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Temperature checks at the Tanzania-Kenya border. Photo by FILBERT RWEYEMAMU/AFP via Getty Images
Temperature checks at the Tanzania-Kenya border. Photo by FILBERT RWEYEMAMU/AFP via Getty Images

SocietyJanuary 19, 2021

Why do Africa’s Covid-19 numbers look so good?

Temperature checks at the Tanzania-Kenya border. Photo by FILBERT RWEYEMAMU/AFP via Getty Images
Temperature checks at the Tanzania-Kenya border. Photo by FILBERT RWEYEMAMU/AFP via Getty Images

Are the continent’s coronavirus statistics as good as they appear? Felix Geiringer looks at the numbers, and why whether they reflect the reality matters. 

Living in Africa during Covid times, one of the questions I am asked most often is this: how has Africa done so well?

At the start of September, the first wave ending and the second wave still a month or two away, Africa had only reported 1.25 million cases, only 30,000 deaths. Europe, with 60% of Africa’s population, had reported three times as many cases and almost seven times as many deaths. North America, with an even smaller population, had twice as many cases again and even more deaths.  Now, in the midst of wave two, the difference is even more stark. Europe and North America have each reported about 26 million cases to Africa’s 3 million. The gap in death rates has also grown.

How did this occur? Many had expected things to go the other way. Europe enjoys nine times Africa’s GDP, for North America it is ten times. They have better infrastructure including better access to medical care. Africa is home to most of the world’s HIV cases. Many more people in Africa endure malnourishment and overcrowded conditions, things that were thought to make them more susceptible to Covid-19.

Africa’s apparent success has caused many people to go looking for a reason. Perhaps, if we can understand why Africa did so well it will help the whole world to combat the virus.

It is well established that younger people are more resilient to the virus. Africa’s population pyramid is a perfect cone. The UK’s, by comparison, is a garden gnome. Having almost 80% of Africa’s population under 40 must surely have helped.

There is also some suggestion that the BCG vaccination against tuberculosis can provide some protection against Covid-19. Having essentially eliminated TB, Western Europe and North America has largely stopped using this vaccine. BCG is still on the schedule for children growing up in much of Africa. Could having failed to eliminate one disease have help protect against another?

There was an early myth that Africa’s hotter weather would kill the virus. However, this has been debunked. It seemed obviously false:

Having good levels of Vitamin D is now seen as a possible benefit. Africa is not devoid of vitamin D deficiency. However, the problem seems to be worse in parts of Europe and worse still in North America.

Some suggest that Africa is also less urbanised than the rest of the world, but the figures on the degree of urbanization seem to be open to debate. If correct, it is argued that Africa may have more people are living outdoor lifestyles in less densely populated areas. Again, a potential advantage.

As mentioned above, there are some potential comorbidity risk factors that are worse in Africa. However, there are others where Africa has an advantage. Africa has lower rates of obesity and diabetes.

So, if you go looking for them you can certainly find factors that seem like they might back up the official reported numbers. Those reported numbers, however, are far from the full story. Let’s start with an example at the good end.

 

South Africa has taken a science led approach to combatting the virus. It went rapidly into a hard lockdown as well as other measures. This was never going to be able to eliminate the virus. If you want to understand why then take a look at my article from 24 May 2020. But it did buy time for the country to invest in testing facilities and ICU beds. South Africa today is vastly better equipped to meet this threat than it was a year ago.

Even with this sudden investment, the first wave stretched South Africa’s medical resources. A testing backlog grew, and testing had to be restricted to only people in a high-risk category. In addition to this there is also a stigma associated with illness and a significance resistance amongst some South Africans to seeking medical treatment. The official statistics were never going to be the full story.

Indeed, South Africa’s excess death statistics at the end of the first wave showed that there had been over 17,000 excess deaths during a period when only about 3,000 Covid-19 deaths had been reported.  The problem continues.  The most recently reported statistics show 11,063 excess deaths in a week that reported 2,108 Covid-19 related fatalities. Increase South Africa’s Covid-19 deaths by this much and it goes from being a success story to being much more on par with the deaths experienced in Europe and North America.

South Africa is a country that is relatively well resourced compared to many in Africa and which was actively trying to identify and report cases, and it might be missing deaths by a factor of five. Now let’s look at a country at the other end of the spectrum.

The Tanzanian President, John Magufuli, resisted closing churches and mosques at the start of the pandemic, insisting that his people would find their true salvation from the disease in prayer. In April, he called for three days of nationwide prayer. Tanzania reported 509 cases and 21 related deaths in April and at the start of May.  But Magufuli challenged the reliability of the testing and, in early May, he removed the head of the country’s testing laboratory.  No Covid-19 cases or related deaths have been reported in Tanzania since.

