Seychelles: What is causing the post-vax rise in cases?
It may be one of the most-vaccinated countries on earth, but the Seychelles has seen an explosion in cases – and the imposition of crippling new lockdown restrictions – since rolling out the Covid-19 jab. As the rest of the continent races to follow its lead, with Burundi and Tanzania receiving their first shipments in recent days, investigative reporter Sonia Elijah asks what lessons, if any, can be learned from the Seychelles' apparent vaccine failure.
Africa's antibody results explained
NewsAfrica cuts through the media hysteria and gets the lowdown on lockdowns, Covid-19 antibody tests and herd immunity in this Q&A with Professor Sunetra Gupta, a world-leading expert in theoretical epidemiology at the Department of Zoology, University of Oxford.
Q: Why are infections and hospitalisations falling across much of Africa when lockdown measures are being eased, or, in the case of Tanzania, never imposed at all?
A: It's hard to think of any other explanation than the build-up of population-level immunity, also known as 'herd immunity'. Social distancing may accelerate the decline.
Q: What percentage of the population needs to be infected for herd immunity to kick in?
A: This depends on how many people were resistant to the virus to start with.
Several studies suggest that previous exposure to seasonal coronaviruses [such as common colds] confer a degree of protection, and this can bring down the percentage that needs to be infected quite considerably, such that antibody levels of 15-20 per cent may be sufficient to reach what is known as the herd immunity threshold.
Q: Will exposure to the virus show up in antibody tests?
A: Antibody tests are highly variable in their specificity and sensitivity.
We now know that not everybody who is exposed makes antibodies, and also that they decay quite quickly.
This makes it difficult to interpret the results [of antibody studies].
There are, of course, reports of 40-50 per cent or even 70 per cent antibody positivity in certain populations which suggests that they were recently infected and have probably overshot the herd immunity threshold.
Q: Why do governments not test for the full range of antibodies, such as IgA antibodies and T-Cells?
A: It's very difficult and expensive to test for T-cells.
IgA tests in saliva are being trialled.
Q: Given that studies found 12.3 per cent of people in Blantyre, Malawi, had IgG and IgM antibodies alone, what percentage of Malawians are likely to have had the virus and be protected by IgA antibodies and T-cells too?
A: I think most of these numbers have gone up since the study was conducted, but I imagine that we should expect similar levels of antibodies as Stockholm [where infections have slowed through some degree of herd immunity].
Q: How realistic was the concept of 'social distancing' for Africa, given its mega-cities and slums?
A: I think it's totally unrealistic and can have devastating consequences for society [poverty, hunger etc], as we have clearly seen.
Q: Why have Africa's health systems been able to cope better with the pandemic than rich nations, such as the UK, Italy and Belgium?
A: Part of it is down to the age structure.
We know that the risks are very low in people under the age of 65.
It could also be that exposure to other pathogens, especially other coronaviruses, is higher in Africa.
Q: Is talk of a second wave just media hysteria?
A: Lifting of lockdown in areas where the virus has not spread can of course result in a rise in infections.
Hopefully we will not see this in Africa.
Many pathogens exhibit seasonal increases over the winter months, this may be what is happening now in the UK, so it is likely that cases will rise again next winter in South Africa and elsewhere in the southern hemisphere, but this is just normal behaviour for a respiratory pathogen.
In a few years, we may get another real, wave due to the loss of immunity, as we see with other coronaviruses, but hopefully this will not cause a lot of excess mortality as you are often protected against severe disease and death in your second infection.
Has Africa reached herd immunity?
With early antibody tests revealing the virus may have infected millions more Africans than first thought, Andrea Dijkstra speaks to some of the world's leading experts and asks whether the fall in hospitalisations and deaths may mean herd immunity is well within reach.
Early this year, experts estimated that the African continent would be especially hard hit by the pandemic, with high rates of transmission that could quickly overwhelm health care systems.
'Between 300,000 and 3.3 million African people could die as a direct result of Covid-19,' the United Nations Economic Commission for Africa (UNECA) predicted in April.
The organisation emphasised that sub-Saharan Africa would be particularly susceptible because 56 per cent of the urban population is concentrated in overcrowded and poorly serviced slum dwellings, and only 34 per cent of the households have access to basic hand-washing facilities.
'When I heard that corona reached Kenya, I feared the worst,' recalled ICU-nurse Francisca Mumbua, who works at the Covid-19 isolation facility of Machakos Referral Hospital in central Kenya.
'On the TV, we saw people dying in large numbers in western countries like Italy. I thought that our continent would be hard hit with masses losing their lives, as most of our countries are poor and our healthcare systems are limited. We basically expected to be really overwhelmed.'
