COVID World Status Report: 5 – Sub-Saharan Africa

Deaths per case (darker is higher)

This is the fifth in a series of status reports on the COVID situation as at May 23^rd, 2022. This report covers sub-Saharan Africa. The countries are divided into four groups. West Africa covers the area from Senegal to Nigeria. Central Africa goes from Cameroon to South Sudan, and as far south as the two Congos; and includes Sao Tome. East Africa covers from Eritrea down to Tanzania and Malawi, and also includes the Comoros and the Seychelles. Southern Africa goes from Angola southwards, with Madagascar and Saint Helena.

Vaccinations

Here’s the list of percentages of the population fully vaccinated:

The small islands tend to have a greater proportion of people vaccinated than the mainland countries. Of the latter, Rwanda and Botswana stand out at the top. And there are no less than 13 countries at the bottom with less than 10% of their populations vaccinated.

Lockdowns

Here are the graphs of lockdown stringencies over the course of the epidemic, and the current lockdown status, in each of the four groups of countries:

There has been a general downward trend in stringency since the first cases peak, but also great variation in the approaches of different West African countries. Burkina Faso and Cote d’Ivoire have tried hardest to keep stringencies low. Whereas since the beginning of 2021, Guinea has often been the hardest locked down in this group.

These countries tend to have less stringent lockdowns than the West African countries. The Democratic Republic of Congo (DRC) and Gabon have often been highest. But Gabon switched in March 2022 from a high lockdown strategy to a low lockdown one.

Tanzania and Burundi have kept lockdown stringencies low throughout. The Comoros does not show on the spaghetti graph, because they are only supplying data on face mask mandates, not on stringency. Eritrea has had consistently one of the harshest lockdowns in the world, particularly in the first year of the epidemic.

Again, a general downward trend, with Mauritius being the most erratic, going from bottom of the stringency table to top in the space of a few days early in 2021.

Here is the ordered list of current stringencies, in terms of my “harshness” metric:

Here are the current lockdown measures (mandatory only) for the bottom 10.

Country	Measures
Tanzania	International: Screening
Namibia	Gatherings: Up to 101-1000, International: Screening; as well as several recommendations
Gabon	Face covering: Required in some places
Burundi, Botswana, Benin	International: Screening, Face covering: Required in some places
Ethiopia	International: Screening, Face covering: Required in some places; as well as several recommendations
Mozambique, South Africa	Gatherings: Up to 101-1000, International: Screening, Face covering: Required in some places; as well as several recommendations
Cape Verde	Gatherings: Up to >1000, International: Screening, Face covering: Required in some places; as well as several recommendations

At the other end of the scale, here are the lockdown mandates for the top four:

Country	Measures
Togo	Events: Mandatory cancelled, Gatherings: Up to <=10, Stay at home: Required with exceptions (Regional), International: Ban all arrivals/border closure, Face covering: Required outside the home
Angola	Workplaces: Some closed, Stay at home: Required with exceptions, Travel: Mandatory restrictions, International: Quarantine high-risk, Face covering: Required outside the home
Eritrea	Events: Mandatory cancelled, Gatherings: Up to 11-100, Stay at home: Required with exceptions, International: Quarantine high-risk, Face covering: Required when with others
Mauritius	Workplaces: Some closed, Events: Mandatory cancelled, Gatherings: Up to 11-100, International: Quarantine high-risk, Face covering: Required when with others

It’s interesting that all four, in common with many other African countries, have rather draconian face mask mandates. And Angola and Eritrea are still requiring everyone to stay at home most of the time!

Cases

Here is the ordered list of cases per million:

Four of the top ten in cases per million here are small islands. Of the others, Botswana has about 13% of the population diagnosed as cases, and South Africa about 7%. Gabon has about 2%. But throughout most of Africa, case counts per million are very low compared with Europe, the Americas or the Middle East.

Tanzania is at the very bottom, with just 0.06% of the population having been diagnosed as cases. But their data is suspect. Reporting is infrequent and unpredictable, with large batches of cases or deaths (or both) being added at one time; though it does seem to have got better in the last few months. Nigeria’s data, on the other hand, is much more believable, showing a reasonable profile of new cases over time, despite their small number.

To show the cases per million on a map of Africa, I’ll cut out the data for the Seychelles and Mauritius, so Botswana will show in the darkest possible colour.

Cases per million (darker is higher)

Even with the Seychelles and Mauritius removed, it is generally only those African countries with the highest UN Human Development Index which get coloured on this map at all. As in the Americas, countries with better connections to the rest of the world tend to find more cases per million than those with less good connections. The remaining countries in sub-Saharan Africa seem hardly to have been touched by the virus, compared to Europe, the Americas or the Middle East.

