Saturday, 20 March 2021

COVID-19: Sub-Saharan Africa Report, Omnibus Edition

This is the fourth of my “omnibus” reports on the statistics of the COVID virus. Today, it’s the turn of sub-Saharan Africa. This is an area in which COVID doesn’t seem to get much coverage; perhaps because the virus has not been spreading there as effectively as in Europe or the Americas, or even the Middle East.

With North Africa having already been included in my Middle Eastern review, I divided the area into four regions: West Africa, Central Africa, East Africa and Southern Africa. As these are, geographically, extremely disparate regions, I decided to return this time to my original presentation approach. That is, I’ll look at each of the regions separately, then bring the four together for the final few scatterplots.

Here is the list of 44 countries:

West Africa

Central Africa

East Africa

Southern Afruca





Burkina Faso

Central African Republic



Cape Verde




Cote d’Ivoire

Democratic Republic of Congo




Equatorial Guinea








Sao Tome and Principe




South Sudan






South Africa









Sierra Leone








Once again, the data sources are (for epidemic data) Our World in Data and (for lockdown regulations) the Blavatnik School of Government, both at Oxford University. The data I used included figures up to and including March 14th.

West Africa

Here’s the bar chart of the United Nations HDI (Human Development Index) ratings for West Africa:

At an average of 52, that’s generally lower than North Africa. And considerably lower than any of the other regions I have looked at.

Now here are the Freedom House ratings:

In both indices, Cape Verde and Ghana are well ahead of the rest. It’s worth pointing out that Cape Verde is an island well off the mainland, so is likely to be different in kind from many of the other countries I group it with.

So, to cases. Here is the spaghetti graph of daily cases per million (weekly averaged):

That suggests there’s not much correlation between the different countries in this region. Perhaps because there isn’t much international travel between them?

Cape Verde has been hit far harder than anyone else – not surprising, as it still has close ties to Portugal – with Guinea a clear second. But even Cape Verde hasn’t quite reached the Blavatnik School of Government’s (and so, I presume, the WHO’s) “endemic” threshold of 200 new cases per million per day. And except for Cape Verde, total cases per million are orders of magnitude lower than in Europe. The region as a whole seems to have got off relatively lightly from the virus. So far, at least.

Here are the reproduction rates:

The R-rates are all over the place. But many of them have been below 1, or even well below 1, for a substantial fraction of the time.

Here are the lockdown stringencies:

Again, a very wide variation. But there has been a general tendency, after the initial very severe reaction, for the stringencies to decrease with time. As you would expect in a region that has so far suffered only relatively lightly from the virus.

Testing levels are way lower than in any of the other places I’ve looked at before:

But the cases per test figures aren’t as high as I had expected:

It looks as if, in most of these countries, the virus just hasn’t spread very well. Maybe it doesn’t much like the hot and humid conditions that are normal in West Africa?

There’s no data on hospitalizations in this region, so I’ll skip to deaths:

These are all orders of magnitude below European death rates – even in Cape Verde. And here are the deaths per case:

Apart from the first three, even those who get the virus seem to be fighting it off better than in most European countries. Combine that with low transmission rates, and I reckon that the West Africans have done better against the virus than anyone else I’ve looked at so far.

Only three countries in this region – Ghana, Senegal and Cote d’Ivoire – have reported any vaccination data at all. And even Ghana has vaccinated less than 1% of its population.

Central Africa

Passing eastwards, to Central Africa. Here are the UN HDI ratings:

And the Freedom House ratings:

Ouch! South Sudan is one of two countries in the world with a lower Freedom House rating than North Korea. Sao Tome and Principe, on the other hand, towers above the rest. Like Cape Verde, it is an island country off the African mainland, and it has close ties with Portugal. And it’s in an oil-rich region, too.

So, let’s look at the cases per million:

Like West Africa, there isn’t much if any correlation between different countries. And no-one has reached the “endemic” threshold, even though Sao Tome, Equatorial Guinea and Gabon have all made two attempts. Here are the total cases per million:

Gabon and Equatorial Guinea, like Sao Tome, are oil-producing countries. This may well have something to do with their relatively high cases per million, compared to West Africa.

