Study Evaluates African Countries at Risk of COVID-19 Importations

Jonna Lorenz

Jonna Lorenz is a freelance journalist with more than 20 years of experience. Her background is in business and health care news, including reporting, editing and research for newspapers and websites.

Close commercial ties between China and Africa have health officials keeping a close eye on possible importations of COVID-19.

COVID-19 preparations are underway in many countries in Africa, where the risk is being monitored in light of the close commercial ties with China, where the virus originated.

An international team of investigators recently published a modeling study in The Lancet examining the preparedness and vulnerability of African countries against COVID-19 importations.

“I believe that the biggest takeaway from the research is that the African countries with the highest risk of importing COVID-19 are also the ones more prepared to deal with cases,” Chiara Poletto, researcher at Pierre Louis Institute of Epidemiology and Public Health, INSERM, Paris, told Contagion®. “However, some countries are at medium risk of importation and present low level of preparedness and high vulnerability. Resources should be prioritized toward these countries. Onward transmission potentially occurring in countries with weaker health systems is a major public health concern.”

The first case of the disease in Africa was reported in Egypt on February 14th. Measures to control the disease include heightened surveillance and rapid identification of suspected cases, followed by patient transfer and isolation, rapid diagnosis, tracing, and follow-up of potential contacts, noted the study, which evaluated each countries risk based on air travel between locations in China where the virus is circulating, vulnerability and capacity to respond.

“We found that countries are highly heterogeneous in terms of risk of introduction,” Poletto told Contagion®. “The risk of introduction we measured is due to international flights with China. We looked at the provinces in China that were source of the importation risk for each African country and we identified groups of countries differing in the main source of importation—being Beijing, Guangdong or Fujian.”

The study measured each country’s capacity to handle the virus based on State Party Self-Assessment Annual Reporting (SPAR) index, which includes 24 indicators of capacity to deal with the virus. Vulnerability was measured based on the Infectious Disease Vulnerability Index (IDVI). Each indicator ranged from 0 to 100, measuring increasing capacity and decreasing vulnerability.

“Evaluation of the preparedness of African countries requires crossing different indicators, such laboratory capacity, coordination, communication,” Poletto told Contagion®. “Also, socio-economic factors are important. This is why we examined different kind of indicators and chose the two that provided complementary information.”

The highest importation risk was identified in Egypt, Algeria and South Africa, which had SPAR scores of 87, 76, and 62 respectively and IDVI scores of 53, 49, and 69, followed by Nigeria and Ethiopia, which had moderate SPAR scores of 51 and 67, respectively, but high vulnerability, with IDVI scores of 27 and 38.

Algeria, Ethiopia, South Africa and Nigeria were among 13 priority countries identified by the World Health Organization based on travel to China. The study may help prioritize preparedness efforts in Africa.

“A similar analysis can be done for other continents,” Poletto told Contagion®. “However this should take into account the rapidly evolving situation of the epidemic. At the moment, the epidemic is slowing down in China, while an increasingly number of cases are found in countries such as Japan, South Korea, and Italy. These territories are becoming in their turn source of exportation. For instance, the first case of COVID reported in Algeria is a traveler from Italy.”

Cases of COVID-19 in the United States rose to 89 at the start of the week, with 2 deaths reported in Washington.

For the most recent cases in the novel coronavirus outbreak, visit the Contagion® Outbreak Monitor.