Nine months later, and Africa seems to have weathered the pandemic relatively well so far, with just one confirmed case for every thousand people and a little over 35,000 deaths – 3.5 per cent of the global total.
Even South Africa, the hardest-hit country on the continent, has seen a relatively 'low' number of deaths, with about 28 fatalities per 100,000 population, compared to 61 deaths per 100,000 in the United States, for example.
'To our surprise, most of the people who suffered from Covid-19 had a very mild or asymptomatic form of the disease,' said nurse Francisca Mumbea.
'Other moderate cases were managed successfully despite the resource challenges faced by most of the African countries.'
According to the World Health Organization (WHO), more than 80 per cent of coronavirus cases in African countries were asymptomatic versus around 40 per cent in Europe.
'There are simply not so many people in Africa dying from this virus as we see in, for example, Europe', said Professor Yap Boum, an epidemiologist and microbiologist with Epicenter Africa, the research arm of Médecins Sans Frontières (MSF).
Africa's youthful demographics are definitely an important reason for the lower death rates, according to most experts.
The median population age in Africa is 19.7 versus 38.6 years in the US and 42.6 in Europe.
In Kenya, for example, half of the population is younger than 20, and only four per cent are 60 or above.
Meanwhile, in Italy, 29 per cent of people are aged 60 or over while only 18 per cent are aged under 20.
Another difference is that coronavirus has also predominantly affected cities, which in Africa are home to younger people.
'When people retire, they often go back to the village,' explained Boum, who believed that this natural separation between generations might have helped to curb the virus in some African states.
However, demographics cannot get all the credit for the continent's successes. Africa's youthfulness should have resulted in death rates being four times lower than Europe or the United States, according to a recent study called 'Covid-19 in Africa: Dampening the storm?'.
The death rate is actually around 40 times lower than Europe and the US.
According to the Kenyan pathologist Anne Barasa, a difference in genetics between Caucasians and people of African descent could explain the discrepancy.
'We could have some differences in some of the genes that are associated with either the expression of receptors that the virus uses to enter our cells, or genes associated with an immune response against the virus thereby giving us a better protective response,' stated the scientist from the University of Nairobi.
In the United States, however, African-Americans were especially hard hit by the virus and accounted for a disproportionate number of Covid-19 deaths.
This apparent discrepancy might be explained away by recent research from the Boston University School of Medicine, which discovered that patients living in predominantly African-American and Hispanic areas were more likely to be vitamin-D deficient, which put them at a higher risk of acquiring the infection.
A growing number of experts also believe that another important factor is the types of pathogens – or viruses – that people are exposed to, which are often connected to the climate and the levels of hygiene.
'One good example is malaria that you don't find in Europe and the United States. In sub-Saharan Africa we are permanently exposed to malaria, typhoid, as well as other coronaviruses, which at some point might build our immunity,' explained epidemiologist Yap Boum.
'This might make us more equipped to respond to this new Covid-19 virus. And while people in Europe and the United States also have the flu and quite a number of viruses, many people live in more hygienic environments where they are less exposed to those pathogens.'
Such a view isn't universally popular. Professor Salim Abdool Karim – widely seen as a leading voice on the pandemic response in South Africa – pointed to other areas of the world with similarly crowded slums that have been hard hit by Covid-19. 'If this was the case, then why do we see such severe cases in India and Brazil?'
Potential underreporting of Covid-19–associated deaths has also been bandied around. However, to date, African countries have not reported acute health emergencies.
'We haven't really surveyed all deaths to determine whether or not there was possible Covid-involvement,' said the Kenyan pathologist Anne Barasa, 'although we haven't had many unexplained deaths.'
The WHO acknowledged that coronavirus deaths might be under-reported in the continent but didn't suspect a huge gap.
'Although cases are being missed,' WHO Regional Director for Africa Dr Matshidiso Moeti said at a virtual media briefing recently.
'We are not seeing evidence of excess mortality due to Covid-19 or missing deaths.'
Crucially, small antibody surveys suggest far more Africans might have already been infected with the coronavirus than official infection rates suggest, which makes the lower death rates even more striking.
Immunologists from the Wellcome Trust Research Programme at the Kenya Medical Research Institute (KEMRI) in Kilifi, for example, tested 3,174 blood donors from around the country between the end of April and the middle of June, and found that 5.6 per cent of all the donors and 9.5 per cent of those based in Nairobi had Covid-19 antibodies – proteins the body makes when the infection occurs.