Here are the R-rates and the lockdown stringencies:

A similar picture to West Africa, although South Sudan’s recent high level of lockdown stands out against the trend of relaxation elsewhere.

The only country in the region supplying any data at all on testing is South Sudan, and they have tested only just over 1% of the population.

Here are the deaths per million:

Those cumulative deaths per case are generally better even than West Africa. Why so? Heat and humidity? Native medicine practices? Poor reporting? Inquiring minds want to know.

There is no vaccination data at all for this region yet. So, we’re on to…

East Africa

Here are the UN HDI ratings:

These ratings are pulled upwards, in comparison to the previous two groups, by the Seychelles. Somalia does not appear to have a rating at all.

Here are the Freedom House ratings:

Eritrea is the other country, like South Sudan, with a Freedom House rating lower than North Korea.

Here are the cases per million:

Well, there you see it. Apart from a couple of early outbreaks in Djibouti and one in the Seychelles, all of which were quelled, the whole region had the virus basically under control until, right after Christmas, cases took off in the Seychelles. Which now has cases per million comparable with the less badly affected countries in Europe. That’s concerning in the sense that, although a country may have contained the virus well for many months, once it gets going it can still grow fast.

The R-rates show nothing of interest, while the lockdown stringencies show a wider spread than any other region I’ve looked at so far:

The average lockdown stringencies make for an interesting comparison:

Given that it has reported a total of only 3038 cases and 7 deaths in a population of three and a half million, I think that Freedom House have their rating of Eritrea right! Tanzania and Burundi, by contrast, seem to be taking a relatively relaxed attitude. And while the Seychelles did lock down to 80% in January, they are already relaxing the restrictions.

This is in contrast to the UK, where we have been at 86% lockdown or worse continuously for two and a half months. And what some might consider non-essentials – like getting your beard trimmed, getting your watchstrap repaired or buying new underpants – have been arbitrarily deemed “illegal” for months at a time. By which time, they are essentials! Sigh.

To return to reality. The only country in the East Africa region that has done significant testing is Rwanda.

As to deaths per million, the Comoros and the Seychelles predominate. Both are small island communities, vulnerable to a relatively small-scale outbreak. But their deaths per million are orders of magnitude smaller than in Europe.

But when it comes to vaccinations, the Seychelles really stand out. They have fully vaccinated 27% of the population, and part vaccinated another 30% or more. It’s unfortunate that their lockdown level has been rapidly changing during the period in which they have been rolling out the vaccinations, so I can’t even try to assess the efficacy of the vaccines there. In the rest of the region, Rwanda and Kenya have made a start on vaccinations, but no-one else has reported any vaccinations at all.

Southern Africa

Lastly for this missive, to Southern Africa. Here are the UN HDI ratings:

These are generally higher than in the rest of Africa. The last four countries, in particular, pull up the regional ratings.

And here are the Freedom House ratings:

It’s the same four which top the list here, too.

So, let’s look at the cases per million:

At last, we have an African country – South Africa – which has exceeded 200 new cases per million per day. Eswatini briefly, and recently Botswana, have just about got there too.

Here are the total cases per million:

Of the four highest countries in the ratings, three – South Africa, Namibia and Botswana – are at the top. While the fourth, Mauritius, is at the bottom; probably reflecting its island status. Mauritius seems (so far) to have been lucky, where the Seychelles were not.

Here are the R-rates and the lockdown stringencies:

It’s obvious that the R-rate in Mauritius has started to rise, so we can probably expect some more lockdowns there in the fairly near future. But discounting the lowest threads on the R-rate graph, there is a surprising resemblance to European patterns, though the peaks are lower. And since this region is in the Southern Hemisphere, the resemblance suggests that the virus may not be as seasonal as some think.

There is a bit more testing going on here than in other parts of Africa, but testing levels are generally a lot lower than in Europe:

Here are the deaths per million:

Eswatini is all but surrounded by South Africa, which may explain its relatively high death toll. These two are approaching the middle of the European range in deaths per million.

