Africa´s confirmed coronavirus cases have surpassed 1 million, but global health experts say the true toll is likely several times higher, reflecting the gaping lack of testing for the continent´s 1.3 billion people.
While experts say infection tolls in richer nations can be significant undercounts, large numbers of undetected cases are a greater danger for Africa, with many of the world´s weakest health systems.
More than 22,000 people have died of COVID-19.
The World Health Organization calls the milestone a ‘pivotal point’ for Africa as infections in several countries are surging.
The virus has spread beyond major cities ‘into distant hinterlands’ where few health resources exist and reaching care could take days.
Immediately knowing they were at a disadvantage, African nations banded together early in the pandemic to pursue badly needed testing and medical supplies and advocate for equitable access to any successful vaccine.
Swift border closures delayed the virus´ spread.
South Africa’s state is a warning for Africa´s other 53 countries of what might lie ahead.
While dire early predictions for the pandemic have not played out, ‘we think i´s going to be here at a slow burn,’ the WHO´s Africa chief, Matshidiso Moeti, said Thursday.
African nations overall have conducted just 8.8 million tests since the pandemic began, well below the Africa Centers for Disease Control and Prevention´s goal of 13 million per month.
Countries would love to increase testing if only supplies weren´t being snapped up by richer ones elsewhere.
Africa CDC director John Nkengasong said estimating the true number of cases on the continent is ‘very tricky.’
Some 70% of infections are asymptomatic, he has said.
Africa´s young population also might be a factor. Without a dramatic increase in testing, ‘there´s much we don´t know.’
Reflecting the pandemic´s diverse nature across Africa, just five countries account for 75% of confirmed cases: South Africa, Egypt, Nigeria, Ghana and Algeria.
Nigeria alone could have had close to 1 million cases by now if Africa´s most populous country hadn´t acted quickly, the Africa CDC´s Nkengasong said.
Still, with insufficient testing, people live with the fear that loved ones may have had the virus without knowing for sure.
In Burkina Faso, Yaya Ouedraogo lost his uncle and cousin in April. Both were in their 70s with a history of high blood pressure and diabetes, and both had complained of shortness of breath, fever and body pain, he said.
‘They had all the symptoms of coronavirus, but in certain areas no one was investigating it and they didn´t get tested,’ he said.
The WHO Africa chief has said officials don´t think the continent is seeing a ‘silent huge epidemic,’ with thousands dying undetected, but she acknowledged under-reporting of cases.
‘What we´d like to see – to be able to be really confident – is higher testing rates,’ Moeti told reporters last week, and she criticized the ‘very distorted global market’ in which richer countries have the bulk of testing materials while poorer ones scrape by on just hundreds of tests a day.
Moeti also worries about a related danger for which even less data exists: the number of deaths from diseases such as malaria, HIV and tuberculosis as resources are diverted to COVID-19.
Whatever Africa´s real coronavirus toll, one South African church has quietly been marking the country´s ‘known’ number of deaths by tying white ribbons to its fence. The project´s founders say each ribbon really stands for multiple people.
Already, the Rev. Gavin Lock wonders about what to do when the length of fence runs out. Maybe they´ll change the ribbons´ color to represent 10 people, or 50.
‘It´s a work in progress,’ he said.