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Global Health Security: COVID-19 in Africa

Interventions towards managing the Covid-19 outbreak

Background

On 11th March 2020,the World Health Organisation (WHO) declared the outbreak of a new type of Coronavirus, SARS-CoV-2 that causes Covid-19 respiratory disease, a global pandemic. By the morning of 23rd March 2020, 39 countries in Africa had officially reported cases with a total of 1,360 active cases, 144 deaths, and 144 full recoveries. It is recognized globally that the epicenter of the epidemic has shifted from Asia to Europe and this is accompanied by an increase in cases reported in Africa. African scientists need to be adequately prepared to inform interventions to prevent and mitigate the possible impacts of this pandemic on the continent.
In Africa, the initiatives against this disease are spearheaded by the Africa CDC, African Union, and the WHO. Several nations have announced various mitigation measures to prevent the entry of COVID-19 into their territories. The measures range from very weak to very strong based on the available evidence. Africa needs a body of knowledge to draw upon advice for governments based on best-practice in various areas of managing the pandemic. Fellows of the African Academy of Sciences (FAAS), eminent scientists in and outside Africa, have put in their input on the work done so far. However, there is an urgent opportunity for African scientists to do more to mitigate the greatest threat to humankind in our generation. By working together, individuals and institutions could leverage our synergies to result in the whole being more than just the sum of its parts. The African Academy of Sciences (AAS) supposes that the open questions for researchers and policymakers on the continent can be worked upon to build a coherent response.

What we know about COVID-19

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronavirus disease (COVID-19) is a new strain that was discovered in 2019 and has not been previously identified in humans. Coronaviruses are zoonotic, meaning they are transmitted between animals and people.
Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, the infection can cause pneumonia, severe acute respiratory syndrome, kidney failure, and even death.

What are some of the urgent questions that need to be answered by scientists on the continent on COVID-19?

There is a need for the AAS to support the research agenda for countries on the continent to have local data for policymaking. Below are some pressing questions that need to be discussed or addressed. They by no means form a concise list of questions, but provide a good starting point for discussions:
From an epidemiological point of view, what is the anticipated model for the spread of the disease? There is a need to build disease outbreak models for African countries to determine potential peaks of the disease and infuse this knowledge to the control efforts.
How long should the intensive social distancing or partial or full lockdown of countries be? There is a need to build models that can advise on the periods needed for the intensive transmission of the disease to pass. This will help countries to avoid double or triple peaks for the disease. Is there a case for a controlled infection model that provides robust herd immunity?
What is the best way of identifying potentially infectious asymptomatic subjects on the continent? Is there a case for identifying asymptomatic subjects considering the testing capabilities that countries have?
What type of virus will be circulating in Africa during the outbreak? Will the virus be genetically the same as that in other geographical areas and will we be able to catch a genetic mutation of the virus in good time? What will be the clinical significance of possible mutations?
Are there adequately qualified groups on the continent capable of delivering clinical trials on new or repurposed drugs (e.g. Remdezivir, Chloroquine, Tocilizumab) on severely ill patients? Or testing of vaccines (e.g. CEPI funded Moderna/NIH candidate COVID vaccine) on healthy volunteers?
How do we best protect our vulnerable groups from the intense periods of SARS-CoV-2 transmission? The vulnerable groups could include those with advanced age, those with concomitant non-communicable chronic diseases including those on immunosuppressive medications and those with infections like HIV & m-TB.
What groups can contribute or need to be supported towards the global effort of developing diagnostics or vaccines or pharmacotherapeutics for this disease? What capacities can we leverage to scale up the production of supplies against the outbreak?
What opportunities can be harnessed to develop a fund for supporting some of the above-mentioned efforts? How can institutions/non-profits remain connected to their constituents and raise the revenue their programs require in these days of social distancing? What can we recommend using digital engagement to maintain resource mobilization momentum for Covid-19 initiatives?
How do we propose to deliver social distancing, self-quarantine, and isolation in high-density urban areas like slums? Lower economic communities relying on income received daily to survive? How will we deliver social distancing in congested public transport in Africa? Are there viable alternatives? How do we curb the misinformation and myths about this virus? How do we improve public health messaging and social marketing to bring the whole population to take the outbreak seriously without causing panic?
From basic science ACE2 has now been defined as the receptor-binding domain for SARS-COV2, it will be interesting to understand the expression levels, and any related prevalent mutations and their possible clinical relevance (could we use existing H3Africa data for this analysis?). This is key if we are to develop genetic/African specific tools to block transmission.
Urgency is required to develop innovations that can address the needs of healthcare workers and care facilities, given the global lack of sufficient PPEs, ventilators, etc that could be developed/scaled/produced on the continent?
There is a need to have accelerated ethical review with protocols reviewed and approved on much shorter timelines while retaining the rigorous protection needed from African ERC’s. Is there a place for using delegated opinion from global ERC’s for multicentre studies in this critical period of the disease? Is there a role for the AAS to institute a credible emergency review committee that is ratified by African countries?
Ongoing scientific initiatives on Covid-19
  • Genetic sequencing of the virus in Nigeria by H3A scientist
  • Intra-African collaboration between South Africa and Nigeria
  • Development of a rapid test kit for the virus by Grand Challenges Africa GCA/AAS supported innovator based in South Africa
  • In Senegal, there is a very significant scale up to produce diagnostic rapid kits in collaboration with various funders
The AAS Covid-19 Team is led by
Dr. Moses Alobo
m.alobo@aasciences.africa

COVID-19 Webinar

We were very excited that you made time to join us for the AAS Covid-19 all hands webinar that sought to define the Research and Development priorities and opportunities for Covid-19 in Africa. Your well thought out comments, questions, and participation in the webinar were well received and made the strategy stronger. We look forward to contacting your teams in the future to take this work forward.
You can access the presentation from the session here and the webinar recording here.