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Africa's second wave was more severe than the first — Africa CDC

The first case of COVID-19 in Africa was reported in Egypt on 14 February, 2020, just 14 days after World Health Organisation had declared the outbreak a public health emergency of international concern.

The African Union (AU) Commission, through the Africa Centres for Disease Control and Prevention (Africa CDC), convened an emergency meeting of all ministers of health on 22 February, 2020, to develop and endorse a Joint Continental Strategy for COVID-19 Outbreak.

Since February, 2020, Africa CDC has rolled out six additional pandemic response initiatives across the continent targeting surveillance and testing; medical supply availability; public health and social measures (PHSMs); safe travel, livelihoods, and economies; pathogen genomics; and vaccine development and supply.

Researchers at the Africa CDC write that to successfully and equitably inform the implementation of the continental strategy and all of the associated initiatives across the continent, it was important to understand the regional and AU Member State-specific infection rates, mortality rates, testing capacity, ability to implement mitigation measures, and overall pandemic effect. Africa CDC has monitored the evolution of the pandemic across the globe since early January, 2020, through routine event-based surveillance. Within Africa, this information provided situational awareness and informed continental response efforts.

Despite the spread of COVID-19 to almost all countries in Africa within 3 months, country-reported case counts suggest that the pandemic has spread much slower on the continent than in the rest of the world.

To date, a comprehensive analysis of the heterogeneity of the pandemic across all five AU regions and 55 Member States has not been done.

Further, many of the initial modelling projections, response recommendations, and pandemic evolution discussions about COVID-19 in Africa have come wholly or partly from entities outside of the continent trying to fit other global experiences to Africa, not fully appreciating the diversity and differences across the continent.


Study details
The first and second waves of the COVID-19 pandemic in Africa: a cross-sectional study

Stephanie J Salyer, Justin Maeda, Senga Sembuche, Yenew Kebede, Akhona Tshangela, Mohamed Moussif, Chikwe Ihekweazu, Natalie Mayet, Ebba Abate, Ahmed Ogwell Ouma, John Nkengasong

Published in The Lancet on 24 March 2021

Although the first wave of the COVID-19 pandemic progressed more slowly in Africa than the rest of the world, by December, 2020, the second wave appeared to be much more aggressive with many more cases. To date, the pandemic situation in all 55 African Union (AU) Member States has not been comprehensively reviewed. We aimed to evaluate reported COVID-19 epidemiology data to better understand the pandemic's progression in Africa.
We did a cross-sectional analysis between Feb 14 and Dec 31, 2020, using COVID-19 epidemiological, testing, and mitigation strategy data reported by AU Member States to assess trends and identify the response and mitigation efforts at the country, regional, and continent levels. We did descriptive analyses on the variables of interest including cumulative and weekly incidence rates, case fatality ratios (CFRs), tests per case ratios, growth rates, and public health and social measures in place.
As of Dec 31, 2020, African countries had reported 2 763 421 COVID-19 cases and 65 602 deaths, accounting for 3·4% of the 82 312 150 cases and 3·6% of the 1 798 994 deaths reported globally. Nine of the 55 countries accounted for more than 82·6% (2 283 613) of reported cases. 18 countries reported CFRs greater than the global CFR (2·2%). 17 countries reported test per case ratios less than the recommended ten to 30 tests per case ratio range. At the peak of the first wave in Africa in July, 2020, the mean daily number of new cases was 18 273. As of Dec 31, 2020, 40 (73%) countries had experienced or were experiencing their second wave of cases with the continent reporting a mean of 23 790 daily new cases for epidemiological week 53. 48 (96%) of 50 Member States had five or more stringent public health and social measures in place by April 15, 2020, but this number had decreased to 36 (72%) as of Dec 31, 2020, despite an increase in cases in the preceding month.
Our analysis showed that the African continent had a more severe second wave of the COVID-19 pandemic than the first, and highlights the importance of examining multiple epidemiological variables down to the regional and country levels over time. These country-specific and regional results informed the implementation of continent-wide initiatives and supported equitable distribution of supplies and technical assistance. Monitoring and analysis of these data over time are essential for continued situational awareness, especially as Member States attempt to balance controlling COVID-19 transmission with ensuring stable economies and livelihoods.

The Lancet material and study (Open access)

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