Africa holds its breath as coronavirus hits Europe and Middle East

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Despite only two diagnosed African cases of coronavirus so far, a Lancet study says South Africa, along with Algeria and Egypt, are at greatest risk on the continent, while a Bloomberg report warns that sub-Saharan Africa may be the region hardest hit economically and socially outside Asia.

With COVID-19 now reaching dozens of countries, and with Austria, CroatiaSwizerland and Brazil declaring cases, a World Health Organisation expert has warned that countries outside China are “simply not ready” for a pandemic and need to learn urgently from how China.

The Centre for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota has given its latest perspective on COVID-19.
Three more European countries have reported their first COVID-19 cases, mostly linked to Italy's outbreak, and more newly affected Middle East countries confirmed more illnesses linked to an outbreak in Iran.

In other developments regarding the novel coronavirus, the leader of the World Health Organisation (WHO) joint mission to China gave a detailed report on the group's findings in China, and case numbers grew in other affected Asian countries, mainly in South Korea and Japan.

The WHO-led international joint mission wrapped up its visit to China on 24 February, and Dr Bruce Aylward, who led the 25-member group, has briefed reporters on the team's experiences and findings. He said that, without a drug or vaccine available to battle the new virus, the country used standard public health tools such as case finding and contact tracing with rigor and innovation "on a scale that we have never seen in history."

Though Wuhan and Hubei province are the epicentre, the outbreak evolved differently as the virus spread to other provinces, and though the central government enforced rules, provincial health officials had the flexibility they needed to tailor the response to their situations.

The team also observed how China "repurposed the machinery of government" to battle the outbreak and used big data tools, including artificial intelligence, to manage a massive amount of information, such as contact tracing.

Aylward also said the team observed an agile, science-driven response, during which the government updated its clinical guidance six times as it learned more about the virus and illness.

China's stringent measures, such as sealing off towns and ordering people to stay in their homes, changed the course of the outbreak, with a decline that is now occurring sooner than expected, Aylward said. Team members had multiple ways of getting a sense of the decline, such as talking to doctors in Wuhan who spoke of open hospital beds and no more waiting lines for testing at fever clinics.

Because of the decline in cases, Chinese researchers report slower-than-expected enrolment of patients in drug treatment trials.

Aylward urged countries that are bracing for outbreaks to shift their mindset. "The world is not ready, but can get ready fast," he said, emphasising that countries can indeed affect the course of the disease with aggressive and tough programs, noting that key steps should include planning for a heavy demand on hospitals and respiratory support, such as ventilators, staffing for contact tracing, and getting the public on board.

A big question that still remains unanswered is how many mild cases go undetected, a metric that is key for getting a better handle on the disease's severity and fatality rate. Aylward said the group saw bits of information, such as testing of samples from China's flu surveillance system and testing of convenience samples, that hint the number of milder cases may not be great. However, he said that over the last few days China approved two serology tests, which will help answer the question.

He said though asymptomatic transmission might play some role, household exposure seems to be the main driver of the outbreak. And he noted that many health workers who got sick were exposed in the community.

Regarding the clinical spectrum, Aylward said about 88% of patients remember having a fever and 68% had a dry cough. Only about 12% had a runny nose, hinting that COVID-19 might not have much upper respiratory involvement. Some patients reported a prodrome that consisted of fatigue, muscle pain, and a vague feeling of being unwell. In those who have symptoms, 80% have mild disease, 13% have severe illness, and 6% are critically ill, the group found.

When pressed on whether countries outside China – especially those without strong central governments – could replicate China's experience, Aylward said countries can be masters of their own fate. "Can that be replicated? Why not?"

Italy's health ministry reported 93 more cases and 4 more deaths, raising the case total to 322, including 10 deaths. Though the outbreak is centred in northern Italy near Lombardy, the country today reported the first cases in more regions, including Tuscany, Sicily, Liguria, Bolzano province. Also, Italy's health ministry said officials from the WHO and the European Centre for Disease Prevention and Control will meet with Italian health officials in Rome to discuss the next steps for managing Italy's outbreak.

In other European developments, three countries – Austria, Croatia, and Switzerland – reported their first COVID-19 cases. Austria's health ministry reported two confirmed cases – the patients are isolated in a hospital in Innsbruck, and one is from Lombardy, the epicentre of Italy's outbreak.

Croatia has reported the country's first case, which involves a man who had recently travelled from Italy – a health ministry official said the man has mild symptoms and had visited Milan.

Switzerland reported its first case, which was detected in Ticino canton near the border with Italy. The patient is a man in his 70s who had visited the Milan region.

