COVID-19 WHO African Region: External situation report 07 / 2020

Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 1 COVID-19 Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 2 Date of issue: 15 April 2020 Data as reported by: 14 April 2020 as of 11:59 PM (GMT+1) Coronavirus disease 2019 (COVID-19) cases continue to rise rapidly across the African continent. No new countries have been affected since our last situation report on 8 April 2020 (External Situation Report 6). To date, 45 (96%) out of 47 Member States of the WHO African Region have reported COVID-19 cases. Comoros and Lesotho are the only Member States with no reported cases to date. Over the past week, there has been a 51% increase in the number of cases and a 60% increase in the number of deaths reported in the WHO African Region. As of 14 April 2020 (epidemiological week 16), a cumulative total of 10 759 confirmed COVID-19 cases with 520 deaths (case fatality ratio CFR:4.8%) have been reported across the 45 affected countries in the region. The list of affected countries and their respective number of cases and deaths is presented in Table 1. Figures 1 and 2 show the daily and weekly distribution of cases by country, respectively. Although a rapid increase in the weekly number of reported cases has been observed since week 9 (week ending 1 March 2020), this trend appears to have substantially slowed down between weeks 14 and 15. Indeed, between weeks 9 and 12, the percent increase in weekly cases ranged between 400% and 600%. In weeks 13, 14 and 15, the percent increase was 179%, 36% and 5%, respectively. The highest number of weekly reported cases was reached during week 15 (week ending 12 April 2020), with 3 294 reported cases across the region. The most affected countries in the WHO African Region are: South Africa (2 415 cases), Algeria (2 070 cases), Cameroon (855 cases), Cote d’Ivoire (638 cases), Ghana (636), Niger (570) and Burkina Faso (515 cases). Together, these countries account for 66% of the cases reported in the region. Between weeks 14 and 15 a decreasing trend in the weekly case incidence was observed in Algeria and Cameroon, while an increasing trend occurred in Cote d’Ivoire, Ghana, Niger and South Africa. Among countries that reported over 100 confirmed COVID-19 cases, the highest case fatality ratios (CFR) were observed in Algeria (CFR: 15.7%), Democratic Republic of the Congo (CFR: 8.3%), Mali (CFR: 8.1%) and Burkina Faso (CFR: 5.4%). Figure 3 shows the distribution of cases by week of notification in the six most affected countries. Information on sex and age is currently available for 2 428 (23%) and 1 892 (18%) cases, respectively. The male to female ratio among the confirmed cases is 1.7, and the median age is 41 years old (range: 0 - 105). The distribution of cases according to age and sex is presented in figure 4; older males continue to be disproportionately affected by this outbreak. Deaths 100 1. Situation update Cases 10 759 COVID-19 Deaths 520 Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 3 Country Date of first notification to WHO Cumulative alive Cumulative deaths Cumulative recovered Total cases CFR New cases New deaths Algeria 25-Feb-20 1053 326 691 2070 15.7% 87 13 Angola 29-Mar-20 13 2 4 19 10.5% 0 0 Benin 16-Mar-20 29 1 5 35 2.9% 0 0 Botswana 30-Mar-20 12 1 0 13 7.7% 0 0 Burkina Faso 9-Mar-20 317 28 170 515 5.4% 0 0 Burundi 31-Mar-20 5 0 0 5 0.0% 0 0 Cameroon 6-Mar-20 710 15 130 855 1.8% 0 0 Cape Verde 19-Mar-20 9 1 0 10 10.0% 0 0 Central African Republic 14-Mar-20 7 0 4 11 0.0% 0 0 Chad 19-Mar-20 21 0 2 23 0.0% 0 0 Congo (Republic of) 14-Mar-20 61 5 8 74 6.8% 0 0 Cote d'Ivoire 9-Mar-20 518 6 114 638 0.9% 12 0 DR Congo 10-Mar-20 212 21 21 254 8.3% 13 1 Equatorial Guinea 13-Mar-20 38 0 3 41 0.0% 0 0 Eritrea 21-Mar-20 34 0 0 34 0.0% 0 0 Eswatini 13-Mar-20 7 0 8 15 0.0% 1 0 Ethiopia 13-Mar-20 65 3 14 82 3.7% 8 0 Gabon 12-Mar-20 74 1 5 80 1.3% 5 0 Gambia 18-Mar-20 6 1 2 9 11.1% 0 0 Ghana 11-Mar-20 611 8 17 636 1.3% 0 0 Guinea 13-Mar-20 332 0 31 363 0.0% 44 0 Guinea-Bissau 25-Mar-20 40 0 0 40 0.0% 0 0 Kenya 13-Mar-20 166 9 41 216 4.2% 8 0 Liberia 16-Mar-20 49 6 4 59 10.2% 0 0 Madagascar 