As the novel coronavirus (COVID-19) has marched through China and Europe, Uganda has avoided any cases to date, and Kenya has only had three cases. Like everyone else in the region, I’ve been wondering whether this is likely to continue, and what might happen if the disease did arrive at scale. I wanted to collect a number of resources that I’ve found useful in thinking about this in a single place. I am not an epidemiologist and am not making any predictions about the geographic spread of the disease.
Is coronavirus likely to spread to the region?
There are two factors which may play to Kenya and Uganda’s advantage when it comes to preventing the arrival of additional coronavirus cases in the area. First, the virus has been spreading globally when infected individuals travel between countries. Both countries have relatively few direct flight links outside of the continent. Kenya has closed its borders to non-residents as of March 15, and is requiring all travelers to self-quarantine for 14 days. Uganda is requiring travelers from countries with current coronavirus cases to self-quarantine as well.
Second, in countries currently affected by coronavirus at scale, the disease has also been spreading among communities in contact with an infected person. However, there’s some tentative evidence that this type of spread is only happening in relatively cool climates. A new paper from Sajadi et al. (2020) notes that all cases of community transmission have been concentrated in a narrow band with temperatures around 10 degrees Celsius / 50 degrees Fahrenheit. This may be because the coronavirus can’t survive as long outside the body in warmer temperatures.
If this finding holds true, it suggests that if additional infected individuals do travel to Kenya and Uganda, the coronavirus may not spread significantly beyond them. However, there is still a great deal of uncertainty here, and we shouldn’t trust that warm weather will prevent community transmission.
Are Kenya and Uganda prepared to track the spread of the virus?
There’s reason to be optimistic about public health capacity to track potential coronavirus cases. Both countries already have infectious disease surveillance infrastructure in place at the international airports due to the recent Ebola epidemic in the nearby DR Congo. All travelers to Nairobi and Entebbe must report their travel histories, share contact information, and go through a thermal screening at both airports. Of course, airport screening won’t stop all infected people from entering the country because some may not have symptoms yet, but it’s still useful for surveillance.
In addition, both countries are building on much longer histories of population-level disease surveillance, including those for polio and HIV / AIDS. As this article from Think Global Health notes,
Because of the robust responses to these diseases, many African countries are starting from a very different baseline than twenty years ago. Although this has not generally included support for ICU-level care that will be required by the sickest people with COVID-19, what these investments have supported are increasingly human resource for health, supply chains, information and surveillance capacities for prevention, detection and long-term response capacity against diverse infectious threats.
Finally, because the onset of the epidemic has been delayed here, both countries have had more time to prepare. The Africa Centres for Disease Control have been running online trainings for healthcare workers about the coronavirus, and have also developed and distributed coronavirus test kits to most countries across the continent, including Kenya and Uganda. Both countries have already banned international conferences, and Kenya has also opened a 120-bed isolation center for potential patients.
What happens if coronavirus does spread within the region?
If community transmission of coronavirus does occur within Kenya and Uganda, one of the main risks is that it may overwhelm healthcare systems with people seeking care. Taking early preventative measures to slow the spread of the virus makes it more likely that sick people can access care when they need it, as this graph from Our World in Data shows. Unfortunately, Kenya and Uganda are grappling with weak health systems and poverty, both of which may make it more difficult to contain the virus if it does arrive.
In both countries, health systems tend to be underfunded. In Kenya, significant revenue comes from user fees, which discourage poor people from accessing healthcare. Uganda abolished user fees for healthcare in 2001, but poor people still find it difficult to access care. Kenya is doing fairly well at providing essential medicines, but Ugandan clinics often lack drugs. The number of intensive care unit (ICU) beds in both countries is low, and only 23% of Ugandan ICUs have ventilators. On any given day, nearly half of healthcare workers in both countries are absent from their jobs, often because of poor pay and long commutes. If coronavirus spreads among the population and leaves many people in need of hospitalization, it’s clear that the health systems will struggle to keep up.
Poverty can also make it difficult for people to take other steps to keep themselves safe from coronavirus. Only 14% of Kenyans have access to soap and water at home, and in Uganda only 8% of families with young children have access to soap and water at home. Hand sanitizer is available in shops, but not widely used. Without well-functioning state-run social safety nets, most people also don’t have the luxury of taking time off from work to rest if they are sick. This both increases the risk that the disease will spread, and makes it more difficult for infected people to recover. Informal insurance within families and religious groups can mitigate this somewhat, but churches have also been vectors for infection in the US and South Korea, meaning that this insurance mechanism could possibly increase the risk of contacting the disease.
Even without cases of coronavirus in the region, the social and economic impacts of the disease are already being felt. Xenophobic statements about Chinese residents have been reported in Kenya. And in both countries, an economic slowdown is expected as traders have been cut off from Chinese imports. The indirect economic effects as people lose their livelihoods may be just as serious as the disease itself. It’s important for both countries to continue expanding their social safety nets and ensure that healthcare is affordable, even if coronavirus never comes ashore.