COVID-19 WHO African Region: External situation report 30 / 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: 23 September 2020 Data as reported by: 22 September 2020 as of 00:00 AM (GMT+1) The number of coronavirus disease 2019 (COVID-19) cases in the WHO African Region is now at 1 149 940 with 25 008 deaths. Since our last External Situation Report 29 issued on 16 September 2020, a total of 29 218 new confirmed COVID-19 cases and 764 new deaths were reported from 45 countries between 16 and 22 September 2020. This is a 2% and 17% decrease in incidence cases and deaths, respectively, as compared to 29 710 cases and 921 deaths registered during the previous reporting period (9 - 16 September 2020). Case incidence has continued to decrease in the past weeks, with South Africa continuing to consistently register the largest number of reported cases for many weeks. However, a 6% increase in case counts was noted in South Africa in the past seven days. Twenty-nine countries recorded a decrease in new cases, with 20 of them registering a decrease of more than 20%; Sao Tome and Principe (89%), Mauritius (75%), Botswana (69%), Seychelles (67%), Lesotho (61%), Senegal (55%), Malawi (47%), Mauritania (46%), Liberia (44%), Gambia (39%), Rwanda (38%), Ghana (37%), Zambia (34%), Burundi (33%), Burkina Faso (30%), Côte d'Ivoire (30%), Zimbabwe (28%), Namibia (27%), Sierra Leone (23%) and Eswatini (20%). During this reporting period, 16 countries reported percentage increase in case-counts; Niger (350%), South Sudan (80%), Congo (65%), Chad (62%), Mali (55%), Mozambique (31%), Uganda (30%), Angola (24%), Equatorial Guinea (20), Benin (18%), Democratic Republic of the Congo (12%), Nigeria (11%), Gabon (9%), South Africa (6.1%), Ethiopia (5%), and Guinea (5%). Only Eritrea and United Republic of Tanzania did not officially submit any report indicating any new confirmed case. A total of 150 new health worker infections were recorded from seven countries: Mozambique (72), Comoros (34), Ethiopia (16), Uganda (14), Namibia (6), Eswatini (5) and Liberia (3). Comoros reported health worker infections for the first time since the beginning of the outbreak in the country. During this period, 764 new COVID-19 related deaths occurred in 27 countries, with 477 (62%) of the deaths recorded in South Africa. This was followed by Ethiopia, with 92 (12%) deaths, Algeria with 57 (8%) and Kenya with 25 (3%). Kenya, South Africa and Algeria registered a 29%, 14% and 7% decrease in the deaths, respectively; while the number of deaths in Ethiopia increased by 7%. The other 23 countries that reported new deaths during the reporting period include; Angola (16), Madagascar (12), Nigeria (12), Namibia (10), Mozambique (8), Zambia (7), Cabo Verde (6), Uganda (6), Eswatini (5), Rwanda (5), Democratic Republic of the Congo (4), Senegal (4), Gambia (3), Ghana (3), Botswana (2), Guinea (2), Zimbabwe (2), Cameroon (1), Congo (1), Gabon (1), Mali (1), Malawi (2) and Togo (1). As of 22 September 2020, a cumulative total of 1 149 940 COVID-19 cases was reported in the region, including 1 149 939 confirmed, with one probable case reported in Democratic Republic of the Congo. South Africa has consistently registered more than half, 58% (663 282), of all reported confirmed cases in the region. The other countries that have reported large numbers of cases are Ethiopia (70 422), Nigeria (57 613), Algeria (50 214), Ghana (46 062), Kenya (37 218), Cameroon (20 690), Côte d’Ivoire (19 327), Madagascar (16 136) and Senegal (14 759). These 10 countries collectively account for 87% (995 723) of all reported cases. 