Meanwhile, France and Spain – two earlier affected countries – have reported more infections. France reported two new cases, one involving a Chinese woman who recently returned from China and one involving a man who had recently travelled to Lombardy region in Italy. France now has 14 cases.

Spain reported as many as three new patients. Two are a male traveller from Italy and his companion who were staying on the Canary Islands' resort island of Tenerife, where the hotel they are staying is on lockdown. The other is an Italian woman living in Barcelona who had recently visited northern Italy, including Bergamo and Milan.

The Iran Health Ministry has reported 34 more cases and 3 more deaths, raising its case total to 95, which includes 15 deaths. In another development, the country's deputy health minister, who appeared to be suffering from symptoms while addressing reporters, and a member of parliament are among the confirmed cases.

Meanwhile, four countries in the Middle East (Iraq, Bahrain, Oman, and Kuwait) have reported more cases – all linked to Iran travel. Iraq's health ministry reported 4 more cases, bringing its total to 5. The patients are members of an Iraqi family who had travelled to Iran. Bahrain has reported 22 more cases, raising its total to 23. The Bahrain Health Ministry said the 6 more recent patients had travelled from Iran. The Omani Health Ministry reported 2 more cases, lifting its total to 4. Both involved Iran travellers. And Kuwait's health ministry reported 1 more case, involving a woman who was in quarantine with a group of Iran travellers, putting its total at 9 so far.

The South Korean Centres for Disease Control and Prevention in three updates reported (60, 130, and 84 ) 274 new cases, down from 438, raising its total to 977. It also reported 2 more deaths, lifting the fatality count to 10. Daegu and Gyeongbuk are still the main hot spots, and the Shincheonji Church of Jesus cluster and a large hospital cluster make up 68.8% of cases.

The Japanese Health Ministry has reported 8 more cases, plus 1 more asymptomatic carrier, raising its total to 147, though it notes 164 overall cases that include 17 asymptomatic carriers. The latest cases are from Nagano prefecture, Kumamoto, Sapporo, Ishikawa prefecture, Nagoya, and Tokushima prefecture. Also, Japan reported another death in a passenger from the Diamond Princess cruise ship, a man in his 80s from Tokyo.

Elsewhere in Asia, Thailand reported two new cases, one a woman who had travelled to China and the other a driver who had served Chinese tourists. The country's case total is now at 37. And Singapore reported one more case, linked to an earlier patient, raising its total to 91.

South Africa’s government has been commended by Chinese consul-general in Cape Town Lin Jing for having come up with a “very effective, efficient and appropriate” strategy to deal with the risks of a coronavirus outbreak. According to a Business Day report Jing briefed MPs of the tourism and health committees on the spread of the coronavirus (Covid-19) in China and the progress made in containing it. The co-operation between Chinese representatives in the country and the government had been very successful in keeping the coronavirus out of Africa, he said.

Jing estimated 3,000 South African citizens are in China of whom 500 are in Wuhan, the epicentre of the epidemic.

He stressed, though, that the turning point of the crisis has not yet arrived, especially as an estimated 220m people will be returning to work after the spring festival at the end of February with more than 100m more going back to work after March and 100m students returning to school. This will make prevention and control more difficult. “This grand domestic migration has dramatically increased the risks of spreading the virus. This is a tremendous challenge.”

Meanwhile, a Bloomberg report says even without a single confirmed case, sub-Saharan Africa may be the region hardest hit outside of Asia by the spread of the coronavirus. The outbreak has shut down entire swathes of the Chinese economy, threatening world economic growth and curbing appetite for oil and metals that are the lifeline of many African nations.

A slowdown in the number 2 economy and a 5% drop in oil prices over one year could mean $4bn in lost export revenue for sub-Saharan Africa, or the equivalent to 0.3% of its gross domestic product – more than any other continent outside of Asia, according to a study by the Overseas Development Institute. “Many developing countries are increasingly dependent on China for trade, both for imports and exports,” Dirk Willem te Velde, principal research fellow at the institute, said.

African central bankers are starting to sound alarm bells. The South African Reserve Bank will take into account the virus impact on the global economy at its next rate-setting meeting, Chris Loewald, a member of its monetary policy committee is quoted in the report as saying.

Unlike when the SARS epidemic started in China in 2003, the Chinese economy is now more integrated into the rest of the world, representing 18% of global GDP. In just over a decade, the Asian nation has displaced the U.S. as Africa’s single largest trade partner.

CIDRAP material

WHO situation report

WHO team findings

Full Business Day report

Full Bloomberg report

The Lancet abstract

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