In early June 2020, Magufuli announced that the power of prayer had indeed eliminated COVID-19 from Tanzania.  However, US officials have disputed this. In May they said that hospitals in the capital, Dar es Salaam, were overwhelmed with cases. In mid-June 2020, they continued to report that the risk of contracting Covid-19 in the capital, and other locations in Tanzania, remained high.

What about the rest of Africa?  There were many reports of underfunded medical systems under severe pressure in many African countries before the pandemic. The pandemic exposed these issues. Africa’s ICU capacity was woefully inadequate. Some African nations started the pandemic with no testing capacity whatsoever.

Most of Africa falls somewhere in between South Africa and Tanzania – accepting the science but possessing nowhere near the resources needed to respond.

Go to the Worldometers coronavirus site and look at countries by tests per capita. What you will see is that most of Africa is stuck somewhere near the bottom of the table. For the most part these countries are conducting as many tests as they can and are reporting the results.  However, the reality is that the spread of the virus is much, much worse than those numbers suggest – not for any sinister reason but because it is all they can do with the resources they have.

Of course, the reported statistics are not the complete picture anywhere. For example, excess death statistics suggest that the UK and the US’s death numbers may be off my significant margins. Now grasp how much worse that will be for a country with a tiny fraction of the resources the UK and US possess.

So, how Africa is doing so well in tackling Covid-19? The answer is: it probably isn’t.

Why is this important? It isn’t a competition after all. We’re enjoying the praise in New Zealand for how well it has gone here, but there is no actual medal attached – no final at Lords if our PCT is in the top two.

It is important because, despite many nice noises that were made along the way, Africa is not receiving equal access to vaccinations. Poorer nations played a major role in the vaccine trials, some are even manufacturing them, only to be priced out of receive them in any significant numbers. Notwithstanding the good intentions of some, the enormous wealth gap between Africa and the rest of the world is translating to a vaccine access gap. And Africa needs those vaccines, as desperately as, if not more desperately than, everywhere else.

It is important for people to know that the context of the vaccine imbalance is a human tragedy unfolding right now and on a large scale.

Keep going!
Stormwater outlet at Browns Bay on January 23, 2017 in Auckland, New Zealand. (Photo by Dave Rowland/Getty Images)
Stormwater outlet at Browns Bay on January 23, 2017 in Auckland, New Zealand. (Photo by Dave Rowland/Getty Images)

SocietyJanuary 18, 2021

It’s going to be 20 years before Auckland’s shitty beach woes go away

Stormwater outlet at Browns Bay on January 23, 2017 in Auckland, New Zealand. (Photo by Dave Rowland/Getty Images)
Stormwater outlet at Browns Bay on January 23, 2017 in Auckland, New Zealand. (Photo by Dave Rowland/Getty Images)

It’s a seemingly age old question: why do Auckland’s beaches become unswimmable after every single downpour? Stewart Sowman-Lund investigates.

Ah, the beach. A staple of the New Zealand summer. Unless, of course, you’re based in Auckland and it’s raining. The start of 2021 has been a lot like every other New Year: headlines flooding in to warn prospective swimmers that Auckland beaches have become “unsafe” due to “high levels of faecal bacteria”. As in literal shit. Human shit, to be specific.

Recently, more than 50 beaches around the region were deemed unsafe to swim in as a result of deadly floaters making their way in from the city’s sewage following a weather event. 

So, what causes it in the first place? And when – if ever – will our beaches stop being so shitty? I set out to understand the faecal phenomenon and ask whether it’s a problem that will persist for summers ad infinitum.

What makes Auckland beaches unswimmable?

It’s fairly common knowledge that a lot of Auckland’s existing waste and stormwater infrastructure is combined, leading to overflows that often end up precisely where they shouldn’t be: the sea.

“Rainfall happens at very high intensity so if you want to have a system that can handle all the rain you have to have really, really big pipes and really, really big wastewater treatment plants,” Auckland University environmental engineer Jakobus van Zyl tells me. “It’s better to keep them separate, but some of the older plants in Auckland do have combined systems. The problem comes when the sewer system can’t handle the capacity.” 

Spillages happen when the flow in the sewer is higher than the capacity of the pipe, van Zyl explains. “The pipe can’t handle the capacity so it goes higher and spills out of manhole covers and places like that. One of the big issues is that when it rains you always get some of that rainwater in the sewage system, even though the systems are separated.”

Auckland Council Healthy Waters general manager Craig Mcilroy says that the combined systems – which can be found at a lot of the Western isthmus beaches – are designed to overflow when there’s wet weather. And it doesn’t take much. “Probably no more than one millimetre of rain is enough to trigger one of those overflows, which is why a number of those beaches have permanent no swim signs. None of that will be sorted until the Central Interceptor is commissioned in 2026.” 

