February 28, 2020

expert reaction to first case of COVID-19 in sub-Saharan Africa, in a person who travelled from Milan to Nigeria

The first case of COVID-19 in sub-Saharan Africa has been confirmed in a person who travelled from Milan to Nigeria.

Prof Devi Sridhar, Professor of Global Public Health, University of Edinburgh, said:

“Nigeria has just confirmed its 1st case of COVID-19. It should be recognised that the government did an excellent job containing Ebola and that they have world-class public health experts as well as the African CDC. Ideally, all the contacts for this individual can be tracked and the virus contained. However, once we lose track of contacts, or have community transmission, then the road ahead is extremely difficult- and the strategy will need to shift to social distancing, individual preventive behaviours like hand washing and staying home if ill, as well as preparing hospitals and the health service for the health needs of projected patients.”

Prof Trudie Lang, Director, The Global Health Network, Nuffield Department of Medicine, University of Oxford, said:

Nigeria has reported their first confirmed case in Africa, and this was a person returning from Milan, and not from person to person transmission within Africa. This shows that the Nigerian government had the right systems in place to detect and confirm this case, and they can hopefully contain spread from this case by tracing their contacts.

This however does highlight the concern that was raised when the WHO announced this COVID19 outbreak as a public health emergency. The reason for this designation was given as the need for global collaboration to mitigate the disproportionate impact this new virus could have in vulnerable populations and less well resourced nations. This is in a large part the potential for the virus to overwhelm health care provision in those counties. Not solely the impact of COVID19, where the mortality rate remains overall low and so the risk to individuals is low, but real fear that health systems become swamped and unable to manage their ongoing health care, thereby presenting an even greater threat than the virus. 

Detection of cases in Africa is going to be challenging for several compounding reason. In countries like the UK we are asking people with a suspected case to stay isolated and then the system can swab people away from the usual care system, and send the sample to a regional laboratories, and get the results back within a very short time. Where population densities are so different, transport challenging and there are few laboratories equipped to test these samples different approaches are going to be needed. 

The most pressing need is for inexpensive testing kits to be made available across the globe so diagnosis can be done on the spot in every setting. Then efforts to limit spread can accompany this effort which will firstly need a careful understanding of the local social context and appropriate strong public health messages to reduce transmission.

We still have so many unknowns in terms of transmission and we need answers through research to guide us. For example we still don’t know if people who have COVID19 but no symptoms can infect others. It might be that people are infectious in the pre-symptomatic stage. Or it might be that the high proportion of infected people who never get unwell don’t actually pass on the virus either. This would be a good scenario and make stopping transmission easier. However, these are just some of the many questions we still have and what makes the job so difficult for those guiding public health measures. 

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All our previous output on this subject can be seen at this weblink:

http://www.sciencemediacentre.org/tag/covid-19

The SMC also produced a Factsheet on COVID-19 which is available here:

https://www.sciencemediacentre.org/smc-novel-coronavirus-factsheet/