Here are the daily cases per million spaghetti graphs:

Take out Cape Verde, and you get this:

By European standards, cases per million have been piffling in this region. Although the timing of the latest and biggest peak suggests that omicron has already been there for several months. Even Guinea-Bissau (dark brown) currently has cases per million well below earlier peaks. We already knew that the virus doesn’t spread very easily in West Africa, perhaps because of the heat and humidity. But can it really be, that the West Africans have managed to beat off the thing, without breaking much sweat?

Let’s take a look at one individual country, Benin:

Given the infrequency of the reporting, that cases profile actually looks quite reasonable. The deaths seem a bit lower than I would have expected for that number of cases, but not outside the bounds of possibility.

If you look at recent daily deaths per million for all the countries in this group, you find something astonishing. Not a single COVID death had been reported by any of these 13 countries in the week ending on May 23^rd 2022! Now, it’s true that a lot of these countries only report COVID cases and deaths every two weeks or so, and this can easily stretch out to a month. But the last COVID death reported in Benin was on January 19^th, in Burkina Faso May 9^th, in Cote d’Ivoire April 20^th, in Gambia February 9^th, in Ghana March 10^th, in Guinea April 28^th, in Guinea-Bissau April 19^th, in Liberia February 28^th, in Nigeria April 14^th, in Senegal April 24^th, in Sierra Leone January 10^th, in Togo April 16^th. Even in Cape Verde, there hasn’t been a COVID death reported since February 22^nd. There has been a recent increase in new cases there, but they are still way below earlier levels.

Meanwhile, Cote d’Ivoire, Ghana, Guinea, Nigeria, Senegal and Togo, at least, are still reporting a steady flow of a few tens of new cases a week. I know this is Africa, but surely 13 independent sets of case-counters can’t all be out to lunch at the same time? It really does look as though they’ve beaten the damned thing. In the cases of Senegal, Burkina Faso, Nigeria and Gambia, they have done that without any more than 15% of the population being fully vaccinated. And Benin and Cape Verde are doing it without much in the way of harsh lockdowns. Here are their current lockdown statuses in full:

Country	Measures
Benin	Schools: Open, Workplaces: Open, Events: Allowed, Gatherings: No restrictions, Public transport: Recommended closed, Stay at home: No measures, Travel: No restrictions, International: Screening, Face covering: Required in some places
Cape Verde	Schools: Open, Workplaces: Open, Events: Recommended cancelled, Gatherings: Up to >1000, Public transport: Open, Stay at home: Recommended, Travel: Recommended not to travel, International: Screening, Face covering: Required in some places

So, let’s go to Central Africa:

The big peak, Sao Tome and Principe, is distorting the picture; so, let’s take that country out.

The peak of cases in Gabon has been higher than elsewhere, but otherwise this looks quite similar to the West African situation. Furthermore, as in West Africa, none of the Central African countries has reported any COVID deaths in the week ending May 23^rd. The timeliness of the reporting is poorer than in West Africa – the Democratic Republic of Congo, for example, has a single report of 610 cases and 1 death for the whole month from mid-April to mid-May. Sao Tome is showing its last COVID death on March 19^th, and a steady flow of about 10 cases a week. South Sudan is showing the last death on March 10^th, and a flow of 40-50 new cases a week.

Even Gabon is showing about one case a day on average, and the last COVID death was reported on April 28^th. And this, with just 11% of the population being fully vaccinated, and without any lockdown mandates currently except Face covering: Required in some places. Here are the cases and deaths graphs for Gabon on its own:

Those cases and deaths profiles actually look perfectly reasonable to me.

To East Africa:

Again, the picture is dominated by one island remote from the African continent, the Seychelles. Taking the Seychelles out:

That looks as though the omicron variant has been through practically every country. That recent small peak in Burundi reminds me of the peak in the UK back in March, when BA.2 took over from BA.1 as dominant variant. There is what looks like the beginning of more small peaks coming. A repeat of that, in different places?

Let’s have a closer look at Burundi on its own:

I don’t see anything particularly suspicious about the shapes of these graphs. But the numbers are all rather low. That said, the then president of Burundi is said to have died of COVID in June 2020. Even after his death, the Burundians refused vaccines until September 2021. Do I believe that this country, where lockdowns have been kept to a minimum, and vaccinations have not been a factor, has really done as well against the virus as these figures suggest? Umm… maybe. But probably not.

To Southern Africa:

Mauritius and Botswana hit, briefly, European levels of new cases per million. The steeply rising brown line at the right is Namibia; this is (or will be) the fifth peak in cases there.