21-Mar-20 90 0 20 110 0.0% 2 0 Malawi 2-Apr-20 14 2 0 16 12.5% 0 0 Mali 25-Mar-20 87 10 26 123 8.1% 0 0 Mauritania 13-Mar-20 4 1 2 7 14.3% 0 0 Mauritius 18-Mar-20 264 9 51 324 2.8% 0 0 Mozambique 22-Mar-20 26 0 2 28 0.0% 7 0 Namibia 14-Mar-20 13 0 3 16 0.0% 0 0 Niger 18-Mar-20 466 14 90 570 2.5% 0 0 Nigeria 28-Feb-20 242 10 91 343 2.9% 0 0 Rwanda 14-Mar-20 85 0 49 134 0.0% 7 0 Sao Tome & Principe 6-Apr-20 4 0 0 4 0.0% 0 0 Senegal 28-Feb-20 114 2 183 299 0.7% 8 0 Seychelles 14-Mar-20 9 0 2 11 0.0% 0 0 Sierra Leone 31-Mar-20 11 0 0 11 0.0% 1 0 South Africa 5-Mar-20 1978 27 410 2415 1.1% 143 0 South Sudan 5-Apr-20 4 0 0 4 0.0% 0 0 Tanzania 16-Mar-20 43 3 7 53 5.7% 4 0 Togo 5-Mar-20 45 3 29 77 3.9% 0 0 Uganda 21-Mar-20 47 0 7 54 0.0% 0 0 Zambia 18-Mar-20 13 2 30 45 4.4% 0 0 Zimbabwe 20-Mar-20 14 3 1 18 16.7% 1 0 Total - 7962 520 2277 10759 - 351 14 Table 1. Number of confirmed COVID-19 cases in the WHO African Region, 25 February – 14 April 2020 (n = 10 759) Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 4 Figure 1. Daily number of confirmed COVID-19 cases in the WHO African Region by country, 25 February – 14 April 2020 (n = 10 759) Figure 2. Weekly number of confirmed COVID-19 cases in the WHO African Region by country, 25 February – 14 April 2020 (n = 10 759) Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 5 *Week 16 data is up to 14 April 2020 and is therefore partial. Figure 4. Age and sex distribution of confirmed COVID-19 cases in the WHO African Region, 25 February – 14 April 2020 (n= 1 892) Figure 3. Epidemic curves of COVID-19 outbreaks in Algeria, Burkina Faso, Cameroon, Cote d’Ivoire, Ghana and South Africa, 25 February – 14 April 2020 (n = 10 759) CFR: 15.7% CFR: 1.8% CFR: 0.9% CFR: 2.5% CFR: 1.1% CFR: 1.3% Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 6 Since the declaration of the COVID-19 outbreak on 31 December 2020, the global number of cases has surpassed the one million mark. As of 14 April 2020 at 18:00 CET, a total of 1,848,439 confirmed cases, including 117,217 deaths (case fatality ratio 6.3%), were reported globally. Both the global number of confirmed COVID-19 cases and deaths have significantly increased in the course of the past week. As of 14 April 2020, 212 countries/territories/areas and one international conveyance have reported laboratory confirmed COVID-19 cases. The 10 countries with the highest number of cumulative cases are: United States of America (553 822), Spain (169 496), Italy (159 516), Germany (125 098), France (97 050), The United Kingdom (88 625), China (83 696), Iran (Islamic Republic of) (74 877), Turkey (61 049) and Belgium (30 589). All affected countries have reported new confirmed cases in the past two weeks. Please refer to the WHO Daily Coronavirus disease (COVID-2019) situation reports for further information: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. On 11 March 2020, the WHO Director-General declared the COVID-19 a pandemic. Chinese authorities identified a new type of coronavirus (novel coronavirus, SARS-CoV-2) from a cluster of pneumonia cases in Wuhan city, Hubei Province, China, on 7 January 2020. SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. According to the information provided, the initial cases described in Wuhan were linked to Hunan seafood market in Wuhan (the market was closed on 1 January 2020). The possible source of the outbreak is still under investigation by the Chinese authorities and it may have emerged from an animal species, as has been the case for other coronaviruses. The exact extent of the outbreak remains unknown. On 30 January 2020, the WHO Director-General declared the COVID-19 outbreak a public health emergency of international concern (PHEIC), with temporary recommendations issued for all countries. On 28 February 2020, WHO raised the risk assessment for the COVID-19 outbreak internationally from “high” to “very high". The WHO Regional Office for Africa (AFRO) is working closely with its 47 Member States, as well as partners, in order to implement several outbreak preparedness and response interventions. Surveillance WHO has established a global surveillance system to provide a mechanism