Clarifying three common misconceptions about Covid-19 in Africa

MYTH 1: ‘Covid-19 is a disease of the ageing West’

Sixty percent of Africa’s 1.25 billion people are under age 25—the youngest population in the world. Age is known to be a strong risk factor for severe illness, complications, and death. Early U.S. epidemiologic data suggests that the case fatality was highest in persons aged ≥85 years (range 10%–27%), followed by 3%–11% for ages 65–84 years, 1%–3% for ages 55–64 years, and <1% for ages 0–54 years.

Having said this, Africa has a large population of immunocompromised individuals (HIV/AIDS) and people with a previous and active history of lung disease in the form of pulmonary tuberculosis (TB). These are important potential risk factors for severe Covid-19 disease, and mortality for these at-risk populations will be higher as evidenced in patients in China: those with no reported underlying medical conditions had an overall case fatality of 0.9%, but case fatality was 10.5% for those with cardiovascular disease, 7.3% for diabetes, and approximately 6% each for chronic respiratory disease, hypertension, and cancer.

Africa is blessed with strong values that support close-knit family units. These encourage interaction between generations, with grandparents playing a big part in traditional African culture. Therefore, although young and fit Africans may statistically recover with no sequelae (long term conditions as a result of the disease), they may easily spread Covid-19 to family members who may be older and have other risk factor for severe disease.

Conclusion- Africa, although with a younger average-age population compared to other continents, has other significant risk factors for potentially severe Covid-19 disease.

MYTH 2: ‘I do not have a fever nor am I feeling sick so why the fuss?’

Several studies have documented Covid-19 infection in patients who never develop symptoms (asymptomatic) and in patients not yet symptomatic (pre-symptomatic). Since asymptomatic persons are not routinely tested, the prevalence of asymptomatic infection and detection of pre-symptomatic infection are not well understood. This is especially important in that as many as 13% of confirmed cases of Covid-19 infection in children were asymptomatic.

This is important because of how it affects transmission. Epidemiologic studies have documented Covid-19 transmission during the pre-symptomatic incubation period and asymptomatic transmission has been suggested in other reports. This means that you could make other people sick, without ever realising that you had had the virus, or before you develop symptoms. Risk of transmission is thought to be greatest when patients are symptomatic. This is because viral shedding is greatest at the time of symptom onset (when you feel actively sick) and declines over the course of several days to weeks. However, because transmission is still a risk before any symptoms do begin, the practice of social distancing and other precautions are still valid, even when one is feeling completely healthy.

This further applies to the use of fever as a screening tool. Although fever is one of the most common symptoms for Covid-19, it can be absent as stated above, when patients are asymptomatic or in the pre-symptomatic stage. In one study of 1,099 hospitalised patients with Covid-19, fever was present in only 44% at hospital admission but later developed in 89% during hospitalisation. It is concerning as many airlines and airports in our continent solely use this screening method.

Conclusion: Persons who are infected may be feeling completely normal but still carry the risk to transmit the virus, and therefore all precautions still apply.While fever remains an important screening test, it is not a definitive way to confirm or rule out the disease.

MYTH 3: ‘Once I recover from virus symptoms and isolate for 14 days, I can continue life as normal.’

On the 24th of April 2020, the WHO issued a statement saying that catching Covid-19 once may not protect you from getting it again. This is despite the evidence of antibodies in your immune system that were previously thought to confer immunity for subsequent infections. The WHO guidance came after some governments suggested that people who have antibodies to the coronavirus could be issued an “immunity passport” that would allow them to travel or return to work, based on the assumption that they were safe from re-infection. There is currently no basis for this idea, and people issued such a certificate could ignore public-health guidance, increasing the risk of the disease spreading furthers.

Conclusion - Recovering from Covid-19 does not mean you cannot get it again, and therefore public-health measures need to continue to apply for those who have recovered as well.

This article is supported from data extracted from the Centers for Disease Control and Prevention (CDC).