Leveraging Africa’s preparedness towards the next phase of the COVID-19 pandemic

by  and 

The Lancet | May 14, 2020

The coronavirus disease 2019 (COVID-19) response in many African countries has been swift, progressive, and adaptable, despite resource limitations.

As the novel coronavirus infection spread through Wuhan (China) in January, 2020, African countries rapidly acquired de novo severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing capacity so that by March, most could confirm COVID-19. Airport screening began early and efforts to mitigate the spread of COVID-19 have typically emphasised case identification, contact tracing and isolation, handwashing and hand hygiene, and several social distancing and stay-at-home measures with, in some cases, lockdowns of exceedingly high risk areas (appendix). These strategies are likely to remain integral to disease mitigation until an effective vaccine is deployed or population immunity is sufficient to slow transmission. However, the application of COVID-19 mitigation strategies in sub-Saharan Africa needs careful and continued deliberation because of the unique socioeconomic dynamics in this region. In this Comment, we discuss some of these challenges and suggest potential, non-resource-intensive solutions.

Rapid urbanisation has led to an informal sector surge and consequent increase in people living in informal settlements and slums within African cities.

These communities are particularly susceptible to economic shock resulting from stay-at-home orders and lockdowns, which need to be tempered with food and basic necessity provisions.

Water tanks can be set up for handwashing and sanitation in these susceptible communities, as well as public toilets which could potentially serve as sentinel COVID-19 surveillance sites through periodic faecal matter sampling and testing.

An added layer of complexity is the multigenerational structure and large size of typical African households.

Household transmission is a substantial driver of SARS-CoV-2 spread in the community and multigenerational households might be prone to higher fatality.

Interrupting COVID-19 transmission is challenging because a substantial proportion of transmission occurs in the presymptomatic stage.

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