Here are the deaths per case:

The cumulative deaths per case figures in East and Southern Africa are worse than those in West and Central Africa. As are the cases per million on the mainland, excepting the oil producing areas. This suggests, maybe, that the heat and humidity of the equatorial lowlands do give some level of protection against dying from the virus. If not also against catching it in the first place.

As to vaccinations, Mauritius, Zimbabwe, South Africa and Angola have made starts. But their progress is, as yet, minimal.


Now for some scatterplots referring to Sub-Saharan Africa as a whole.

The correlation of hospital bed provision with human development index is clear:

The lack of relation between cases per million and population density is, surprisingly, rather similar to the situation in Europe:

The correlation between cases per million and human development index is comparable with the Americas:

And the expected negative correlation between Freedom House rating and average lockdown stringency is there, too:

To sum up

Despite low levels of testing, West and Central Africa have done pretty well in containing the virus so far, in comparison to Europe, the Americas and even the Middle East. Cases per million are well lower, and deaths per case are comparable with, or a bit lower than, Europe. What could have caused this? Is it that African health care systems are better than European and American ones? Or, otherwise put, that European and American health care systems, despite all the money sloshing into them, fail to do their job properly? Or is it some external factor, like high heat and humidity, lessening both the virus’s reproduction and its fatality?

East and, particularly, Southern Africa are not doing as well against the virus as West and Central Africa. But the Seychelles stands out as somewhere that is taking vaccination seriously. And the variability in lockdown levels in East Africa, in particular, is amazing.

…and a wider view

Now, what have I found, from my COVID observations of the world so far? There seems to be a signal that countries with higher levels of “human development” (whatever that means) tend to be more vulnerable to the virus than those at lower levels. Oil producing countries, which presumably have more contact with Westerners than their development index would lead you to expect, also seem to be more vulnerable.

The cynic in me ponders that this virus, if it was designed (an open question), might have been designed to “even up” economic inequalities between countries. Not by bringing the lowest up towards the level of the highest; but by hitting the highest so hard, that they are dragged down into the mire of poverty with the rest. Such an attitude does, indeed, accord with the tenets of communism. But far more, it accords with the desire of the international political-corporate élites (and their national yes-men and -women) for world-wide hegemony. And with the “lock ’em down and make it hurt” fever, that has gripped those national yes-men, including Boris Johnson, for more than a year now.

Next up, Asia. That should be interesting.


Opher Goodwin said...

Lol Neil - I don't think a virus can be designed to attack affluent countries over poor ones. That is not remotely possible.
I think what we are probably looking at is a mixture of factors. I bet obesity levels play a big part in death-rates but it could also be vitamin D levels.
I reckon this virus (which is spread in microdroplets) does not cope well with strong UV from sunlight or heat - which is why it spreads poorly outside. I expect levels to drop in the UK as soon as summer arrives.
Interesting Neil - BTW I trimmed my beard today with a Remington electric trimmer - very efficient and only £9.

Neil said...

Opher, the observation that prompted the thought about levelling down economies was that more economic activity means wider travel, as well as individuals dealing with more people from outside their normal social circle. So a virus which transmits easily in a situation of relatively short-term contact, and doesn't kill so many of its hosts that it quickly runs out of potential victims, would be likely to affect richer countries more than poorer ones.

Obesity might well have something to do with death rates once the virus has been caught, but that would show up in the deaths-per-case. The USA, the spiritual home of obesity, is two-thirds of the way down among the 35 countries in the Americas. Maybe it partially cancels out their (historically, very good but also extremely expensive) health care system?

Vitamin D also might have an effect, but the R-rates in Southern Africa (and most of all in South Africa) increased quite strongly from August to December/January. That's from winter to mid-summer; not what you'd expect if lack of Vitamin D was a contributor. I know that South Africa is closer to the equator than Europe, and the others are closer still; so maybe they still sun themselves there in the middle of winter!