1. Situation update Cases 1 149 940 830456 COVID-19 Deaths 25 008 Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 3 To date, a total of 958 256 (83%) case-patients reported from all the 47 countries have recovered. Six countries are still reporting fewer than 1 000 cases: Sao Tome and Principe (908), Burundi (476), Comoros (470), Mauritius (367), Eritrea (364) and Seychelles (139). The total number of deaths reported in the region is 25 008, reported in 45 countries, giving an overall case fatality ratio (CFR) of 2.2%. Two countries, including Eritrea and Seychelles have not registered any COVID- 19 related deaths since the beginning of the pandemic. Since the beginning of the outbreak in the region, the majority of the deaths have been reported from: South Africa 64% (16 118), Algeria 6.8% (1 689), Ethiopia 4.5% (1 127), Nigeria 4.4% (1 100), Kenya 2.6% (659), Cameroon 1.7% (416), Zambia 1.3% (331), Senegal 1.2% (302), Ghana 1.2% (297), Democratic Republic of the Congo 1.1% (271), and Zimbabwe 0.9% (226). The top five countries: South Africa, Ethiopia, Algeria, Niger ia, and Kenya account for 83% (20 693) of the total deaths reported in the region. Chad (7.0%), Liberia (6.1%), Niger (6.0%), Mali (4.3%), Angola (3.7%), Algeria (3.4%) and Sierra Leone (3.3%) have the highest country specific case fatality ratios. The current figures in the region represent 3.7% of confirmed COVID-19 cases and 2.6% of deaths reported worldwide. South Africa remains the hardest hit country on the African continent and is ranked eighth globally, although with relatively low numbers of deaths. Table 1 shows the affected countries and their corresponding number of cases and deaths. The daily and weekly distribution of cases by date and week of reporting are presented in Figures 1 and 2, respectively. Figures 3 and 4 show the distribution of cases and deaths with case fatality ratio by reporting date in South Africa and in the other top six countries. Health worker infections continue to increase gradually with 43 031 (3.7%) infections reported in 43 countries since the beginning of the outbreak. South Africa remains the most affected, with 27 360 (64%) health workers infected, followed by Algeria (2 300), Nigeria (2 175), Ghana (2 065), Ethiopia (1 307), Kenya (970), Cameroon (808), Guinea (501), Namibia (441), Equatorial Guinea (429), Mozambique (412), Senegal (349), Guinea-Bissau (282), Malawi (280), Uganda (274) and Eswatini (268). The other 28 countries that have recorded health worker infections are shown in Table 1. Liberia 16% (214/1 336), Niger 16% (184/1 189), Guinea Bissau 12% (282/2 303), Sierra Leone 10.6% (230/2 174), Sao Tome and Principe 9.7% (88/908), Equatorial Guinea 8.5% (429/5 018) and Mauritius 8.2% (30/367), have the highest country specific proportion of health worker infections among confirmed cases. Complete data on age and gender distribution is only available for 1.0% (11 861), males (61%) 7 228 in the 31- 39 and 40-49 age groups are more affected than females (39%) 4 633 across the same age groups in the African region. The male to female ratio among confirmed cases is 1.6, and the median age is 37 years (range: 0 - 105). The distribution of cases by age and sex is presented in Figure 5. Diverse transmission patterns have been observed across the region, with established community transmission seen in 35 (74%)countries, nine (19%) countries have clusters of cases and three (6%) with sporadic cases. As of 22 September 2020, the seven African countries in the WHO EMRO Region reported a total of 268 390 confirmed COVID-19 cases: Egypt (102 141), Morocco (103 119), Libya (29 446), Sudan (13 555), Tunisia (11 260), Djibouti (5 404), and Somalia (3 465). Additionally, a total of 9 261 deaths has been recorded from Egypt (5 787), Morocco (1 855), Sudan (836), Libya (460), Somalia (98), Tunisia (164) and Djibouti (61). A cumulative total of 1 418 330 confirmed COVID-19 cases 34 269 deaths (case fatality ratio 2.4%) with 1 166 173 cases that have recovered have been reported in the African continent. Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 4 Country Total Cases Total Deaths Recovered Cases Probable Cases Case fatality ratio (%) Health Worker infections South Africa 663 282 16 118 592 904 0 2.4 27 360 Ethiopia 70 422 1 127 28 991 0 1.6 1 307 Nigeria 57 613 1 100 48 836 0 1.9 2 175 Algeria 50 214 1 689 35 307 0 3.4 2 300 Ghana 46 062 297 45 258 0 0.6 2 065 Kenya 37 218 659 24 147 0 1.8 970 Cameroon 20 690 416 19 340 0 2.0 808 Côte d'Ivoire 19 327 120 18 630 0 0.6 187 Madagascar 16 136 226 14 743 0 1.4 70 Senegal 14 759 302 11 621 0 2.0 349 Zambia 14 389 331 13 629 0 2.3 139 Namibia 10 607 116 8 359 0 1.1 441 Democratic Republic of the Congo 10 523 271 10 011 1 2.6 256 Guinea 10 387 65 9 780 0 0.6 501 Gabon 8 704 54 7 875 0 0.6 57 Zimbabwe 7 711 226 5 979 0 2.9 238 Mauritania 7 403 161 7 011 0 2.2 5 Mozambique 7 114 45 4 064 0 0.6 412 Uganda 6 712 64 2 778 0 1.0 274 Malawi 5 739 179 4 065 0 3.1 280 Cabo Verde 5 337 52 4 742 0 1.0 90 Eswatini 5 307 106 4 672 0 2.0 268 Equatorial Guinea 5 018 83 4 509 0 1.7 429 Congo 5 005 89 3 920 0 1.8 166 Central African Republic 4 802 62 1 831 0 1.3 1 Rwanda 4 738 27 2 991 0 0.6 0 Angola 4 236 155 1 462 0 3.7 40 Gambia 3 540 110 2 002 0 3.1 142 Mali 3 030 129 2 380 0 4.3 0 South Sudan 2 664 49 1 438 0 1.8 128 Botswana 2 567 13 624 0 0.5 56 Benin 2 325 40 1 960 0 1.7 139 Guinea-Bissau 2 303 39 1 468 0 1.7 282 Sierra Leone 2 174 72 1 652 0 3.3 230 Burkina Faso 1 896 56 1 189 0 3.0 117 Togo 1 683 41 1 286 0 2.4 68 Lesotho 1 390 33 754 0 2.4 20 Liberia 1 336 82 1 218 0 6.1 214 Niger 1 189 69 1 104 0 5.8 184 Chad 1 155 81 967 0 7.0 75 Sao Tome and Principe 908 15 880 0 1.7 88 United Republic of Tanzania 509 21 180 0 4.1 1 Burundi 476 1 463 0 0.2 35 Comoros 470 7 450 0 1.5 34 Mauritius 367 10 340 0 2.7 30 Eritrea 364 0 309 0 0.0 0 Table 1. Number of confirmed COVID-19 cases in the WHO African Region, 25 February – 22 September 2020 (n =1 149 940) Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 5 Seychelles 139 0 137 0 0.0 0 Total (N=47) 1 149 940 25 008 958 256 1 2.2 43 031 * Chad and Liberia are implementing community mortality surveillance that could have attributed to high case fatality ratios. Figure 2. Weekly number of confirmed COVID-19 cases in the WHO African Region by country, 25 February – 22 September 2020 (n=1 149 940) Figure 1. An epicurve of confirmed cases of COVID-19 in the WHO African Region, 25 February – 22 September 2020 (n=1 149 940) Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 6 Figure 4. Epicurves showing distribution of confirmed cases and deaths with case fatality ratios of COVID -19 in the other top six reporting countries: Ethiopia, Nigeria, Algeria, Ghana, Kenya, and Cameroon, 25 February – 22 September 2020 (n=282 219) Figure 3. The distribution of confirmed COVID-19 cases and deaths for South Africa by reporting date, 5 March – 22 September 2020 (n=663 282) Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 7 As of 22 September 2020, at 10:38 CET, a total of 31 174 627 confirmed cases, including 962 613 deaths (CFR 3.1%), was reported globally. Both the global number of confirmed COVID-19 cases and deaths have continued to increase significantly during the past weeks. To date, 215 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 (6 740 464), India (5 562 663), Brazil (4 544 629), the Russian Federation (1 115 810), Peru (768 895), Colombia (765 076), Mexico (697 663), South Africa (663 282), Spain (640 040) and Argentina (631 365). All affected countries have reported new confirmed cases in the past week. 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 characterized the COVID-19 as 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. 2. Global update 3. Current risk assessment Figure 5. Age and sex distribution of confirmed COVID-19 cases in the WHO African Region, 25 February – 15 September 2020 (n=11 861) Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 8 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. Cross-pillar country actions Ghana has produced and disseminated guidelines for international flight operations in the context of COVID-19; many countries are engaged in these guidelines as the Region opens up to international travel. Nigeria is interrogating surveillance responses to understand factors affecting sample