WHO Estimates Africa’s COVID-19 Caseload is Seven Times Higher Than Official Count
South Sudan’s Minister of Health, Elizabeth Chuei, getting vaccinated against COVID-19.

Africa is estimated to have seven times more COVID-19 cases and three times as many deaths as officially reported, according to the World Health Organization (WHO) Africa region.

This means that the continent could have around 59 million cases and 634,500 deaths.

“We’re using a model to estimate the degree of under-estimation. Our analysis indicates that as few as one in seven cases is being detected, meaning that the true COVID-19 burden in Africa could be around 59 million people,” said Dr Matshidiso Moeti, WHO’s Africa executive director.

 “The proportion of underreporting on deaths is lower. Estimates such as around one in three deaths have been reported. Deaths appear to be low on the continent, in part because of the predominantly younger and more active population,” she told a media briefing on Thursday.

The case figure was extrapolated from country-based seroprevalence surveys while the mortality figure was reached on the basis of excess death statistics, said WHO’s team lead on operational partnerships, Dr Thierno Balde.

“With limited testing, we’re still flying blind in far too many communities in Africa,” conceded Moeti. 

The WHO recommends that member countries should perform 10 tests per 10,000 people each week yet around 20 countries – more than a third of African countries – do not reach this benchmark, said Moeti.

“Most tests are carried out on people with symptoms, but much of the transmission is driven by asymptomatic people. Estimates suggest that between 65% and 85% of COVID-19 cases are asymptomatic. The reported cases we see could therefore just give the tip of the iceberg,” she added.

Dr Matshidiso Moeti, WHO Africa Executive Director.

Community-based testing

The WHO has thus decided to invest $1.8 million to roll out COVID-19 rapid tests in hot spots, starting with pilots in eight countries including Senegal.

“The community testing initiative is a radically new approach, which shifts from passive to active surveillance through working with communities, local authorities and hotspot districts,” said Moeti.

“We will use antigen detection, rapid diagnostic tests which are reliable, affordable, easy to use, and provides results in around 15 minutes.”

People living within a 100-metre radius of a case in various hotspots will be eligible for a free test and the WHO expects to reach over seven million people.

The WHO hopes that, by identifying potential spreaders early, countries will be able to break the chain of transmission and contain flare-ups – particularly as the continent expects a surge in infections during the festive season in December when there is a lot more movement of people.

“This community testing strategy is a key component in transitioning towards localised management of COVID-19 outbreaks,” Moeti stressed.

Deaths lower in Africa

Despite the mortality undercount, WHO Africa officials said that deaths appear to be low on the continent.

Moeti attributed this in part to the continent’s “predominantly younger and more active population”. 

Balde added that the continent also had a relatively low prevalence of the co-morbidities such as diabetes and hypertension that had made COVID-19 fatal for many people.

“There are also some hypotheses mentioning the existence of viruses and linked to the coronaviruses that some Africans have been exposed to over the years,” added Balde.

However, only a minority of African countries have accurate statistics on excess deaths.

Zero vaccinations

Only three countries in the world have not yet started to vaccinate their citizens against COVID-19 despite WHO engagement and support, including the Africa states of Burundi and Eritrea.

However, Balde said that Burundi was expected to start to roll out vaccinations within the next few weeks as the country had recently joined the African Vaccine Acquisition Trust (AVAT) and signed a contract with COVAX.

However, he said that WHO was still working in Eritrea and doing advocacy “on all levels”.

Only 4.9% of Africans have been vaccinated against COVID-19, said Moeti.

Image Credits: UNICEF.

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