The puzzling slow spread of COVID-19 in Nigeria and the African continent

A few days ago, I had a conversation with a colleague in Nigeria. The conversation was centred on the novel coronavirus (COVID-19) and its spread in the country. I wondered why many people in the country have become lax about the spread of the virus, with several people going about their business as usual. Of course there are relatively fewer reported cases of COVID-19 infections in Nigeria compared to other countries. For example, Western countries such as the UK, Italy, and the United States have recorded higher numbers of COVID-19 cases. Even within the African continent, countries like South Africa have recorded more cases of COVID-19 in comparison to Nigeria.

Since the first reported case of COVID-19 in Nigeria on February 27, scientists have expressed concern about the spread of the virus in the country, primarily because of its population. With over 200 million people, Nigeria is the most populous black nation in the world. Beyond population, several factors such as limited awareness, lack of trust in the government, limited healthcare resources, and security challenges theoretically increase the likelihood of the spread of the virus in the country. Nigeria has however reported a little over 60, 000 cases with over 48, 000 recoveries and just over 1000 deaths as at October 2020. In fact, the latest CDC world data for COVID-19 cases for Nigeria continues to show a significant drop in the daily reported cases for the country.

COVID-19 daily reported cases show a continued drop in positive tests. Source: https://ourworldindata.org/coronavirus/country/nigeria?country=~NGA

With these numbers, the country has performed relatively well in comparison to nations with more resources, particularly as the virus seem to be spreading slower than the predicted spread at the start of the outbreak.

The low numbers are not unique to Nigeria. Other African countries have similarly reported fewer cases of the virus compared to countries on other continents. The slow spread of the virus has in fact become of puzzling interest to experts within the African continent and beyond. According to the Africa Centre for Disease Control (African CDC), there have been reports of an average of 10% decline in diagnosed cases, and Africa accounts for only 5% of all COVID-19 cases and 3.5% of global deaths from the virus. Given that the continent accounts for 17% of the world’s population, these are interesting data. To put this in perspective, in four European cities (UK, France, Spain and Italy), combined cases have exceeded 60, 000 deaths while all 54 African countries have reported just under 40,000 deaths. Even when compared to some low-middle-income countries, such as India and Brazil, with more than 110,000 and 151,000 deaths respectively, African countries have equally presented better outcomes. The map below presents the levels of COVID-19 infections using clusters; one can quickly notice how the clusters in African countries are much smaller than those in other continents.

Map comparison of reported COVID-19 cases in Africa compared to other continents. Source: https://news.google.com/covid19/map?hl=en-GB&mid=%2Fm%2F02j71&gl=GB&ceid=GB%3Aen

Several reasons have been adduced for this low death rate in Africa, including the relative youthfulness of the population—60% of the African population are below the age of 25—since older people are more susceptible to COVID-19 related illnesses. There is also the possibility of a genetic impact on the transmission of the virus. The more pertinent question, however, is the reason for the slow spread of COVID-19 on the continent. Here, I focus on Nigeria to explore some of the possibilities.

When I spoke to my colleague in Nigeria, he mentioned an increasing belief that the virus is a problem only among the elites in Nigeria and, possibly, Africa.

In his words, “the gap between the rich and the poor is wide, such that most rich people do not interact with the poor. Hence, the spread is among their circle of contact.”

Although this is anecdotal and might not be entirely accurate, it differs considerably from reports on COVID-19 and inequality in Western countries. These studies have reported a higher risk of COVID-19 infection among people within the lower socio-economic class who are more likely to work within healthcare settings and live in crowded spaces where exposure to the virus is high. To determine the level of spread of the virus on the African continent, researchers are conducting antibody tests to screen for individuals who might have remained asymptomatic. This should also help to understand the low spread on the continent. According to the director of the African CDC, John Nkengason, the organisation has selected Nigeria with six other countries for the antibody testing: Liberia, Sierra Leon, Zambia, Zimbabwe, Cameroon and Morocco. The result of this research will be valuable in understanding the spread of COVID-19 among populations within these countries.

Several other hypotheses have been suggested for the difference in the cases reported and predicted numbers. First is the inadequate testing capacity in the country and in Africa as a whole. Nigeria conducts approximately 0.02% of tests daily—for a country with more than 200 million people, this is equivalent to just 2.6 tests per 1,000 people. Compare this to the UK with more than 200,000 daily tests among 65 million people, equivalent to 320 tests per 1,000 people. Thus, it can be reasonably assumed that cases of COVID-19 and deaths on the continent might be underreported due to low testing. The WHO for the African region already points to the need for increased testing capacity in African countries. Most African countries also have a limited mortality database, making monitoring mortality cases a challenge.

Another hypothesis is that the high population of young people in some African countries may have contributed to the low cases of COVID-19 in those countries. It has been suggested in reports that there is a higher possibility of severe outcomes when the older population is affected. More than half of the Nigerian population, for instance, is between 15 and 45 years. This could also be as a result of the low life expectancy of the country (below 60 years) which means that few people make it beyond 60, thus, reducing the population most vulnerable to the virus. Of course, studies have also reported that young people are at risk of COVID-19 infection with the possibility of severe outcomes.

The perpetual exposure to infectious diseases and malaria parasite might be another contributor to the fewer cases reported in Nigeria and other African countries. There are also suggestions that the country might have learnt from dealing with the Ebola virus outbreak in 2014. Measures adopted then may have helped contain the spread of COVID-19. There are also discussions around the impact of warm weather on the viability of the virus. The average temperature of Nigeria is above 25C, at which it has been suggested that the virus is not viable. Some studies have reported however that increased temperature have limited impact on the viability of the virus. Therefore, care should be taken irrespective of the temperature in the environment.

The Nigerian government in collaboration with the different health agencies such as the NCDC (Nigeria Centre for Disease Control) and WHO have continuously rolled out awareness messages to sensitize citizens on the importance of social distancing and personal hygiene to limit the spread of the virus. This is important in curbing the spread of the virus especially with reports of individuals relaxing measures adopted in protecting against the virus. Although the NCDC has cautioned that there might be a second wave of the virus, current data from Nigeria show under 300 new cases daily despite the relaxation of restrictions. There are still concerns about a second wave of the virus, however. The former President of the Nigerian Academy of Sciences and virologist, Prof Oyewale Tomori, has expressed these concerns, especially with schools and airport reopening. In his words, “unless we return to abiding by the guidelines—wearing face masks, regularly washing hands, and keeping the safe distance—COVID-19 will return with a massive second wave vengeance. Now that we have reopened our airports, expect more COVID-19 troubles.” The current #EndSARS protests across Nigeria may even have some impact on the second wave outbreak expected within the country.

In all, there is a need to acknowledge the efforts of Nigeria and other African countries in the fight against the spread of COVID-19, and although the data shows decreasing number of new infections, citizens of these countries should be encouraged to keep on with the adopted guidelines required for protection from COVID-19 infection.