COVID19 makes its presence known in SubSaharan Africa... Will South Africa become the next Brazil

About 1 month ago, I posted about COVID in Africa and potential links to the environment.  At that time the numbers were as follows (based on WHO and Worldometer):
 
June 11                          Cases                Deaths              Total Case fatality (%)
Cape Verde  -                  657                   6                       0.9
Nigeria                            14,554              387                   2.7
Senegal                            4,759               59                     1.2
Ghana                              10,358              48                     0.46       
Angola                             118                   5                       4.24
DRC                                 4,515               98                     2.17
South Africa                     58,568             1284                 2.2

South Africa had by far the most COVID-19 cases and deaths and Angola the least.  The total case fatality represents the fraction of people who died after testing positive.    South Africa, Nigeria, and DRC all had case fatalities that were significant.

Since that time, the dry season is now in full swing south of the Equator and north of the Equator, the wet season is occurring.  The dry season is associated with biomass burning in places like Angola, Zambia, Madagascar.

Satellite depiction of Fires South of the Equator (July 14, 2020)

The fires produce poor air quality and lots of small aerosols made up of black carbon.  Very bad for the lungs overall and especially during the COVID-19 Pandemic.

Satellite depiction of clouds and rainfall north of  the Equator (July 14, 2020)

In West Africa, the commencement of the rainy season is tied to cool and humid conditions, rain coming from organized and disorganized weather systems.  Over the next three months, some of the weather systems will move westward and become tropical depressions, storms, or hurricanes impacting the Caribbean, Central Americas, and the United States.    The rainy conditions over West Africa are linked to vector-borne and water-borne diseases such as Malaria, Yellow Fever, and Cholera.   Also, the flu becomes prevalent in West Africa during this time which combined with COVID-19 could be very impactful.


Current status of Covid-19 in Sub-Saharan Africa

July 13                            Cases                Deaths              Total Case fatality (%)
Cape Verde  -                  1698                   19                    1.1
Nigeria                            32,558              740                    2.27
Senegal                            8,198               150                    1.83
Ghana                              24,518              139                   0.57
Angola                             506                   26                     5.14
DRC                                 8075               190                    2.35
South Africa                     276,242          4079                  1.48   

In the last 30 days, the numbers of cases have by a factor of 2-3 in most cases but somewhat higher in Angola.


July 12 single day          Cases                Deaths              
Cape Verde  -                  75 (july13)                                   
Nigeria                            571                    16                 
Senegal                           121                                   
Ghana                              270                                 
Angola                             21                                     
DRC                                 62                                   
South Africa                     12,058             111               


Let's take a look at North and South of the Equator as this may provide some clues as to the role of the environment.

South of the Equator (Angola, Botswana South Africa)

Caption: New and cumulative COVID-19 cases in Angola, Botswana and South Africa

Angola and Botswana have less than 1000 cases each.  However, you would note that the majority of the cases have occurred since June 1st and are rising.  This was the start of the biomass burning season where pollution levels have increased.

South Africa, on the other hand, has demonstrated exponential growth with the number of COVID cases approaching 300,000 today and new cases between 10,000-14,000 per day over the last week.
South Africa is now #9 globally, with only the United States, Brazil, and India recording more cases per day.  Based on the current growth, it will be in the top 5 for COVID-19 cases before August 1st.

Caption: Cumulative Mortality in South Africa and Botswana

As for fatalities, South Africa is also showing an exponential growth curve with most of the deaths occurring since June 1.  Botswana, on the other hand, has recorded only one fatality since May.




North of the Equator (Gulf of Guinea) 

Caption: New and cumulative COVID-19 Cases in Nigeria and Ghana

Nigeria and Ghana are major economic forces in West Africa and both have experienced increased in COVID-19 Cases since late May.  This coincides with the start of the rainy season which I will discuss in the next blog.  Since June both countries have experienced 400-700 new cases per day.

North of the Equator (Sahel and Cabo Verde) 

Across the Sahel (Senegal, Mali, Burkina Faso, Niger), the number of cases has been considerably lower up to the present.  These countries have yet to experience the full monsoon but the rainy season has gotten off to a fast start.   Cabo Verde has the same rainy season as Senegal and so we also compare values there.  Cabo Verde has more recorded cases than Niger and Burkina Faso whose populations are 20 times larger.   I don't know if it is because there are fewer tests in these countries or if the virus is moving quickly in Cabo Verde.  It does seem a bit odd.

Caption:  New and Cumulative  COVID cases in Senegal (left) and Cabo Verde 

Both countries show that COVID-19 cases continue to rise since May.  Senegal and Cabo Verde are averaging more than 100 and 40 cases per day since June 1.  Senegal has more than 8000 cases and Cabo Verde more than 1600.   Because Cabo Verde has only 550,000 persons and Senegal 16 million there are more cases per person in Cabo Verde.



COVID Mortality north of the Equator 

Covid Mortality in Nigeria/Ghana (Right) and Senegal/Cabo Verde (left)

COVID-19 mortality has increased in Nigeria and Ghana, but Nigeria has 5 times the number of COVID-19 deaths.  More than 400 COVID-19 related deaths occurred since June 1 in Nigeria.  It would be interesting to know what other co-morbidities (hypertension, asthma, flu, cardiovascular disease).  

COVID-19 Mortality in Senegal is similar to Ghana with rapid increases since June 1.  Cabo Verde has seen a rise in deaths since June 1st.  What co-morbidities are driving fatalities in these countries?

Is South Africa the next Brazil?

South Africa and Brazil are two good examples of emerging economies that have a significant number of black people. Brazil is about 4 times as large (200 million people) as South Africa (55 million).  The rapid rise in COVID-19 cases in South Africa is alarming.  However, there are 3-5 times more cases per day reported in Brazil.

Caption:  New and cumulative cases in Brazil (Left) and Brazil and South Africa Mortality curves.

Part of the problem in Brazil has been the same as the United States, the failure of leadership to acknowledge COVID-19 as a public health threat.  I believe that the South African government does not take such a position, but Brazil should be enough warning for all of Africa to take heed and as my brother, Jeff says to govern themselves accordingly.

Looking at the cumulative death curves shows that South Africa is about 3-6 weeks lagging Brazil. South Africa is in the heart of its winter season where several factors such as pollution, and colder temperatures (40s and 50s) keep people indoor.  Near Cape Town, large winter storms will be rolling by every week bringing rain, wind and cooler temperatures. This is their flu season and a prelude to what is expected in the United States in 4 months. 

In the next blog, I will give an overview of observed Environmental conditions in north and south of the Equator and how they may have influenced COVID-19 over the last 1-2 months.

Could there be a lower number of fatalities in Africa relative to Europe and the United States?? 

Some have stated that because the populations of Africa are so young relative to other countries, that more people will survive COVID-19.  This could be the case as we see in the US that a larger number of younger people have come down with COVID-19 and the current death rates are lower.

However, you have to be extremely cautious with this perspective.   For example, we know that the access to medical care is poor in many regions of the continent. We know that non-communicable diseases like asthma, diabetes, hypertension, and cardiovascular disease are emerging across much of Africa.  We also know that people have fewer resources and disposable incomes to deal with COVID-19 related illnesses.   Finally, the number of tests outside of South Africa remains low in SubSaharan Africa, so that there could, in fact, be many more cases than reported.  No matter, I urge black people in Africa and the diaspora (Caribbean, Europe, US, South America) to remain vigilant to COVID-19, because..... Black Lives Matter everywhere.