African countries are rushing to reinforce their defences against the rapidly spreading coronavirus, as health officials say many countries on the continent are ill-equipped to combat the potentially lethal disease.
There have been no verified infections in Africa to date, but porous borders, a continuing flow of travellers and poorly resourced healthcare systems have raised fears that the virus could spread rapidly if the precautions of local authorities prove inadequate.
“Our greatest concern is the potential for the virus to spread to countries with weaker health systems,” Tedros Adhanom Ghebreyesus, the World Health Organization’s director general, said last week.
There have been 20,438 confirmed infections in China, including 425 deaths, as well as at least 185 confirmed cases in 25 countries, and two deaths outside China, including one reported in Hong Kong and one in the Philippines.
On Friday, the WHO sent out a guidance note to all countries on how to prepare for a possible outbreak, warning that speed was essential to ensure the “novel coronavirus does not overwhelm health systems”.
The organisation has identified 13 top priority countries on the continent, including much of eastern, central and southern Africa, which either have direct links or a high volume of travel to China.
All the concerned states have put in place controls at airports, using thermal cameras to detect potentially infected passengers, and have readied isolation units.
At the weekend, Air Tanzania joined five other African airlines in suspending or restricting flights to China, though Ethiopia’s national flag carrier, which carries almost half of all passengers, has maintained flights.
Hundreds of Chinese companies have extensive operations across Africa and commercial ties between individuals have increased very significantly in recent years. There are large Chinese-origin communities in almost every major city in Africa, as well as more than 80,000 students from the continent in China itself. At least 4,000 are thought to be in Wuhan, the city at the centre of the outbreak. A 21-year-old student from Cameroon living in Jingzhou city was reported on Tuesday to be among new cases.
J Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic & International Studies in Washington, said the disease risked taking root if it reached certain African countries.
He warned that such a scenario could lead to a “global pandemic”.
Many poor African states have experience of disastrous viral outbreaks such as the Ebola virus, which killed more than 11,000 between 2014 and 2016, and have reinforced their defences.
Serufusa Sekidde, a Ugandan public health specialist who was in China during the 2003 (Sars epidemic, said many countries were much better prepared than before, though there were “still lots of loopholes”.
“Communication and coordination varies from place to place. Tracking and surveillance is better in some countries, especially those with experience of Ebola and polio,” Sekidde said.
In Kenya, the ministry of health has moved to reassure citizens and has dealt rapidly with reports of suspected cases, including one at a Chinese construction company in the west of the country.
“I think, as in most developing countries, the weakness is ultimately in the entire health system: the ability to rapidly detect and then isolate the cases that occur,” said Dr Rudolf Richard Eggers, the WHO country representative in Nairobi.
“If the numbers are small, then that can probably be done reasonably efficiently. If the numbers rise like they did in Ebola in west Africa, the health systems get overwhelmed pretty quickly.”
Nigeria has urged anybody arriving from China to “self-isolate” for at least two weeks, even if they are not ill, and in Mozambique, the government has suspended visas for Chinese citizens and forbidden its citizens from travelling there.
Authorities in South Africa said they had set up an emergency operations centre and were monitoring passengers at 36 entry points. The South African post office has stopped sending or receiving parcels from China.
On Monday, the Chinese ambassador to South Africa, Lin Songtian, described a “global battle between humanity and nature that required the concerted efforts of the international community to win it over”.
“We are fighting day and night. More medical personnel nationwide are on standby to assist anytime. More than 100 local hotels in Wuhan opened their doors free of charge for the medical personnel, visitors and foreigners,” Songtian told reporters.
Though the vast and unstable Democratic Republic of Congo is among the most potentially vulnerable African states, officials have experience of dealing with repeated outbreaks of other infectious diseases, including Ebola.
Kakule Kanyere Moise, the provincial minister of Kivu, the eastern province affected by Ebola, said he would make every effort to strengthen border controls. “We are working with the Ebola response team to warn our Ebola-affected population against [the] deadly new virus,” he said.
Authorities in the DRC will also have to monitor the movement of thousands of unregistered traders who travel to and from China.
The Federation of Enterprises of Congo, a major business association, said it had suspended commercial activities involving China as a preventative measure.
“[We have asked] that the economic operators who go to China temporarily suspend their activities because they can make the country catch the virus,” said Ally Yousouf Biondi, the president of the Federation of Enterprises of Congo. “As we are fighting Ebola, which has killed many of our families, let’s avoid going to the Asian country for our economic interests. I beg you not to go any more, I call on the authorities to strengthen security at the borders.”
Several countries, including Ethiopia, Kenya, Angola, Botswana and Ivory Coast, have signalled possible infections.
But confirming coronavirus can take time, as health authorities lacking expertise have to send samples to labs in countries such as South Africa.
“It is very possible that there are cases that are going on on the continent that have not been recognised,” John Nkengasong, the director of the Africa Centres for Disease Control and Prevention, told reporters.
“This strain is big. I have not seen a rapidly evolving outbreak like the one we are dealing with,” Nkengasong said.
