The Economist - USA (2020-08-08)

36 Middle East & Africa The EconomistAugust 8th 2020

“I

t’sbeenhectic,”saysThaboNko,an

undertakerinSoweto,a townshipon

theoutskirtsofJohannesburg.Beforethe

pandemichewoulddotwoorthreeburials

ina week.Thesedaysheisdoingabout20.

Thenearestpubliccemeteriesarefull,so

hehastoburysomecorpses50kmaway.

Surprisingly,allthedeathisnotgood

forbusiness.Overwhelmedauthoritiesare

behindonissuingthedeathcertificates

familiesneedtoclaimontheirfuneralin-

surancepolicies.Forthefirsttimesince

openingin2007,MrNkoislayingpeopleto

restbeforeheispaid.“Ihadtodropthat

rule,”hesays.“Thereistoomuchtodo.”

SouthAfricahastheworld’sfifth-high-

estnumberofreportedcases.Itaccounts

for53%oftheconfirmedcasesand43%of

deathsfromcovid-19 inAfrica. Butthat

doesnotmeantherestofthecontinentis

beingspared.Insteaditreflectsa lackof

data in mostother countries—and how

theirpeaksmaybeyettocome.

AsofAugust5ththeAfricaCentresfor

DiseaseControlandPrevention,a public-

healthbody,hadrecorded992,710casesin

Africa.Ittookaboutfivemonthsforthe

continenttoreach500,000casesandan-

othermonthtoreachcloseto1m.Thecom-

pounddailygrowthrateofnewcasesover

thepasttwoweekswashigherinsub-Saha-

ranAfricathaninotherregions.Inreality

themillionthAfricancontractedcovid-19

manyweeksago.

Thefullextentoftheundercountisun-

known.Theshareofteststhatcomeup

positiveisbelow5%inonlya fewcoun-

tries,suggestingwidespreadunderreport-

ingelsewhere.Lowtest-positivity-ratesare

found in states with relatively efficient

governments,suchasBotswana;countries

withfearedsecurity forces,likeUganda;

andthosethathaveboth,suchasRwanda.

Elsewherethesharesaremuchhigher.

InmostofthecountrieswheretheInterna-

tionalRescueCommitteeworkstherates

areindoubledigits—forinstanceSomalia

(17%,asofJuly30th),Congo(20%),South

Sudan(19%),IvoryCoast(16%)andtheCen-

tralAfricanRepublic(16%).Relativetoits

population, Britainhas done 600 times

moreteststhanhavetheAfricancountries

wheretheircworks.

Another hint of underreporting is

foundinthenumberofcasesamongAfri-

ca’selites,whoaremorelikelytogettests.

AtleastthreeofSouthSudan’sfivevice-

presidents have had covid-19. Burundi’s

formerpresident,PierreNkurunziza,prob-

ablydiedofit.SotoodidPerranceShiri,

Zimbabwe’sagricultureminister(whowas

betterknownfororganisingmasskillings

inMatabelelandinthe1980s).Unlikemost

of thecountry’sdoctors,his pallbearers

hadprotectivegear.

Patchydatamakeit hardtoassessmany

African countries’ responses. Mauritius,

anislandthatquicklycloseditsborders,

haslargelysuppressedthevirus.Rwanda’s

track-and-trace system, which includes

randomtesting,hasslowedtransmission.

Casesseemto begrowing quicklyin

mostcountriesastheyloosenlockdowns

totrytorevivetheireconomies.Statesthat

appearedtohavethevirusundercontrol,

suchasEthiopia,KenyaandZambia,areall

experiencingdailygrowthratesabovethe

regionalaverage.Ghana’s widelypraised

testingstrategy,involvinga “pooledmeth-

od”inwhichmultiplesamplesaretestedat

once,isbecominglesseffectiveascases

rise.InNigeria,hometonearlyone-sixth

ofAfricans,testingisheldbackbyshort-

agesofreagentsandkits.Itisusingless

thanhalfofitstestingcapacity,according

toa surveybytheTonyBlairInstitute.

TwosupposedadvantagesforAfrican

countriesaregeographyanddemography.

Therelativeisolationof ruralareaswas

meanttoslowtransmission.Itstillmight.

But,notesMatshidisoMoeti,theheadof

the who Africa region, “the virus has

spilled out of major cities and spread into

distant hinterlands.”

The continent’s youthfulness is more of

an obvious boon. Most Africans were born

in the 21st century. Africa has a lower share

of people over the age of 65 than any other

continent. A recent paper published by the

American Journal of Tropical Medicine and

Hygieneargued that Uganda’s age structure

will keep death rates lower than in other

parts of the world. (Other pan-African

models suggest that such advantages are

outweighed by poor health systems.)

About 2% of Africans diagnosed with

covid-19 have died. That is only half the glo-

bal average. But such numbers should be

treated with great caution. There is a delay

between diagnosis and death, so the rate

can be misleading when infections are ris-

ing rapidly. Also, only a few African coun-

tries keep good cause-of-death records.

The whosays it is trying to improve this,

but the work is not happening fast enough.

And politicians may not see it as in their in-

terest to reveal how many people have died

on their watch.

Even in South Africa, which has reliable

records, the toll is probably far higher than

the official tally of 9,298. On August 5th the

country’s Medical Research Council noted

that from May 6th to July 28th there were

28,329 more deaths from natural causes

than forecast by historical trends. The vast

bulk of these will probably have been relat-

ed to covid-19.

Such data chime with Mr Nko’s experi-

ence. South Africa has an older population

than other African states. But many covid-

watchers fear that what is happening at the

southern tip of the continent may be re-

peated elsewhere. Whether it will be re-

corded is another question. 7

JOHANNESBURG

Africanears1mreportedcasesofcovid-19.Thetruenumberismuchhigher

ThepandemicinAfrica

Onemillionandnotcounting

Each mound, a loss