'The results suggest [that] about one in 20 people aged 15-64 years have been exposed to SARS-CoV-2, which is in sharp contrast with the very small numbers of Covid-19 cases and deaths reported during the same period,' wrote the authors of the paper, which has not yet gone through peer review and was published as a pre-print in July.
If the survey's results accurately reflected Kenya's overall infection rate, then 2.5 million Kenyans would have had coronavirus in that period.
Such a high number of infections should have resulted in around 12,500 deaths using the World Health Organization's conservative estimate of a 0.5 per cent morbidity rate. And yet, by midway through the survey, Kenya had only reported 71 deaths from coronavirus - far lower than the number of deaths reported globally in countries with similar levels of antibodies. Even by the end of September the country had reported only 700 deaths from Covid-19.
Other antibody studies in Africa have shown similarly surprising findings.
Two recent surveys done by the National Health Institute in Mozambique on around 10,000 people from the north-eastern cities of Nampula and Pemba found antibodies to the virus in five per cent and 2.5 per cent of participants respectively.
Mozambique has recorded just 58 Covid-19 related deaths.
Researchers in neighbouring Malawi – where a lockdown was ruled unconstitutional, and the virus thus spread largely unchecked – found similar results.
They tested 500 asymptomatic health care workers in the southern city of Blantyre and concluded that 12.3 per cent of them had been exposed to the coronavirus.
Immunologist Kondwani Jambo, of the Malawi-Liverpool Wellcome Trust Clinical Research Programme, who conducted the study, said: 'Although health care workers are at higher risk to be infected, the outcomes do tell us that more people have been infected than estimated and the trajectory of the epidemic [in Malawi] is different from Europe, China and the Americas.'
Such a hypothesis might go some way to explaining a study among people who visited public health facilities for antenatal care and routine HIV tests in the Cape Town area. It found that 40 per cent of respondents had antibodies against Covid-19.
The researchers stressed that the results are preliminary and based on a skewed sample of 2,700 people, who aren't representative of the overall population.
Still, the South African study suggested that 'especially in poorer communities, a relatively high proportion of people has been exposed to and infected with Covid-19,' according to Mary-Ann Davies, director of the Centre for Infectious Disease Epidemiology and Research at the University of Cape Town.
Professor Yap Boum said that he also found a high prevalence of Covid-19 antibodies in people from Cameroon. 'During mobile screenings in [the capital] Yaoundé, we tested 3,000 random people and around 16 per cent already had antibodies.'
The regional representative for Epicenter Africa said that we have to be very careful with these smaller, not peer reviewed test cases, but added: 'The results definitely tell us that more people have already had the virus than we found through regular Covid-19 testing. We have missed a large group of people, probably because they were not sick.'
Meanwhile, more and more experts have argued that these antibody studies are undercounting the number of people who have had the virus.
A team led by the Biostatistics Unit at Cambridge University's School of Clinical Medicine argued, for example, that many of the antibody tests used in studies miss out mild cases where people have overcome the disease by producing low levels of antibodies.
Most of the surveys only look for two types of dominant antibodies – Immunoglobulin G (IgG) and Immunoglobulin M (IgM) – but fail to look out for another antibody, IgA, which often acts as the body's first line of defence against viruses and bacteria.
A study in Luxembourg, for example, discovered more than five times as many people had IgA antibodies than IgG antibodies.
While researchers in the Austrian ski resort of Ischgl found that a staggering 42.4 per cent of the population tested positive for antibodies when they added IgA testing to the mix.
In June, a paper by Sweden's Karolinska Institute suggested another way in which antibody tests may have been undercounting the number of people who have had the virus.
They found that many people showed an immunological response to Covid-19 in their so-called 'T-cells' – another part of the body's immune system – without necessarily showing antibodies in their blood.
'No single test can identify all individuals that have been infected by SARS-CoV-2,' the immunologist Jambo acknowledged.
'The IgG-based tests, like any other single test, underestimate the true proportion of the population that has had Covid-19, but they give you a minimum estimate useful for tracking the trajectory of the epidemic.'
Sunetra Gupta, a professor of theoretical epidemiology at Oxford University in the UK, acknowledged that some of these tests might have seriously underestimated the number of people who have been exposed to the virus.
She said: 'Therefore, IgA tests in saliva are now being trialled. However, it's very difficult and expensive to test for T-cells.'
In even more positive news, some scientists are even starting to argue that the fall in hospitalisations and deaths across the continent might be because Africa is already nearing 'herd immunity' – the idea that so many people have already caught the virus that there are not enough uninfected people for them to pass it on to, causing the virus to largely die out.
