Late Monday night, on February 24, an Italian citizen flew into the Murtala Muhammed International Airport in Lagos. The next day, the 44-year-old man went to work in Ogun State. The following day, he visited a staff clinic where he was suspected of having COVID-19 and promptly transferred to the Infectious Disease Hospital. By Thursday, it was official; he had become Nigeria’s patient zero.
On February 28, just one day after the country’s first confirmed case, the government activated its highest level of alert for a public health emergency; the Nigeria Centre for Disease Control deployed Rapid Response Teams to Lagos and Ogun State to investigate suspected cases and implement community-based surveillance; and contact tracing began.
On March 8, fewer than 10 days into the response effort, the index patient was clinically and psychologically stable at the designated treatment facility. A total of 217 contacts were identified, including 40 people from his job in Ogun State and 169 passengers and crew from his 10 p.m. Turkish Airline flight from Milan to Lagos. There were 40 asymptomatic contacts under quarantine. And one asymptomatic contact tested positive, becoming Nigeria’s second confirmed case.
To date, 9,580 people of interest who entered the country were placed under institutional quarantine. Nigeria now has 6,175 confirmed cases. Of those, 1,472 cases—nearly 25 percent—were detected through contact tracing.
As evidenced in the aforementioned details from the Nigeria CDC Situation Reports, Africa’s most populous nation—and the first sub-Saharan country with a COVID-19 infection—set a standard for how governments across the continent would attack the viral enemy. Many national ministries of health have traced the origin and movement of the virus with meticulous documentation much like government officials did for the infamous Patient 31, who was credited for the surge of cases in South Korea.
Currently, Africa has 88,172 reported cases, according to figures from the Africa Centres for Disease Control and Prevention. Yet, international observers have long questioned the paucity and accuracy of the numbers. How could a continent of 54 nations and 1.3 billion people possibly have fewer than half the number of infections of New York City? (It has 190,978 reported cases, according to Johns Hopkins University.)
Familiar Territory
Given that the continent has more than 100 public health emergencies every year, Africans don’t have the luxury of doubting the severity of a pandemic. Cholera, whooping cough, yellow fever, pneumonic plague and flesh-eating bacteria are among the diseases listed in the latest Compendium of Short Reports on Selected Outbreaks in the WHO African Region 2016–2018.
“Most of our countries have experiences with outbreaks, so we understand the importance of early containment,” said Dr. Mary Stephen, a technical officer for health emergencies at the World Health Organization Regional Office in Africa. “We are conscious of our fragile healthcare systems, so we do everything we can to reduce the negative impact.”
A shortage of ICU beds and ventilators exposed cracks in mightier health care systems around the world. The advantage in Africa is that public health professionals recognize their limitations and have experience in overcoming them.
Measures like contact tracing help prevent outbreaks, which could overwhelm a system that must maintain essential health services and treat other communicable diseases, Dr. Stephen explained. “If you have a lot of cases, it’s possible to break the chain of transmission, but it requires more time, effort and resources. So we’re always racing to be ahead of the virus.”
Frontline health workers stood watch, armed with temperature scanners, at international borders as if they were waiting for the viral predator to appear. There’s little coincidence that many index cases on the continent were detected under quarantine or at the arrival gate.
Uganda had evaded the virus for weeks until its first reported case on March 21, when a 36-year-old man returning from Dubai was intercepted at Entebbe International Airport. Today, according to the Ugandan Ministry of Health, there have been 75,228 people tested for COVID-19, and 260 tested positive. There have been 3,922 contacts traced, with 1,100 people under institutional quarantine and 1,272 contacts under followup.
On March 31, Sierra Leone reported its first COVID-19 infection, according to the Ministry of Information and Communication. The 37-year-old man, who returned home from France, had been under institutional quarantine with 718 other suspected cases. As of today, the country has confirmed 519 cases and has traced 5,513 contacts.
When the Ministry of Health and Population confirmed the first three cases in Malawi on April 2, it was during a 14-day quarantine. The index patient was a 61-year-old woman returning from India; the second case was her relative, and the third case was her domestic worker. Today, the country has confirmed 70 cases and traced 633 contacts.
Last week, Lesotho became the 54th African nation to report a COVID-19 infection. The Ministry of Health had conducted 216 negative tests since the onset of the pandemic. Last Wednesday, the ministry announced it conducted an additional round of 81 tests; of those, one test was positive. Yesterday, there were 283 tests with negative results, and 18 test results were pending.
Continental Response
With ongoing outbreaks, limited resources and a lot to lose, Africa had little time to waste.
On February 1, when the continent had yet to report any cases, representatives from WHO, the Africa CDC and the West Africa Health Organization met at the Institute Pasteur in Dakar, Senegal, for training in laboratory diagnostics for COVID-19. It would be the first of several workshops taking place in different countries, prepping medical professionals in areas of prevention and control and case management.
On February 22, a week and a day after Egypt’s Ministry of Health and Population reported it had the continent’s first COVID-19 case, the African Union convened an emergency session. National ministers of health met with officials from WHO-Africa and the Africa CDC in Addis Ababa, Ethiopia, to assess preparedness and response efforts.
Some of those efforts were relevant to previous epidemics, so many countries were able to rely on existing infrastructure. Dr. Stephen pointed out how the Integrated Disease and Surveillance Response, established by WHO to track outbreaks on the continent, had been in use for the past 20 years; points-of-entry screenings were already in place for Ebola; and the Polymerase Chain Reaction machines to diagnose for other diseases could also test for COVID-19 with the required reagents.
African nations, more than most, were simply better prepared for this battle. These sentiments are often expressed by Dr. Mike Ryan, executive director of the WHO Health Emergencies Programme. He has a tendency to single out mitigation efforts on the continent, much like a professor does when he singles out exemplary students.
Just last week, Dr. Ryan praised the efforts of the African Union in devising comprehensive response plans. “It’s great to see that political leadership,” he said during Friday’s news conference. “We are seeing a lot of African leaders step forward, working closely with the WHO Regional Director for Africa, trying to come up with strategies that adapt to social and economic circumstances of countries.”
Every African nation has a WHO office supporting the health ministers and other government agencies to ensure maximum control of COVID-19, Dr. Ryan said.
However, last week, Burundi expelled WHO officials from their country. The United Nations made the announcement but couldn’t provide a reason for the expulsion.
Dr. John Nkengasong, director of the Africa CDC, characterized the situation as unfortunate, during his Thursday news conference.
“This war has to be won in a coordinated fashion, and cooperation is key and central to this fight,” said Dr. Nkengasong, who added that member states were in dire need of the clinical and technical expertise that WHO provides.
In an effort to integrate the continent, countries can’t operate in isolation, he warned.
As Dr. Nkengasong often says when he makes a plea for African solidarity, “A COVID-19 infection in one member state is a COVID-19 infection in all member states.”