collection and is working to understand the underlying challenges behind the decline in COVID-19 testing decline and to identify actions that can be taken to facilitate a reversal in this. Nigeria is supporting the Federal Ministry of Health in reviewing case management of a hotspot strategy at Pillar level with partners as well as planning to review the draft interim guidance on home-based care and planning review of UN treatment centre guidelines. Risk communication information in relation to re-opening of schools in Nigeria has been developed and shared. PPE supplies continue to be tracked in Nigeria, to identify and separate pending supplies in the pipeline, with feedback given to COVID-19 UN portal managers. Uganda is revising patient discharge criteria to a time/symptom-based approach, as well as strengthening protocols for health worker safety. In Uganda, mortality and community-based disease surveillance is being digitized and COVID-19 Routine Aggregate Reporting is being integrated into the national system, while the COVID-19 Treatment Units and Points of Entry into their National Back Bone Infrastructure, and electronic laboratory requests are being rolled out. Botswana is using geo-fencing bracelets in quarantine and isolation as part of the opening of borders. The Gambia received computers and furniture for their National Public Health Laboratories from Jah Oil Company Ltd. Cote d’Ivoire no longer uses GeneXpert testing and four laboratories have stopped COVID-19 testing. Emergency Medical Team (EMT) The deployment of the Polish EMT PCPM (Polish Center for International Aid) supported the operations of the temporary COVID-19 hospital set up in Millennium Hall exhibition center in Addis Ababa. The deployment will be effective from next week. The MoH (South Sudan) agreed to the terms of reference of the deployment of IMC EMT and the proposed team composition regarding the offered support to the IDU in Juba. The preliminary deployment timeframe is for two months from 1 October 2020. Following initial contact made with UK-med in response to support the establishment of an HDU for COVID- 19 treatment at Nimule hospital in South Sudan, further communication has been made with the WCO in order to liaise with the MoH to confirm their need in this regard. WHO recommendations for international traffic in relation to COVID-19 outbreak are available at https://www.who.int/news-room/articles-detail/updated-who-recommendations-for-international-traffic-in- relation-to-covid-19-outbreak WHO continues to monitor IHR measures being implemented by countries in the region: 5. IHR travel measures and cross border health 3. Actions to date Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Page 9 • 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. • Due to movement of goods through the ground crossing, countries have intensified screening at ground crossings, which has led to detection of COVID-19 cases among truck drivers. For the last two months, the African Region has continued to report a decrease in both COVID-19 cases and deaths. We observed a slight decrease (2%) in case incidence during the past seven days, however with a sustained decrease in deaths (14%) for the same period. A total of 29 (62%) of the 47 affected countries reported decreases in incidence cases in the past week, while 16 (34%) countries registered an increase. In this period, the lowest daily death count was reported on 20 September 2020 since 23 May 2020 when 10 and 31 deaths were reported in South Africa and the region, respectively. South Africa and Ethiopia, which bear the greatest burden of disease in the region, recorded a 6% and 5% increase in case count, respectively. At the same time, South Africa registered a 14% decrease in deaths while Ethiopia had a 7% increase. The region continues to carefully monitor the current trends of the outbreak, while maintaining vigilance. 6. Conclusion Annex 1. Global and Regional time line for COVID-19 as of 23 August 2020