'In a few important case studies – Kenya, for example – what seems to be happening is the epidemic may be peaking earlier than our naive models predicted,' Professor Francesco Checchi, a specialist in epidemiology at the London School of Hygiene and Tropical Medicine, told The Guardian.
He said a similar pattern had emerged in Yemen, where little was done to control Covid-19 because of the ongoing conflict there.
'Yemen is one of the few countries where, to my knowledge, there is almost no prevention of Covid transmission,' Checchi told the British newspaper.
'The anecdotal reports we're getting inside Yemen are pretty consistent that the epidemic has [...] passed. There was a peak in May, June across Yemen, where hospitalisation facilities were being overwhelmed.'
He added that this is no longer the case and concluded that, 'it was possible that the population had accrued some sort of 'herd immunity', at least temporarily.'
Some experts argue that something similar is happening in parts of Africa where falling case numbers are not because the lockdowns were so successful, but rather they were so unsuccessful the virus spread like wildfire.
In many areas, like urban slums, lockdowns proved almost impossible to enforce, meaning large number of people might have already been exposed.
'I won't say that a full country already managed to reach herd immunity,' Yap Boum told NewsAfrica.
'But in some specific clusters, 60 per cent of the people might have been already exposed [to the virus].'
The epidemiologist singled out Kenya as an example, where about 56 per cent of the population lives in urban slums.
'Although the Kenyan government imposed a lockdown, over half of Kenyans didn't have the possibility to lockdown as they are living in overcrowded informal settlements.
'They are sharing one toilet with hundreds of people, they live with many family members in a single bedroom house, have to move around through narrow alleys, and often don't wear facemasks as they don't feel the burden of the disease so much.'
He added the seroprevalence – or antibody results – will definitely be 'high in these areas', and said that he believed this might be the reason that infection rates are going down in Kenya.
He continued: 'In Cameroon, where we were not having any lockdown, and only bars were closed, infection cases are going down probably because many people already got the virus.'
However, some experts believe that the drop in Covid-19 cases in countries like Kenya and Cameroon should be treated with great caution as they might be connected to a decline in people getting tests.
In Kenya, for example, the number of tests performed per 10,000 people halved between August and September.
'This decline closely mirrors trends for Nairobi and Mombasa counties but potentially may mask the national picture, as other counties are experiencing increasing case numbers,' the WHO stated recently.
A change in testing policy in South Africa could also have had an effect on the numbers of new cases, according to the WHO.
'The country's current policy of testing only those who present with symptoms makes full interpretation of case numbers difficult.'
More antibody surveys may help show the full picture. South Africa has recently initiated a national seroprevalence survey among over 30,000 people.
Meanwhile, a French-funded study is currently testing thousands for antibodies in Benin, Cameroon, Democratic Republic of the Congo, Ghana, Guinea and Senegal.
The Africa Centres for Disease Control and Prevention has also started administering coronavirus antibody tests in Cameroon, Morocco, Nigeria, Sierra Leone, Zambia and Zimbabwe.
And 13 labs in 11 African countries are participating in a global antibody survey coordinated by the WHO.
Government scientists often claim herd immunity will only be achieved when 60 per cent of a population have been infected, however many top immunologists dispute these widely reported claims.
It is more likely, a team from the Liverpool School of Tropical Medicine argued, that the true figure lies between 10 and 20 per cent.
The 60 per cent figure is based on the idea that we are all equally likely to contract the virus. In reality, according to the team's leader, Gabriela Gomes, there is a wide variation in an individual's susceptibility to becoming infected.
This view was echoed by Dr Saad Omer, director of the Yale Institute for Global Health, who told the New York Times: 'Herd immunity could vary from group to group, and subpopulation to subpopulation, and even by postal codes.'
The virus is thought to spread slowly in suburban and rural areas, where people live far apart, but rips through cities and households thick with people.
This became clear when researchers conducted a random antibody survey among households in the Indian city of Mumbai (Bombay).
They found a startling disparity between the city's poorest neighbourhoods and its more affluent enclaves. Between 51 and 58 per cent of residents in poor areas had antibodies, versus 11 to 17 per cent elsewhere in the city.
Furthermore, a neighbourhood of older people may have little contact with others but succumb to the virus quickly when they encounter it, whereas teenagers may bequeath the virus to dozens of friends and yet stay healthy themselves.
In the antibody study in Mozambique, the researchers noted a huge differentiation between people with different professions.
Ten per cent of the market vendors in Nampula had antibodies in their blood, while this was only the case with three per cent of bus and minibus drivers.
Once such real-world variations in density and demographics are accounted for, the estimates for herd immunity might fall.
Other scientists warn that you cannot talk about herd immunity unless you're 100 per cent sure that someone who has had the disease is going to be protected from contracting it again.