It’s worth showing the cases and deaths graphs specifically for South Africa, as they show an almost perfect profile of the epidemic as a whole:

Well, there you have it. Five waves of cases, each at almost metronomic six-month intervals. This virus seems rather regular in its mutation habits! The first wave looks to have been the variant that hit Europe in February 2020. But it took off a lot more slowly in South Africa. The second, third and fourth waves were alpha, delta and omicron, respectively. The recent fifth wave has been driven by the BA.4 and BA.5 variants of omicron. The deaths graph shows that the original variant and alpha were of comparable lethality; but delta has been less lethal than alpha, and omicron less lethal than delta.

Hospital and ICU Occupancy

In the entire region, only South Africa is providing hospital and ICU occupancy data. This shows its hospital beds about 2.3% full with COVID patients, and its ICUs have a little under 6 COVID patients per million population.

Deaths

Here is the ordered list of deaths per million:

Deaths per million, even near the top of this table, are generally lower than in Europe, the Americas or the Middle East. In much of mainland Africa, the death toll per million attributed to COVID is trifling compared to those other parts of the world. One does, however, have to worry a little about the quality of the data. Even those countries, which do a relatively good job of counting new COVID cases, may not always do the same when deciding whether or not a death is due to COVID.

However, it’s still worth showing these deaths per million in map form (islands are not coloured):

Deaths per million (darker is higher)

In broad terms, in sub-Saharan Africa the lethal impact of COVID has been almost exclusively confined to the southern part of the continent, and to four small island communities (Seychelles, Mauritius, Cape Verde, Sao Tome).

Next, here is the ordered list of deaths per case:

Some of the countries with high deaths per million, nevertheless have low deaths per case: Seychelles, Mauritius, Cape Verde, Botswana. Burundi’s low deaths per case is outstanding, if it’s real. As are those in Benin and Gabon. At the other end, Somalia is not actually a war zone today, but has been in relatively recent years.

Here is the corresponding map (small islands are not coloured):

Deaths per case (darker is higher)

This does suggest, perhaps, that the apparent successes against the virus in Burundi, Gabon and Benin – all of which remain white on the above map – may be a little exaggerated. Do I believe their figures? That’s a hard question. I eventually answered: I have confidence in the new cases reporting in Gabon and Benin, and less confidence in Burundi. Gabon’s position in the cases per million league is pretty much where you’d expect them to be, given their relative strength economically and in human development. That means their data collection isn’t all bad. Even if their deaths counts are lower than they ought to be, that doesn’t disqualify the cases counts from any of these countries. So, I’ll take these numbers as the best they can do, given their circumstances. And I’ll believe them.

Another reason for confidence was the map above. If African governments were trying to fool us with their COVID statistics, there would be something there that doesn’t ring true. But there isn’t.

As to average excess mortality, only four countries in the region have provided excess mortality data: South Africa, Cape Verde, Mauritius and the Seychelles. Cape Verde stopped reporting at the end of 2020, and Mauritius and the Seychelles have not reported since the end of 2021. Only South Africa has continued reporting into 2022. But here is the list, anyway:

Nothing to see here, let’s move on. To Asia.

To sum up

In terms of cases and deaths, most countries in sub-Saharan Africa seem hardly to have been touched by the virus, compared to Europe, the Americas or the Middle East. The lethal impact of COVID has been almost exclusively confined to the southern part of the continent, and to four small island communities (Seychelles, Mauritius, Cape Verde, Sao Tome).

In South Africa, whose data is as believable as anyone’s in the region, the epidemic profile shows five waves of cases, each arriving at almost metronomic six-month intervals. The virus seems rather regular in its mutation habits!

In much of Africa, it looks as if COVID deaths may be being under-reported. But that is not necessarily true of new cases. We already knew that the virus doesn’t spread very easily in Western or Central Africa, perhaps because of the heat and humidity. The difficulty was with the quality of the data. But I found that I do, after all, have confidence in the new cases reporting of countries such as Gabon and Benin. There are also countries, such as Tanzania and Burundi, in whose data I have far less confidence.

Based on the data I have, it looks as if – barring a new and more transmissible variant, of course – the epidemic is all but over in Western and Central Africa. And well on the way down in the rest of sub-Saharan Africa, with the possible exception of Namibia. I confess that was not at all what I expected to find!

Senegal, Burkina Faso, Nigeria and Gambia, at least, have achieved this without any more than 15% of the population being fully vaccinated. Benin and Cape Verde have done it without much in the way of harsh lockdowns. And Gabon has done it with just 11% of the population fully vaccinated, and with a low lockdown strategy which has been in place since March 2022. It looks as if, in the conditions which pertain to the spread of the virus in much of Africa, neither lockdowns nor vaccinations have had very much effect, at least since the arrival of the omicron variant.