Coronavirus - Africa: Outbreak Brief #15 - Coronavirus Disease 2019 (COVID-19) Pandemic

Since the last brief (21 April 2020), 563,473 new confirmed1 coronavirus disease 2019 (COVID-19) cases and 40,814 new deaths have been reported globally. This is a 24% increase in cases reported between 21-28 April 2020 compared to a 31% increase in cases reported between 14-21 April 2020. To date, a total of 2,879,512 COVID-19 cases and 198,710 (CFR: 6.9%) related deaths have been reported worldwide. This week six new countries 2 including two from Africa, are reporting deaths for the first time. Worldwide, a total of 213 countries and territories have reported COVID-19 cases. The distribution of cumulative cases (proportion of global cases %) from the WHO reporting regions (excluding Africa) are as follows: Eastern Mediterranean Region 154,628 (5%), European Region 1,359,380 (47%), Region of the Americas.

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1,140,520 (40%), South-East Asia Region 46,060 (2%) and Western Pacific Region 144,833 (5%). For more detailed information on cases and deaths being reported outside of Africa, refer to the WHO daily situation reports3.

As of 9 am EAT 28 April 2020, a total of 33,273 COVID-19 cases and 1,467 (CFR: 4.4%) deaths have been reported in 52 African countries. Since the last brief, the number of COVID-19 cases has increased by 42% (9,768 cases). The five countries in Africa with the highest cumulative number of cases (proportion of reported cases in Africa) are South Africa (4,793; 14%), Egypt (4,782; 14%), Morocco (4,120; 12%), Algeria (3,517; 11%) and Cameroon (1,756; 5%). When population is taken into consideration, Djibouti (105), Mauritius (26), Cabo Verde (20), Equatorial Guinea (18) and Seychelles (11) are reporting the most cases per 100,000 population within the continent. Nine countries are reporting case fatality rates comparable to or higher than the global case fatality rate of 6.9%. Out of these, the case fatality rates for countries with 100 cases or more are: Algeria (12%), Liberia (12%), Sudan (8%) and Egypt (7%). See Table 1 for the full list of countries in Africa reporting cases, deaths, and COVID-19 recoveries in addition to the epidemic phase in each country. Africa CDC is working with all affected countries and is mobilizing laboratory, surveillance, and other response support where requested.

Table 1. Confirmed COVID-19 Cases Reported in Africa4 21-28 April 2020, 9 am EAT

Country	No. of cases (new)	No. of deaths (new)	No. of recovered	Epidemic phase5
Central Region	3,021 (1,109)	101 (26)	961
Burundi	15 (9)	1 (0)	4	2
Cameroon	1,756 (593)	58 (16)	805	2
Central African Republic	50 (36)	-	10	2
Chad	46 (13)	-	15	2
Congo	207 (64)	8 (2)	19	2
DRC	471 (121)	30 (5)	56	2
Equatorial Guinea	258 (179)	1 (1)	9	2
Gabon	211 (91 )	3 (2)	43	3
Sao Tome and Principe	7 (3)	-	-	1
Eastern Region	3,379 (837)	84 (28)	1,248
Djibouti	1,035 (189)	2 (0)	477	2

Eritrea	39 (0)	-	13	2
Ethiopia	124 (13)	3 (0)	50	3
Kenya	363 (82)	14 (0)	114	2
Madagascar	128 (7)	-	75	2
Mauritius	334 (6)	9 (0)	302	3
Rwanda	207 (60)	-	93	2
Seychelles	11 (0)	-	6	2
Somalia	480 (243)	26 (18)	14	2
South Sudan	5 (1)	-	-	2
Sudan	275 (168)	22 (10)	21	2
Tanzania	299 (45)	8 (0)	37	2
Uganda	79 (23)	-	46	3
Northern Region	13,454 (3,402)	973 (156)	3,792
Algeria	3,517 (799)	432 (48)	1,558	3
Egypt	4,782 (1,449)	337 (87)	1,236	2
Libya	61 (10)	2 (1)	18	2
Mauritania	7 (0)	1 (0)	6	2
Morocco	4,120 (1,056)	162 (19)	695	2
Tunisia	967 (88)	39 (1)	279	3
Southern Region	5,153 (1,628)	104 (34)	1,557
Angola	25 (6)	2 (0)	6	1
Botswana	22 (2)	1 (0)	-	2
Eswatini	65 (41)	1 (0)	10	2
Malawi	36 (19)	3 (1)	4	2