Recently, there were at least four separate cases of people who were re-infected with Covid-19 after they had earlier been infected, in Hong Kong, the Netherlands, Belgium and the United States.
'Until we confirm that exposure to SARS-CoV-2 measured by antibodies is protective, we can't really claim to be close to achieving herd immunity,' the Malawian immunologist Jambo cautioned.
Other experts warned that cases in Africa might start to rise again, as many countries have only just started to loosen strict protective measures.
'It's too early to tell whether we are heading towards herd immunity, at least in Kenya, as we haven't opened up completely,' said the Kenyan pathologist Anne Barasa.
Her view was echoed by Professor Salim Abdool Karim, who said: 'If we look at the data, close to 120 countries worldwide have completed their first wave of the pandemic, over half of them have also had a second wave.'
Such a pessimistic outlook, however, isn't shared across the board.
Many scientists point to countries like Sweden, which unlike the rest of Europe didn't lock down, and now isn't experiencing a large so-called 'second wave', like the rest of the continent. The virus there peaked without a lockdown, and the country has experienced few hospitalisations and deaths in recent months.
Cameroonian epidemiologist Yap Boum admitted that it's extremely hard to predict if Africa will suffer from a second wave.
He said: 'While being cautious, I do think that if tens of millions of Africans have already been infected, this raises the questions of whether the continent should try for herd immunity.'
He pointed out that it will take time before a vaccine against Covid-19 will become available – assuming one is ever developed – and said African countries would not be the first to get it.
Meanwhile, measures to control the pandemic, like lockdowns, have crippled economies and could harm public health more in the long run.
In a recent WHO survey of 41 countries in sub-Saharan Africa, 22 per cent of countries reported that only emergency inpatient care for chronic conditions was available, while 37 per cent of countries reported that outpatient care was limited due to the pandemic.
With economies in ruins, and herd immunity potentially much closer than first thought, Yap Boum thinks Africa needs to stop mimicking the West.
'We need to be careful,' concluded the epidemiologist.
'But we also might need to be courageous.'
Update - August 2021: What is causing Africa's increase in cases post vaccination? Click to read.
Lockdown is real killer in Africa
At the last count, Covid-19 had infected 35 million people worldwide, leaving more than a million dead.
Not since the Spanish flu of the early 20th century has the world witnessed such a rapid death toll from a viral disease.
In the 1918 Spanish influenza pandemic, more than 500 million people were infected worldwide, with 50 million deaths.
Global organisations and governments initially responded to the Covid-19 pandemic by calling on people to wash their hands and use social distancing to limit the spread of the viral infection.
The use of one subsequent measure of control – lockdown – has become very controversial, especially in Africa.
Total lockdown involves enforcing complete limitation of movement, and asking people to stay indoors for a minimum of two weeks – the presumed incubation period of the disease.
The aim is that the transmission chain of the disease would be broken, ultimately bringing it under control.
People have, however, questioned the wisdom behind such drastic measures, regarding it as panicky if not downright dangerous – not least because Africa and most of its 1.35 billion people are very disadvantaged.
According to a 2018 report by the United Nations, Africa was home to some 70 per cent of the world's poorest people, with about 422 million – or one in three people in Africa – living below poverty line.
That's nearly half a billion people living on less than $1.90 a day.
The effects of total lockdown will play out subtly in Africa. Many African children die before their first birthday, with 27 per cent of children not seeing out their first year in 2019.
Depressingly, the lockdowns may worsen this.
A study by one US charity predicted there would be an additional 2.3 million child deaths due to the disruption of health services during the lockdown this year.
Women have not been able to take their children to clinics for immunizations against neonatal tetanus, tuberculosis (TB), whooping cough and other antigens, all of which remain serious childhood killers in most communities in Africa.
An analysis by the World Health Organization (WHO) projected a resurgence of these childhood killers, and an extra 200,000 fatalities from TB alone because of disruptions to healthcare caused by the pandemic.
Access to anti-retroviral therapy has also been affected, according to the WHO.
There has also been a disruption in vital drug supplies because of lockdowns. It is predicted that this disruption could also lead to half a million deaths from Aids-related illnesses alone.
To make matters worse, it could also lead to drug resistance. This means that even after the lockdown has ended, Aids patients might no longer respond to the drugs used for their routine treatment, leading to complications from the disease and eventually death.
There are also serious concerns about how a disruption to the supply of mosquito nets and antimalarial drugs could be negatively impacting the fight against malaria in Africa, with several countries reporting rises in malaria deaths during the pandemic.
