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.