There are signs that the rise in cases of the 2019 novel coronavirus may be slowing this week, suggesting that the unprecedented measures to limit people’s movements in the most affected areas of China may be working. But as people start to pick up the infection in countries other than China, the fear now is that it could explode somewhere less able to contain it. African countries, many of which have strong trade links with China but limited healthcare infrastructures, are of particular concern.
No case has yet been diagnosed in Africa, but the continent is bracing for its arrival. A recent African Union workshop in Dakar, Senegal, trained lab technicians from 15 countries in how to test for the virus. Last week, only two public health labs on the continent, in Senegal and South Africa, could test for the coronavirus. By the end of this week, 29 countries will be able to.
But if cases escape detection, and the virus spreads, African nations, among other countries, may struggle to clamp down as China has. Poverty, social instability and weak healthcare systems in some African countries could lead to an epidemic, amplifying the virus with a potentially global impact.
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“If we get a massive wave of infection, we can’t control it,” says John Nkengasong, head of the Africa Centres for Disease Control and Prevention in Addis Ababa, Ethiopia.
But expanded testing capability will help. “A month ago I wouldn’t have said this, but now I think we will be able to catch cases,” says Nkengasong.
In addition, medical surveillance networks are in place. While there has been no end yet to the Democratic Republic of the Congo’s Ebola epidemic that began in 2018, the outbreak has been contained within the country’s borders. “Ebola has put those networks on high alert,” says Nkengasong. “We’re building on that.”
Last week the Bill & Melinda Gates Foundation increased its funding for fighting the coronavirus tenfold to , including $20 million for the regions of Africa and South Asia.
Links to China
At first glance, the risk of the coronavirus reaching Africa seems high, given China’s large investment in the continent – some 200,000 Chinese nationals work in Africa, while .
More than 2600 flights a year run between China and the continent, half of them by Ethiopian Airlines, which – unlike many other airlines – hasn’t suspended flights to China amid the coronavirus outbreak. The SARS outbreak of 2003 never made it to Africa, but there are 10 times more flights between the continent and China now, says Vittoria Colizza of Sorbonne University in Paris.
But this number of flights isn’t especially high either. Using flight data and computer models, Alessandro Vespignani of Northeastern University in Boston calculates that the 25 countries at highest risk of importing a case of coronavirus are mostly in Asia, followed by North America and Europe.
Andrew Tatem and his colleagues at Southampton University, UK, have used a similar analysis to find that London has a 10 times higher risk – and Tokyo 60 times higher risk – of getting a case than Nairobi or Johannesburg. Other African cities have 10 times lower risk than that, or none at all.
Detection and quarantine
But if the risk of importing the virus is relatively low, says Colizza, the problem is what happens once a case arrives. That person and their contacts must be found and quarantined, and that is difficult in places where health infrastructure, and sometimes public trust, are limited.
Using air travel data and official assessments of countries’ response capabilities, she identifies Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana and Kenya as .
Some are already stretched due to other infections, including malaria and Rift Valley fever. “We are fighting six epidemics now,” a representative of Sudan told the World Health Organization in Geneva last week. “We don’t need another one.”
The WHO testing anyone with respiratory symptoms who has been exposed to a known case of the coronavirus, plus anyone with unexplained severe respiratory symptoms who has been in China in the previous two weeks.
While these guidelines are useful in countries with limited testing resources, they mean someone with mild symptoms who has been in China may not be tested. Similarly, someone with severe symptoms may not be tested if they contracted the virus in another country – although the recommendations may soon be changed following the cases in Europe that have been traced to Singapore.
The WHO says doctors should also test all unexplained outbreaks of pneumonia. But it can be hard to spot such clusters where health resources are limited.
“I am confident we will pick them up,” says Nkengasong. “Everyone is very alert.”
Article amended on 11 February 2020
We clarified the WHO’s testing guidelines.
Article amended on 11 February 2020
We corrected the spelling of Andrew Tatem’s name.