In Africa, it has become a tradition to use insecticide-treated bed nets against mosquito bites. Any disruption to their supply will cause deaths to rise.
According to World Malaria Report, 228 million cases of malaria occurred worldwide in 2018, leading to 405,000 deaths.
It is estimated that Africa accounted for 94 per cent of total global mortalities.
Apart from deaths, much of the poverty in Africa has been attribute to malaria, which is estimated to result in loses of about $12 billion a year from increased healthcare costs, reduced productivity and a decrease in tourism in African countries.
Malaria is also a serious contributor to infant mortality in Africa. It has been shown to cause abortions and still births, leading to some 200,000 infant deaths a year.
But it's not just other diseases that are on the rise. Maternal health has also been severely affected during the lockdown.
Even in the US, where maternal mortality is low, it is known that maternity wards in some health facilities were converted to accommodate Covid-19 patients.
There were also offers of induced labour to get women in and out of hospitals as quickly as possible to limit exposure to infection with the virus.
Maternal health, meanwhile, has taken a deadly turn for the worse in Africa, where services have been less accessible and less affordable for millions of women in dire need of help.
A study in the medical journal The Lancet estimated there may be more than 12,000 extra maternal deaths in Africa because of the pandemic.
The predictions for neonatal deaths are even more staggering. According to the Johns Hopkins Bloomberg School of Public Health, anywhere between a quarter of a million and 1.1 million children might die because of problems created during the pandemic.
If true, it would echo the Ebola epidemic in West Africa, when, between 2014 and 2016, the use of maternal and neonatal services dropped so much, the rise in maternal deaths, neonatal deaths and stillbirths outnumbered the deaths caused directly by Ebola.
Moreover, a study by UN Women revealed that women faced a higher risk of gender-based violence because of Covid-19 lockdowns.
Cases of domestic violence, particularly against women and girls, as well as rape and sexual assaults, have increased in many countries around the world, including Nigeria, where an increase in health, financial and security worries are thought to have created tensions in confined, crowded households.
There is an even more serious angle to this grotesque story: mass unemployment.
A vast number of Africans are not engaged in formal paid employment and rely on piece-meal work on farms, factories or construction sites, or in other unstable roles such as cobbling, wheelbarrow pushing or petty trading. According to World Bank reports, informal workers, most of whom are women, are responsible for more than 90 per cent of the workforce in sub-Saharan Africa.
Lockdowns have ensured that this crucial way of living is severely disrupted, resulting in hunger, malnutrition, frustration and despondency.
With so much disadvantage, many think the decision by governments to apply total lockdowns may have been misplaced.
They may be right. Nigeria, the most populous country in Africa, has recorded less than 60,000 cases of Covid-19 and just over 1,100 deaths in a country of up to 200 million people.
The hunger, starvation, malnutrition and deaths caused by the lockdown on such a large population may not be easy to track.
But it is easy to assume that many more people could have been killed by lockdown-induced poverty than the number attributed to the virus.
It may be easy to blame governments for taking hasty decisions on the lockdown issue. If truth be told, they may have been panicked into lockdowns.
The World Health Organization predicted 10 million cases within the first six months of occurrence of the disease, and cited the prospect of Africa's fragile health systems being overwhelmed by the number of expected deaths.
Without emergency aid, other United Nations experts said, there could be 1.2 billion cases worldwide within six months and 3.3 million deaths.
With these loud predictions, many advanced countries went for a total lockdown, and predictably, many African countries followed suit.
But while the advanced countries may be able to pay their citizens not to work, African countries cannot afford such luxuries, and have been left in the lurch.
It is not so easy to correct the trajectory when dealing with a disease that has successfully defeated many expert predictions.
But we are now left to wonder how much sense there was in the total lockdown.
We are also left to ask whether in blindly following the lockdown route, African governments did not end up shooting themselves – and us – in the foot.
Uganda's lethal lockdown exposed
Uganda's lethal response to Covid-19 has led to an epidemic of violence, poverty and hunger, reports Zachary Ochieng.
As the world continues to battle the coronavirus pandemic, human rights watchdogs have criticized the Ugandan security forces for using excess force in imposing Covid-19 containment measures.
In its efforts to mitigate the spread of the pandemic, the government imposed a raft of restrictive measures.
This included a ban on transport and non-food markets, which millions of poor Ugandans rely on to make ends meet. All bars were also closed.
Subsequent measures included a nighttime curfew, banning the use of all privately owned vehicles, and closing shopping malls and non-food stores for 14 days.
The government announced that the police, the army and a community-policing paramilitary group called the Local Defense Unit, coordinated by the Ugandan army, would conduct patrols to help enforce the directive.
