It has a foothold on a continent of 1.2bn people, more than half of whom don’t have access to proper healthcare.
Adriaan Kruger / 12 March 2020 11:01
A Congolese health worker administers a vaccine to a child at the Himbi Health Centre in Goma, Democratic Republic of Congo. Image: Olivia Acland, Reuters
The efficient market hypothesis states that financial markets are efficient and that asset prices will quickly reflect all relevant information, even after periods of mispricing or “irrational exuberance” as a former US Federal Reserve chair termed it.
If one believes in efficient markets, two factors should have been a serious-enough warning of the dangers of the coronavirus: the dramatic fall in share prices, which initially reduced the value of operating businesses by $5 trillion, and the sharp increase in the gold price.
Those who shun financial data should at least have taken note when the World Health Organisation (WHO) declared the outbreak to be a “public health emergency of international concern” towards the end of January, while figures about infections and deaths started rising rapidly.
Now dubbed Covid-19, the response to the outbreak provides another clue of how serious it is.
Japan closed its schools and universities two weeks early for their annual holidays, despite the Japanese passion for education. China effectively closed Wuhan where the virus was first detected and closed a lot of its factories – a huge step for the world’s manufacturing giant. It also closed schools.
The past few weeks have shown how fast the virus is spreading around the world, with 282 cases as at January 20 rising to more than 110 000 confirmed cases by March 8.
However, it is still unknown exactly how dangerous Covid-19 is and how it will affect people and the frail SA economy.
Basically, any virus is a grim numbers game and, in this case, the early numbers were bad enough to grab the world’s attention. Then it got worse.
While experts will input a string of numbers into their computer models to try to predict the spread and severity of a virus, two numbers are of utmost importance. First is the infection rate, measured by the so-called R0 or R-zero, which ranks how infectious a disease is. Secondly, the fatality rate shows how deadly a virus is.
A WHO article explains that a R0 greater than one suggests that the number of people infected is likely to grow, whereas a R0 of less than one suggests that the viral transmission “is likely to die out”.
One example of a very infectious virus is measles. A single person can infect around 12 people, expressed as a R0 of 12. Fortunately, measles has been all but eradicated thanks to a global programme of vaccination over decades.
Initially, the infection rate of the current outbreak of the coronavirus was estimated at between 2 and 3, but this is described as a moving target because a lot of factors determine the infection rate, such as general living conditions, the overall health of a population, nutrition and access to clean water and healthcare.
The WHO says the R0 value is situation-dependent. “It’s affected by the host population, for instance, how susceptible people are due to nutritional status or other illnesses that may compromise one’s immune system.
“It’s affected by the environment, including things like demographics, socio-economic and climatic factors,” it warns.
Medical News Today describes the R0 value as a “theoretical parameter regarding the speed at which a disease is capable of spreading in a specific population”. It quotes figures from a previous flu outbreak, H1N1, which had an R0 of 2.3 in the US and 1.3 in Canada.
An academic paper by researchers from Cornell University, Brian Williams and Eleanor Gouws, has found huge discrepancies between the infection rates of HIV between different African countries, with some lower than the mean of 4.6, but five countries reporting an R0 of more than 6.3.
The fairly long incubation period of Covid-19 of up to two weeks (or longer, with WHO research having shown incubation as long as 27 days) makes it difficult to prevent the virus from spreading.
A quick scan with a thermometer at an airport terminal will miss the virus during its incubation period.
In addition, ‘normal’ cold and flu symptoms such as a runny nose and cough will barely register in most households as a serious disease during the coming winter months.
The fatality rate is also difficult to calculate during the early days of an outbreak due to a lack of data. Initial estimates put the fatality rate at around 2%, but the figure crept up to 3% as more data became available.
By the beginning of this week, the number of infections and the fatality rate continued to increase as the virus spread among differentiated populations. Worldometer reported 110 312 cases by Monday of which 66 226 had an outcome in that the patient either recovered or died.
The reported deaths of 3 831 people equals a fatality rate of 6% – double the rate initially calculated. However, the scientists caution that a precise estimate of the fatality rate is impossible at present due to a lack of data.
Once again, specifics relating to the population determine the fatality rate – with a huge difference between a wealthy and healthy European nation and countries such as Niger or Zimbabwe, which essentially have little in the way of health services.
An article in medical research journal The Lancet specifically questioned the danger of Covid-19 in African countries.
John Nkengasong, director at the Africa Centres for Disease Control and Prevention and WHO special envoy on the coronavirus, and epidemiology analyst Wessam Mankoula tried to answer the question in their peer-reviewed article.
“What might happen to Africa – where most countries have weak healthcare systems, including inadequate surveillance and laboratory capacity, scarcity of public health human resources and limited financial means – if a pandemic occurs?
“With neither treatment nor vaccines, and without pre-existing immunity, the effect might be devastating,” say the authors.
They base their view on well-known facts regarding the health challenges Africa already has to face:
- Rapid population growth;
- Increased movement of people;
- Existing endemic diseases such as HIV, tuberculosis and malaria;
- Re-emerging and emerging infectious pathogens such as the Ebola virus, Lassa haemorrhagic fever and others; and
- Increasing incidence of non-communicable diseases.
They neglected to add poverty, malnutrition, low literacy rates and high population density in large towns and cities.
Nkengasong and Mankoula list Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana and Kenya as countries with variable capacity to deal with the virus and high vulnerability (due to big populations).
Another sign of the seriousness?
The authors seem concerned about the spread of the virus, noting in a footnote to the article that “China’s response to the novel coronavirus stands in stark contrast to the 2002 Sars outbreak response”, indicating their belief that the virus is more dangerous than previous pandemics.
Elke Mühlberger, associate professor in microbiology at Boston University, has published several research articles on viral diseases such as the deadly Ebola virus that is still one of the biggest killers in Africa.
She wrote on Live Science that a pandemic like the 1918 Spanish flu outbreak that affected up to 40% of the world’s population could happen again, if a novel influenza strain emerges, especially one that could be transmitted easily between humans.
Luckily, medical science has developed over the last 100 years since 1918 and even more so since 1347 when the Black Plague killed half of Europe’s population when hospitals hardly existed and people were largely illiterate and oblivious of hygiene and basic health matters.