Dangerous liaisons? As the COVID-19 wave hits Africa with potential for novel transmission dynamics: a perspective

Abstract

The COVID-19 global pandemic was first reported inWuhan, China, followed by subsequent outbreaks in other parts of Asia, Western Europe, and North America (Miller et al. 2020; Velavan and Meyer 2020). Towards the end of February 2020, the first case of COVID-19 was reported in Brazil, marking the arrival of the COVID-19 wave in South America (Miller et al. 2020). Recently, the COVID-19 wave has hit Africa, turning the continent into the next potential hotspot for the global pandemic. To date, significant outbreaks have been reported in all regions of Africa, including East Africa, West Africa, southern Africa, central Africa, and North Africa (Africa CDC 2020; Martinez-Alvarez et al. 2020). As of 6 August 2020, 1,007,366 confirmed cases of COVID-19 and 22,066 deaths have been reported in Africa, and the infections continue to rise rapidly (Africa CDC 2020). Southern Africa, with a total of 565,100 confirmed cases, accounts for slightly more than half (i.e., 56%) of the cases in Africa. The World Health Organization predicts that up to 190,000 could die in Africa if COVID-19 is not controlled (WHO 2020c, d). Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), the etiologic agent that causes COVID-19, is transmitted predominantly via respiratory droplets released by symptomatic and asymptomatic infected persons via coughing, sneezing, and through direct contact with contaminated surfaces (WHO 2020b, c). Accordingly, current control methods for minimizing transmission via these routes include wearing appropriate personal protective equipment (PPE), practicing hand hygiene via frequent and regular hand washing, and social distancing based on national lockdowns and quarantines (WHO 2020b, c). Several recent studies have suggested the fecal–oral route as a potential transmission mode (Goh et al. 2020, Gu et al. 2020; Gwenzi 2020b; Heller et al. 2020; Hindson 2020). For example, the fecal–oral route transmission was discussed in detail in an earlier review paper focusing on low-income countries (Gwenzi 2020b). This is because SARS-CoV-2 RNA has been detected in the human gastrointestinal tract, stools, and even rawwastewater (Ahmed et al. 2020; Lodder and de Roda Husman 2020; Randazzo et al. 2020; Yeo et al. 2020). The outbreak of COVID-19 in Africa, particularly in subSaharan Africa, is significant in a number of respects. First, the region experiences chronic poverty, and has poor social security and health care systems with limited capacity to cope with a pandemic of such magnitude. Second, the COVIDwave arrived during wintertime, when conditions are conducive for the transmission and persistence of SARS-CoV-2. Finally, the region experiences a variety of inherent risk factors predisposing humans to COVID-19. Hence, novel COVID-19 transmission modes via fecal contamination of drinking water and food sources, and human exposure via the fecal-oral route cannot be ruled out. However, an African perspective on the practical implications of the potential for novel transmission of COVID-19 and its potential interactions with the inherent socioeconomic drivers, risk factors, and challenges in Africa is still lacking. This perspective, which targets policy-makers, practitioners, aid agencies, and the research community, seeks to address this gap. Figure 1 summarizes the focus of the current perspective. The current perspective posits that, collectively, these socioeconomic drivers, risk factors, and challenges, coupled with the highly infectious COVID-19 with a fatality rate of about 4% and a high risk for novel transmission, constitute “dangerous liaisons.” In turn, this will result in adverse human health outcomes and long-lasting knock-on effects in fragile African countries. Hence, novel transmission dynamics * Willis Gwenzi [email protected]; [email protected]