But in the process of enforcing these restrictions, security forces used excessive force, including beatings, shootings and arbitrarily detaining people across the country.
According to Human Rights Watch, police shot two construction workers riding on a motorcycle on March 26 in Mukono, on the outskirts of Kampala.
On March 28, six police officers shot at a group of people in Bududa, in the Eastern region, ostensibly to enforce the ban on public gatherings.
Shockingly, 12 people had been killed by security forces by July, when only one death from coronavirus had been reported.
Such security excesses are not new in Uganda. Successive regimes have used the police and military power to violently oppress political opponents, quell any riots or enforce certain regulations.
On the flip side, Uganda's military was instrumental in the successful treatment of Covid-19 patients at the country's national referral hospital, having set up a 100-bed capacity mobile hospital, complete with ICU facilities.
Even so, cases of police brutality in African countries that imposed lockdowns are on the rise. Nigeria, South Africa, Uganda and Kenya have been cited as some of the countries whose security apparatus used excessive force to impose the Covid-19 containment measures.
But it's the lockdown's toll on Uganda's economy and health service that may really drive up the death count.
Uganda's finance minister, Matia Kasaija, has estimated that the country's harsh lockdown will drive some 780,000 people into poverty. While an August report by the Development Initiatives found that one in four of Uganda's urban poor had lost '100 per cent of their daily income during and after the pandemic.'
The report also noted that Uganda has registered an increase in 'preventable deaths' during childbirth, as well as increased deaths due to malaria and other diseases due to the disruption caused by lockdown.
It concluded: 'The socioeconomic consequences of [containing] Covid-19 currently outweigh the positive health impact of limiting its spread.'
Uganda's economy was projected to grow by 5.3 per cent in 2020 before the lockdown, but predicted growth has since being revised down to 3.5 per cent, by Deloitte, as disruptions to global trade and job losses at home take their economic toll.
Douglas Opio, the CEO of the Federation of Uganda Employers, said that more than 5,000 companies had already gone to the wall because of the lockdown, with 'over 400,000 workers' affected by conservative estimates.
He added: 'We are not sure how many more will lose their jobs'.
Denis Jjuuko, a communications consultant and Rotarian, from Kampala, said: 'Job losses have been many, and incomes have been halved for those still lucky to have jobs.' He added: 'There has also been a surge in teenage pregnancies and forced marriages.'
Hope for safari recovery post Covid
Almost 10 per cent of Africa's economy relies on the tourism industry, which was shuttered by Covid-19. But, as travel editor and TV tourism expert Jill Starley-Grainger reports, for the millions employed by the safari industry, there is confidence that the good times – and the tourists – will return.
In a typical year, thousands of tourists visit Africa to spot lions, zebras and elephants – and to lounge on the continent's white-sand beaches.
It's a vitally important industry that employs 25 million people directly or indirectly, including a large number in well-paying jobs, such as rangers and guides.
But Africa's safari industry has been particularly badly hit by the coronavirus pandemic, with the impact devastating businesses, communities and conservation efforts alike.
Africa as a whole has suffered a 57 per cent loss in international arrivals due to the pandemic, according to the United Nations World Tourism Organization, and safari business are particularly reliant on an international clientele, most of whom have been unable to travel to Africa since March.
This has led to a significant reduction in customers and the temporary – and potentially permanent – closure of many companies reliant on safari tourism.
A recent survey by SafariBookings.com found that safari tour operators have seen bookings decrease by three quarters or more over the last four months, compared to the same time last year.
And many have received no customers or bookings at all.
The human cost:
Travel operator Aardvark Safaris,, which works with lodges throughout Africa, has seen the devastating human impact of this sudden loss of tourists.
'We support over 1,000 camps and lodges throughout sub-Saharan Africa,' said co-owner Alice Gully.
'And they are all looking at a year with limited or no income. Not only does this affect jobs, but it affects the dependants on these employees.
In Kenya, for example, seven million people are employed in tourism - a third of the country's workforce - and they each have approximately seven dependants.'
In Botswana, Desert & Delta Safaris managed to maintain all of its staff, albeit on reduced incomes, said Andrew Flat, Desert & Delta Safaris' marketing manager.
'High-value, low-volume destinations like Botswana have faced incalculable losses. Botswana is roughly the size of France, but with a population of just over two million people, and around 40 per cent of the country consists of protected parks and reserves.'
With so few visitors to such a vast region, even a small dip in numbers can have devastating consequences for communities.
Some safari businesses have managed to fare a little better, such as Go Places Africa DMC.
It arranges safaris in Kenya, Uganda, Tanzania, Rwanda and Ethiopia, and has managed to maintain all staff.
