COVID-19 in Africa: between hope and reality.

When WHO declared the COVID-19 pandemic to be a Public Health Emergency of International Concern on Jan 30, 2020, countries around the world began to prepare. Preparation, however, is becoming increasingly difficult in many African countries, especially in central African countries, such as Republic of the Congo and others, where the effects of the Ebola virus disease epidemic on the economy and health structures are still being felt. The first case of COVID-19 in Africa was reported on Feb 14, and within a few weeks the virus had spread to 54 African countries. Only a few African Union member states have been successful in implementing detection, prevention, and control measures. Republic of the Congo reported its first case on March 14, and by May 9 a total of 274 confirmed cases and ten deaths had been reported. Very few countries in Africa have sufficient and appropriate diagnostic capacities, and obvious challenges exist to handle an outbreak of this extent.

Densely populated communities in urban areas are particularly vulnerable to COVID-19 outbreaks, and the most vulnerable region in Republic of the Congo is undoubtedly Brazzaville. Our institution, the Congolese Foundation for Medical Research, supports the National Public Health Laboratory with COVID-19 diagnoses and thus with extended monitoring measures. We feel that operational research at the local level in Brazzaville through testing people living in densely populated communities and health workers is a moral responsibility. As of May 9, three asymptomatic health-care workers had tested positive for severe acute respiratory syndrome coronavirus 2. With the number of cases observed in our laboratory growing (up to 24 cases per day), fear and anxiety among our Congolese scientists also grows.

A question that Republic of the Congo and other member states in the region must ask themselves is why are we seeing only a gradual increase in the detection of cases? Are we missing infections? A probable answer is that people with symptoms do not present to health-care facilities because of their concerns about fragile health systems, social stigma, and quarantine in suboptimal facilities. Other questions still to be resolved are related to the dynamics of viral transmission across geographical regions, between humans, across different ecosystems, and within different genetic backgrounds, and to whether any protective herd immunity exists.

Given the fragile health systems in most sub-Saharan African countries, new and re-emerging infectious disease outbreaks can paralyse health systems and existing structures. Yet the COVID-19 pandemic poses a challenge not only for sub-Saharan African countries but also for those with well functioning health systems. The responsibility now for African scientists is to join forces and fight at local and regional levels to ensure the slow down and eventual halt of the spread of COVID-19. This can be well achieved by supporting existing regional and local health structures in sub-Saharan Africa.