Auckland Council is pinning a lot of its hopes on the Central Interceptor, a $1 billion-plus project that will carry wastewater flows from parts of the city out to the Māngere treatment plant. Once completed, it’s projected to decrease overflows in Auckland by about 80%. 

How long have we known about the problem?

Most of Auckland’s water woes come down to the fact that the city’s wastewater and stormwater infrastructure is old. Like, really old – some of it has been around for more than a century. So it’s most definitely not a new problem. While that may cause some to lay blame on our city’s planners of yesteryear, urban design expert Lee Beattie says that’s not the case. “If you think about the Cox’s Bay catchment – the amount of effort that’s gone into trying to fix that – it fundamentally comes back to the fact that we haven’t separated stormwater and wastewater and the infrastructure is just so old and needs replacing. A lot of these issues come from that.”

He adds: “If you look at where those beaches are, a lot of it are those older parts of the city where we need to invest in infrastructure upgrades.”

And it’s not a unique problem. “Look at Wellington,” says Beattie, referring to recent problems with underground pipes in the capital. “For the newer locations, it’s to do with the cost of infrastructure and the increased urban development that comes with it.” Beattie compares city infrastructure to maintaining a car, saying that constant work is needed to keep things operating smoothly. “The system was built a long time ago and was fit for purpose at that point in time. It’s not poor planning, it’s ongoing maintenance and putting aside the financial requirements to do this sort of stuff that’s really expensive to do.” 

Watercare’s acting chief operations officer Anin Nama agrees that the 100-year-old system was perfectly adequate when it was built. In the ’60s Māngere treatment plant was built, which saw the first improvement in terms of water quality. The next lot of work, which is ongoing today, is physically checking peoples’ property to ensure their pipes are separated into both waste and stormwater, Nama says.

I ask van Zyl whether he thinks local government needs to take responsibility for the annual problems that occur on Auckland beaches. It’s not quite that simple, he says. “I think it’s unfair to just say that they’ve been negligent unless we can compare to other cities over time and see that it’s so bad that they should have picked up on it earlier.”

He adds: “They only have so much money so if they spent more on this they would have spent less on other things. I think it’s an impossible job.” 

OK, so what’s being done to fix the problems?

Here’s where it gets complicated. 

“What we are finding, right across the region, is that people are putting stormwater into the wastewater,” Watercare’s Anin Nama says. “When you do that, it inundates the wastewater and we get overflows which go to the environment. We’ve got illegal connections that are happening… where people have plumbed their wastewater into the stormwater.”

There’s no silver bullet nor any other sort of cliché that will make Auckland’s water problems evaporate in an instant – but the Central Interceptor may be as close as we can get. 

Nama calls it a gamechanger. “Those are my own words. It will take the flow that used to go into the environment into the pipe and then into the Māngere treatment plant, effectively becoming a storage tank,” he says.

“However, there will be times when that tank is full because it can’t collect every rain event. The Central Interceptor is designed to protect itself and not overflow, but approximately two to six times a year there will still be overflows that go off into the environment – compared to 52 times a year [at the moment]. It’s a very important project.”

The Central Interceptor sounds great! But is it going to be enough?

In all honesty, probably not – at least not enough to fix things entirely. Improving Auckland’s infrastructure to the point where 100% of beaches are swimmable 100% of the time is, effectively, impossible – a claim that everyone I spoke to agreed with. But Healthy Waters and Watercare have a goal. “What we’ve defined as ‘good’ is 95% of beach availability,” says Craig Mcilroy. “There’s no magic bullet, it will never get to 100%, so my view is we need to define success as 95%.” Cox’s Bay, for example, currently has a permanent no swim sign. Mcilroy thinks even that beach will eventually become swimmable 95% of the time.

Part of the problem, as van Zyl explains, is the ongoing growth and densification of Auckland. It’s hard to predict what the city will look like in a decade, let alone another century. “I think to say that [spillages] can be completely avoided, to never have them, is basically impossible. It’s all about cost and the risk,” he says.

I ask Nama and Mcilroy to put a date on when they hope to reach their goal. “It won’t be until we’ve at least done the Western and Eastern isthmuses, so once we remove those permanent non swim sites that could be a plausible goal within the next 20 years,” Mcilroy says.

“It is a decade or two programme because we’re talking large amounts of work on every property that needs to be separated. It’s a forensic exercise, working on people’s private property,” adds Nama. “I don’t think we are behind where we should be in the investment.” 

So, buckle yourself in for another 20 years’ worth of headlines about Auckland beaches – there’s a long road ahead, but at least we know where we’re going.