for all Member States to report weekly aggregate data on COVID-19 to WHO in a timely manner. This will allow WHO to monitor the epidemic and its severity over time and place as well as to inform national, regional and global risk assessment to guide decision making for preparedness and response. On 9 April 2020, a Webex meeting was held between HIR National Focal Points (NFP) and WHO (AFRO and HQ) in order to introduce the weekly reporting platform to AFRO IHR NFP. WHO AFRO has conducted work sessions with DRC, Niger and Cameroon in order to evaluate the strengths and weaknesses of the Early Warning System and the contact tracing process. WHO AFRO is developing a technical guidance document on contact tracing, which will be shared with countries this week. WHO AFRO has developed data analysis templates in R in order to support descriptive and analytic studies of the COVID-19 cases and deaths reported in DRC, Cameroon, Guinea Bissau, Cote d’Ivoire and Niger. 2. Global update 3. Current risk assessment 4. Actions to date Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 7 Infection Prevention and Control On 10 April a training session on IPC for nurses was organized by WHO AFRO RD; 498 nurses from 42 countries attended the session. Since the beginning of the pandemic: • 6 179 HCW were trained in Algeria (33), Angola (183), Burkina Faso (398), Cameroon (534), Congo (287), Cote d’Ivoire (1 272), DRC (167), Kenya (32), Senegal (1 049), South Africa (1 800) and Tanzania (424). • 1 646 households were disinfected in Burkina Faso (406), Cameroon (1 085), DRC (117) and Senegal (38). • 662 IPC trainers were trained in Angola (430), Burkina Faso (20), Cameroon (4), Congo (10), Cote d’Ivoire (12), DRC (28), Ethiopia (2), Gabon (2), Ghana (1), Kenya (34), Madagascar (2), Malawi (2), Mali (1), Mozambique (2), Namibia (2), Nigeria (6), Senegal (30), Uganda (2), Zambia (1) and Zimbabwe (1). • 100 Covid-19 treatment centres have been assessed across the region in Angola (4), Burkina Faso (3), Cameroon (10), Congo (3), DRC (8), Kenya (4), Senegal (12), South Africa (47) and Tanzania (9). • 92 healthcare facilities have been disinfected in Angola (1), Burkina Faso (28), Cameroon (17), Congo (5), Cote d’Ivoire (3) and DRC (33) Laboratory To date, 44 countries in the region have capacity to test for the COVID-19 virus and are involved in supporting the surveillance and case management of COVID-19. Laboratory capacity is rapidly being built in countries where molecular testing (Real-Time PCR) is currently not available. Over 50 laboratories from 44 countries in the region will receive EQA material in the next month as part of quality assurance of testing in the region Surge procurement and distribution of essential reagents and supplies has been initiated to provide urgently needed critical items to countries for testing for COVID-19 Training materials including instructional laboratory videos are being prepared to provide technical support for countries in lockdown. A genetic sequencing network is being established using key laboratories in the influenza laboratory network to enable further characterisation of SARS-CoV-2 in the region. Virtual technical support, by sharing of digital and visual media, is being provided to respond to country needs and requests. Case management On 10 April 2020, WHO held a virtual interactive learning session on COVID-19 case management: over 1 000 participants from 58 countries around the world, mostly from Africa. On 8 April 2020, WHO AFRO and partners held a meeting to explore the use of Emergency Medical Teams (EMT) concepts, tools and approaches to scale up the clinical case management of COVID-19 patients in the African region. A partner mapping (geographical location, ongoing activities and capacities) is being developed and some partners are preparing concept notes for the scale up of case management in affected countries. WHO AFRO continues to explore collaborative frameworks and the development of Memorandum of Understanding (MoU) where required. Risk Communication WHO continues to provide guidance to national authorities and religious leaders on the management of rumours and misinformation. WHO and partners continue to disseminate messages on preventive key behaviours and actions using mass media. Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 8 National authorities, with support from WHO and partners, are engaging with communities through key influential figures and mass media. Logistics WHO (AFRO/EMRO/HQ), WFP, EAU and Ethiopian airlines have been working collaboratively to organize the air transportation of personal protective equipment (PPE) from the WHO warehouse in Dubai. This PPE distribution, supported by the Jack Ma Foundation, will take place between 14-24 April 2020 and will target 32 countries in the continent (30 in AFRO and 2 in EMRO). This operation is part of the launch of the WFP logistics platform in Addis Ababa. In addition, arrangements are being made to ship testing equipment from different locations in Europe to Sao Tome and Comoros who are completely isolated in terms of international transport. Human Resources Since the outbreak started, 232 experts have been deployed in 39 Countries, including AFRO, to support Coordination (33), Surveillance (19), Laboratory (14), IPC (24), Case Management (19), Point of Entry (5), Epidemiology (11), Risk Com (22), Media Com (10), Logistics (19), Partnership coordination (2), Data Management (15), Information Management Officer (1), SHOC Support (1), Training & Capacity Building (2), Planning & Monitoring (1), technical support to Countries (focal points) (25), Resources Mobilization (2), Planning & Information Management (1), Translator (2), staff wellbeing (1), EOC (1) Technical advisor (1) and Writing and Reporting (1). Lockdowns and international flights restriction in most of African countries remain the main challenge for the deployment of experts to support national response. WHO advises against any restriction of travel and trade based on the currently available information. WHO continues to closely monitor and, if necessary, verify travel and trade measures in relation to this event. WHO continues to monitor IHR measures being implemented by countries in the region: • All countries in the region are conducting entry screening at the Points of Entries (PoEs), mainly at the airports, with some doing so at seaports and ground crossings. • A total of 35 countries are implementing total refusal of entry into their territories; of these, 22 countries allow cargo, humanitarian or emergency flights. • Nine countries are implementing refusal of entry of passengers from high risk countries and three countries allow entry with days 14 quarantine upon arrival. • A total of 23 countries are implementing lockdown; nationwide lockdown in 12 countries and lockdown in affected areas in 11 countries. • Curfew has been put in place in eight countries. 5. IHR travel measures and cross border health Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 9 The COVID-19 pandemic has reached a new milestone in the WHO African Region, with over 10 000 cases and over 500 deaths being reported across all Member States with the exception of Comoros and Lesotho. Six countries (Algeria, Cameroon, Cote d’Ivoire, Ghana, Niger and South Africa) account for two thirds of the cases in the region. In Algeria, although a decrease in case incidence was observed in the past two weeks, the high case fatality ratio is of grave concern. There is a need to strengthen case management and conduct in-depth epidemiological analyses to better understand the risk factors associated with these deaths. The upsurge of cases in Cote d’Ivoire and Ghana requires particular attention. Current response measures in these countries need to be reinforced in order to rapidly contain the spread of the outbreak. Although the weekly incidence rate appears to have substantially slowed down over the past two weeks, the situation remains critical. National authorities need to stay alert and continue to implement proven public health measures such was active case finding, testing and isolation of cases, contact tracing, physical distancing and promotion of good personal hygiene practices. 6. Conclusion Annex 1. Global and Regional time line for COVID-19 as of 14 April 2020