Mozambique	76 (37)	-	9	2
Namibia	16 (0)	-	8	2
South Africa	4,793 (1,493)	90 (32)	1,473	3
Zambia	89 (24)	3 (0)	42	2
Zimbabwe	31 (6)	4 (1)	5	2
Western Region	8,266 (2,792)	205 (65)	2,533
Benin	64 (10)	1 (0)	33	2
Burkina Faso	635 (54)	42 (4)	469	3
Cape Verde	109 (42)	1 (0)	2	2
Côte d’Ivoire	1,150 (271)	14 (4)	468	2
Gambia	10 (0)	1 (0)	8	1
Ghana	1,550 (508)	11 (2)	155	2
Guinea	1,163 (541)	7 (2)	246	3
Guinea-Bissau	73 (23)	1(1)	18	2
Liberia	133 (34)	16 (8)	25	2
Mali	408 (162)	23 (9)	113	2
Niger	701 (46)	29 (9)	385	2
Nigeria	1,337 (672)	40 (18)	255	3
Senegal	735 (358)	9 (4)	284	3
Sierra Leone	99 (56)	4 (4)	10	2
Togo	99 (15)	6 (0)	62	2
Total	33,273 (9,768)	1,467 (309)	10,091

NEW Africa CDC Response Activities:

General

1. Africa CDC is hosting a special webinar for member states titled “Global MediXChange for Combatting COVID-19 (GMCC): The Experience of China” will be held in collaboration with the Jack Ma Foundation, Alibaba Foundation and Alibaba Health will be held on 28 April 2020 at 3pm EAT.
2. Africa CDC has received the third consignment of medical equipment and supplies from the Jack Ma Foundation and Alibaba Foundation. These will be distributed to Member States in the coming weeks.

Healthcare Preparedness and Medical Countermeasures:

3. Africa CDC hosted a webinar on “COVID-19 in an emergency set up- Experience from the Field and Critical care in the ICU” for over 47 member states last week.
4. Interim guidance on community use of face masks has been published on the Africa CDC website6.
5. Africa CDC’s statement on medications to treat COVID-19 is available on the Africa CDC website7.
6. This week’s webinar will be held on Wednesday 29 April 2020 from 1pm EAT. The topic is “Principles of IPC & Evidence-based recommendations on Personal Protective Equipment (PPE) for COVID-19”.

Laboratory:

7. Africa CDC has continued to facilitate testing on the continent and this week 220test kits were sent to Uganda (140) and Ethiopia (80).
8. Africa CDC completed an equipment footprint analysis focused on molecular COVID-19 testing platforms for 38 Member States.
9. Illumina Inc. has shipped equipment and reagents to strengthen SARS-CoV2 sequencing in 10 reference laboratories from 10 Member States in collaboration. The materials are expected to arrive on 30 April 2020 in Addis Ababa for subsequent distribution by Africa CDC.

Surveillance:

10. Conducted webinars on “Essential components of outbreak reporting in the COVID-19 context” in English (22 April 2020) and French (24 April 2020) for all Member states.
11. Africa CDC facilitated training on “Enhanced Surveillance at Points of Entry” for 30 regional participants in Cameroon last week.
12. AFTCOR’s weekly surveillance technical working group met and deliberated on a continental strategy and budget for support of Member States on surveillance as well as identified priority topics for upcoming webinars.
13. The next webinar for surveillance titles “Data Use for Action: Analysis, and interpretation of surveillance data to inform policy decisions” will be held Wednesday 4pm EAT.

