Africa prepares for coronavirus.

With cases of novel coronavirus spreading worldwide, governments and institutions are getting ready for the first cases in Africa. Munyaradzi Makoni reports from Cape Town.

On Jan 30, WHO Director-General Dr Tedros Adhanom Ghebreyesus declared that the novel coronavirus (2019-nCoV) epidemic, centred in China, was a public health emergency of international concern. A large part of WHO's reasoning was that “a global coordinated effort is needed to enhance preparedness in other regions of the world”. As cases continue to rise, and spread worldwide, governments and institutions are taking action to prepare for the first patients in Africa.

“The risk and likelihood of getting an outbreak is very, very high”, said Ambrose Talisuna, the WHO Africa team lead for emergency preparedness. As of Feb 11, Africa does not have any confirmed cases, but suspected patients have been quarantined in Ethiopia, Kenya, Côte d'Ivoire, and Botswana.

Dr Tedros announced on Feb 5 that a US$675 million preparedness and response plan covering February to April, 2020, had been initiated by the international community for China and globally to protect states with weaker health systems.

WHO has prioritised support for 13 countries on the basis of their close transport links with China: Algeria, Angola, Côte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia.

“We all know how fragile health systems [are] in the African continent, they are already overwhelmed by many outbreaks. For us, it is critical to detect coronavirus earlier [so] that we can prevent spreading within communities that can trigger a number of cases that can overwhelm the treatment capacity”, said Michel Yao, WHO Africa programme manager for emergency operations.

The strategy is to prepare country technical guidance, advising ministries of health on how to limit human-to-human transmission, ensure countries have capacity to isolate and provide appropriate treatment to affected people, Yao said.

The Africa Centres for Disease Control and Prevention (Africa CDC) established the Africa Task Force for Novel Coronavirus on Feb 3. It is working with WHO on surveillance, including screening at points of entry, infection prevention and control in health-care facilities, clinical management of people with severe 2019-nCoV infection, laboratory diagnosis, and risk communication and community engagement.

The Director of Africa CDC, John Nkengasong, outlined the threat to Africa posed by 2019-nCoV. “This disease is a serious threat to the social dynamics, economic growth, and security of Africa”, said Nkengasong. “If we do not detect and contain disease outbreaks early, we cannot achieve our developmental goals.”

Yao said WHO is working with various partners to ensure that there is a proper screening process at the main points of entry, that suspected cases are isolated, and that protective equipment is provided. The guidance requires that alerts be raised on suspected cases. Health workers have been taught how to behave in front of people with suspected or confirmed infection. In-country incidence management teams have also been set up.

Even in countries where there is instability, such as South Sudan, coordination mechanisms have been worked out to reach health workers and patients. Thanks to Ebola, Yao said, most of the countries have isolation infrastructure. “We are pushing for the continent to be very vigilant”, he added.

Hilde De Clerck, emerging infections adviser with Médecins Sans Frontières, made the point that some health systems are already well organised and have able leadership but will have to adapt to respond successfully to an outbreak.

South Africa's National Institute of Communicable Diseases and Senegal's Institut Pasteur were initially the only referral laboratories on the continent, and so were responsible for testing samples from other African countries. By Feb 4, more countries—Ghana, Madagascar, Sierra Leone, and Nigeria—were also able to do testing themselves. As of Feb 10, WHO said that 11 countries were capable of testing for 2019-nCoV, and reagents should be delivered to other countries this week.

Africa's preparedness efforts have been boosted with $25 million from the Bill & Melinda Gates Foundation, with some of it going towards training.

15 experts from the African Union received training on laboratory diagnosis for 2019-nCoV in Dakar, Senegal, on Feb 6–8. WHO is also supporting training in Ethiopia and other countries on isolation and treatment and care of infected patients.