity the continent has had to prepare for coronavirus disease is closing,” and called on the whole continent to step up preparedness measures.
Around the world, increased testing has been the first step toward containing the virus. And it follows that countries that test more are often the ones that show a higher number of cases and deaths — without necessarily being worse off than nations that simply aren’t testing enough.
Yet in Africa, that equation isn’t holding — and deaths from the pandemic are serving as the biggest giveaway. South Africa and Ghana have tested the most among major African nations, both in total and as a fraction of their population. But it’s a slender slice of North Africa that’s home to a disproportionate majority of the continent’s fatalities.
Four countries — Algeria, Egypt, Morocco and Tunisia — together account for two thirds of all documented African coronavirus deaths.
These four nations host only 15 percent of Africa’s population, but are also responsible for more than 40 percent of all recorded COVID-19 cases.
To be sure, Africa’s numbers — around 31,893 cases and 1,423 deaths — pale in comparison with other parts of the world. The global toll is close to 3 million cases and 206,000 deaths, according to a collation of national figures by Johns Hopkins University. But within Africa, there’s a definite pattern to the spread of the virus.
As of April 27, 2020, Egypt, Algeria, Morocco and Tunisia had collectively recorded 941 deaths out of 12,930 cases in these countries — meaning a fatality rate of 7.3 percent. That drops dramatically to a death rate of 2.5 percent in the rest of Africa, a continent with 54 nations. South Africa, which is neck and neck with Egypt on total cases, has a fatality rate of less than 2 percent.
And while the WHO in February identified 13 African countries as at particularly high risk due to travel links with China, experts say North Africa’s particular plight might have more to do with Europe. The region’s unique geographical location, culture and socio-political history make it less isolated from Europe — one of the pandemic’s worst hotspots — than the rest of Africa. During the Spanish flu of 1918, most of the first wave was concentrated in North Africa; it was not until the second wave that the rest of the continent was engulfed by the influenza.
Travel flows to the continent are low — only about 5 percent of the world’s inbound tourism comes to Africa, according to a December 2018 Brookings Institute report. But Morocco, Egypt, Tunisia and Algeria are four of the top five tourist destinations in Africa — with South Africa completing the set. They’re much more dependent on trade and tourism than other African nations, says W. Gyude Moore, visiting fellow at the Center for Global Development.
“They are thus much more connected to Europe and integrated into European value chains than their counterparts in [sub-Saharan Africa],” explains Moore, who’s Liberia’s former public works minister. “This integration translates into significant people-to-people exchanges with significant North African diaspora communities in the worst affected European countries –— Italy, Spain and France.”
Indeed, Algeria’s first coronavirus case was an Italian who had entered the country on February 17. And a majority of the country’s initial wave of cases were from a family that hosted a relative who had just returned from France.
Routinely exposed to a range of infectious diseases — from HIV/AIDS and malaria to Ebola and Lassa fever — sub-Saharan Africa might also enjoy a slight edge in the preparedness of its response system, though Moore cautions that the gain is limited. “It might translate into familiarity with the public health measures needed to stop the transmission,” he says, “but in largely informal economies, this familiarity can only provide a limited advantage.”
With the curve increasingly flattening in China, Spain and elsewhere after months of uncertainty and tragedy, experts say it might only be a matter of time before the rest of the continent catches up with North Africa.
“Community transmission started later in [the rest of] Africa,” says Amr Bakr, founder of Cairo-based e-health startup 7keema and a former WHO pandemic preparedness consultant, “so they are still in early curve points.” The low number of cases in sub-Saharan Africa could also be a function of how they’re testing and contact tracing, he says.
Yet that’s where North Africa stands out, with its relatively high cases and a dramatically higher death rate than the rest of the continent — without testing any more than other regions. And some experts have warned that Egypt in particular might be significantly underreporting its official tally. Canadian researchers in mid-March reported dozens of tourists — most of whom were on a cruise ship that docked in the ancient city of Luxor on the east bank of the Nile — who tested positive after returning from Egypt. Their study suggested that at least 6,000 people were infected in the country, whereas the country has formally shown only around 3,200 cases.
Authorities across Africa are currently resigned to treating the fight to contain the virus as a marathon, not a sprint. And dedication to beefing up stamina for the long haul could prove decisive in flattening the curve at both ends of the continent, regardless of the starting point. In the interim, North Africans might be rueing their proximity to Europe — once an advantage, it’s now a clear and present danger.