Risk Communication

14. The 8th press briefing of the continental update for COVID-19 with the Africa CDC director and journalists was held on 23 April 2020. The next press briefing will be held on Thursday 10am EAT.
15. Africa CDC has received partnership proposals from Facebook to support COVID-19 campaigns on the continent.
16. Africa CDC and Emory University are discussing an implementation plan for risk communication training to be facilitated by Emory University.

Recommendations for Member States:

1. All Member States should enhance their surveillance8 to include COVID-199 and for severe acute respiratory infections (SARI)10. Examples of enhanced surveillance include:
   1. Adding questions about travel, contact history, and testing for coronaviruses to existing influenza surveillance systems;
   2. Notifying healthcare facilities to immediately inform local public health officials about persons who meet the case definition for COVID-19, SARI and/or have recent travel to a country with local transmission or history of contact with a case.
2. Member States should continue to enhance surveillance at the borders to screen incoming travelers for severe respiratory illness and a history of recent travel to affected countries or territories reporting local or community transmission.
3. Member States should perform contact tracing of confirmed cases based on transmission type and country capacity.11
4. Notify WHO and Africa CDC immediately if suspected or confirmed cases of infection with novel coronavirus are identified. Africa CDC should be notified by emailing AfricaCDCEBS@africa-union.org.
5. Provide guidance to the general public about seeking immediate medical care and informing healthcare providers about recent travel or contact history in anyone who develops symptoms of severe respiratory illness.

Resources for more information:

Africa CDC Resources

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1 WHO COVID-19 surveillance guidance and case definition: https://www.who.int/emergencies/diseases/novel- coronavirus-2019/technical-guidance/surveillance-and-case-definitions

2 Guinea Bissau, Equatorial Guinea, Sierra Leone, British Virgin Island, French Guiana and Monsterrat

3 WHO coronavirus disease (COVID-19) situation reports: https://www.who.int/emergencies/diseases/novel- coronavirus-2019/situation-reports

4 New numbers reported since last weekly report (21 April 2020, 9am EAT)

5 Phases defined according to Africa CDC’s Recommendations for a stepwise COVID-19 response - https://africacdc.org/download/recommendations-for-stepwise-response-to-covid-19/: Phase 0 (No COVID-19 case): no reported case in-country; Phase 1 (Early stage outbreak): one or more imported cases, limited local transmission related to imported cases; Phase 2 (Expanding outbreak): increasing number of imported cases, increased local spread but all cases linked to known transmission chains, outbreak clusters with a known common exposure; Phase 3 (Advancing outbreak): localised outbreaks start to merge, one or more cases or deaths occur outside known transmission, multiple generations in transmission chains, cases are detected among severe acute respiratory illness (SARI) case with no known exposure; Phase 4 (Large outbreak with nationwide transmission): widespread sustained community transmission, multiple generation transmission chains can be identified but most cases occurring outside of chains, community-wide transmission throughout all or nearly all of the country

6 Africa CDC guidance on community use of face masks available at: https://africacdc.org/download/community- use-of-face-masks/

7 Africa CDC statement on medications for treatment of Novel Coronavirus Disease COVID-19 https://africacdc.org/download/statement-on-medications-to-treat-novel-coronavirus-disease-covid-19/

8 Africa CDC Protocol for enhanced surveillance for COVID-19 in Africa: https://africacdc.org/download/protocol- for-enhanced-severe-acute-respiratory-illness-and-influenza-like-illness-surveillance-for-covid-19-in-africa/

9 WHO COVID-19 surveillance guidance and case definition: https://www.who.int/emergencies/diseases/novel- coronavirus-2019/technical-guidance/surveillance-and-case-definitions

10 WHO SARI case definition: anyone with an acute respiratory infection with a history of fever (or measured fever of ≥ 38 C°) and cough with symptom onset within the last 10 days that requires hospitalization. https://www.who.int/influenza/surveillance_monitoring/ili_sari_surveillance_case_definition/en/

11 Africa CDC Guidance on Contact Tracing for COVID-19 Pandemic: https://africacdc.org/download/guidance-on- contact-tracing-for-covid-19-pandemic/

Distributed by APO Group on behalf of Africa Centres for Disease Control and Prevention (Africa CDC).