'Management and directors took salary cuts to make sure that we were able to pay our staff without any cuts as they rely on their salaries for their livelihood, and some of them are the main bread earners in their families. We also set up internet services for our staff in their homes to ensure regular communication virtually with them as well as with our clients.'
In South Africa, meanwhile, hotels across the country have had virtually no income since March.
Royal Malewane was effectively closed for five months with zero revenue,' said Ross Bowers, marketing manager of the luxury lodge in South Africa's Greater Kruger National Park.
'The pandemic has been devastating for our industry, for our staff and for their many dependents. Government support for the industry has been extremely limited, but we fought hard to keep everyone employed.
He added: 'Since we reopened, we have had very limited local business. We need international visitors to return as soon as possible. Recovery for the safari industry will be extremely slow, but we are optimistic that safaris, nature and wildlife will be highly sought after post-Covid experiences.'
Conservation crisis:
Covid-19's economic impact is significant for conservation, too, with some reporting an increase in poaching activity.
'With no game drives, there are fewer eyes on the ground to watch out for poachers,' said Gully of Aardvark Safaris.
This is a real concern throughout the industry, added Luke Bailes, founder and executive chairman of Singita, which has 15 luxury eco-lodges in Rwanda, Tanzania, Zimbabwe and South Africa.
'If ecotourism stops funding the conservation work of non-profit conservation partners, the likelihood of illegal hunting and poaching increases,' explained the Anglo-Kenyan businessman, whose family have been involved in the Kenyan safari industry since the 1920s.
'Laid-off workers could turn to poaching to make ends meet, and if anti-poaching efforts are not maintained, traffickers have easier access to the animals and will simply stockpile until they can transport to their end markets.'
Some governments have taken heed of the impact on their wildlife and landscapes, and have put plans in place to try to increase protection in some areas.
In South Africa, the government, conservation organisations and local communities recently announced a plan to create protection areas to safeguard rhinos from poachers.
But the funds available for this are limited, and until international visitors return in significant numbers, it's likely that both the landscapes and the animals that conservation projects help will suffer.
Future bookings:
While some African countries have recently started allowing international visitors, more openings are planned in the coming months.
This has helped a little for 2020, but since much of Europe and North America – the two major markets for Africa's wildlife experiences – are still in various forms of lockdown, most safari businesses are pinning their hopes on 2021.
Roar Africa, a luxury specialist operating in 13 countries in southern and eastern Africa, has seen a massive profit hit this year, but does have some bookings for next year.
'We had over 300 trips booked for 2020, and have had to move 80 per cent of them,' said Deborah Calmeyer, Roar Africa's CEO and founder.
'With the recent reopening of Kenya and Rwanda, we have seen more enquiries for travel to these destinations, but we have a long way to go to get to pre-Covid levels of tourism.'
'We have seen a marked increase in enquiries since restrictions began to lift,' noted Toby Pheasant, founder of Bonamy Travel, which operates in 15 countries in Africa.
'There has been an increase of 320 per cent [in enquiries]. But while we would normally expect to convert between 60 and 70 per cent of these, [the number that result in sales] is significantly lower than we would expect, at around 10 per cent.'
It seems many customers are dreaming and planning, but still worried about the pandemic and travel restrictions, so less inclined to make a booking.
But some of the people who missed out on their 2020 safari trip are securing bookings early for next year.
African Bush Camps, which runs 15 luxury camps in Botswana, Zambia and Zimbabwe, has recently seen a noticeable increase in reservations, particularly for 2021, said its CEO and founder, Beks Ndlovu.
'Bookings were up 400 per cent in mid-August for 2021 in comparison to 2019 bookings.'
This increase is no doubt helped by the company's new policy of a 100 per cent refundable deposit – a clever strategy to ensure guests know they won't be out of pocket if the crisis affects their travel plans.
South African tour operator Unearth Experience has seen a similar trend in forward bookings for its safari trips, which it arranges to destinations throughout Africa.
'The majority of our clientele impacted by Covid-19 restrictions have opted to postpone their travel plans versus cancelling their trips.
This has allowed us to have a strong forward book for 2021,' said Rory James Loader, managing director.
Nobody knows how the pandemic will play out, but many safari businesses are doing their best to prepare, and there are hope that many will be able to adapt to ensure the future of the industry.
'Africa is tough, its people and wildlife are resilient,' opined Flatt of Desert & Delta Safaris.
'The silver lining is that we are still here, ready and waiting to welcome guests back to our lodges, and ready to prove that, post-pandemic, nothing beats the social distancing a Botswana safari offers.'
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