Coronavirus: How Fast Is It Spreading in Africa?

By Peter Mwai and Christopher Giles

BBC Reality Check

30 July 2020

Passengers boarding a bus in Lagos being given hand sanitiser

The World Health Organization (WHO) has warned that Africa might be headed for a much larger outbreak than current numbers are suggesting.

We've looked at the situation across the continent, and examined which countries are of most concern.

How fast is coronavirus spreading?

Michael Ryan, who leads the WHO's emergencies programme, has said: "I am very concerned right now that we are beginning to see an acceleration of [the] disease in Africa."

The global humanitarian relief body, the International Rescue Committee, says it believes the true scale of the pandemic may be hidden because of a lack of testing and issues with data.

In terms of confirmed cases, Africa currently accounts for only a small proportion of the global total, but the acceleration in rates of infection in some countries is of increasing concern.

The proportion of cases that are from Africa rose from 2.8% in early June to 5% of all cases reported globally by mid-July.

The upward trend is starting to resemble other parts of the world that have been badly hit by the coronavirus.

Where are Africa's hotspots?

The two countries with the highest numbers of cases are South Africa and Egypt. They accounted for 75% of all the new cases reported by mid-July.

South Africa has the highest recorded number of total cases and reported deaths, and accounts for more than half of all the cases in Africa.

It has the fifth highest number of confirmed cases worldwide, although reported deaths appear lower compared with other countries badly hit by coronavirus.

Could South Africa's fatality rate be misleading?

Research from the South African Medical Research Council (SAMRC) indicates the number of people who have died from the virus could be much higher than officially reported.

It says excess deaths, which is the difference between deaths reported over a particular period and the historical average, rose by 17,000 - that's a 59% increase compared with previous years.

Gauteng province, which includes Johannesburg, has seen a steady increase in cases and accounts for more than a third of the total cases. But Western Cape province (where Cape Town is located) accounts for more than half of the deaths.

Egypt has seen case numbers rising rapidly since mid-May, but there are indications that this may now have reached a peak with recorded new infections levelling off slightly in early July.

There is also concern about what is happening in Nigeria, which is third in terms of total cases recorded so far on the continent.

Circles show number of confirmed coronavirus cases per country.

Source: Johns Hopkins University, national public health agencies

Figures last updated 1 August 2020, 10:26 BST

It's worth stressing that some parts of the continent have seen relatively few cases, such as some areas of central and East Africa.

The Africa CDC (Centres for Disease Control and Prevention) says that five countries account for more than 75% of all the reported cases on the continent.

How many people are dying in Africa?

The reported death rate per capita has been low compared to other parts of the world, despite the poor health infrastructure in many African countries.

Total Cases

South Africa 8,005 13.9 493,183

24 JAN

31 JUL

Egypt 4,805 4.9 94,078

Algeria 1,210 2.9 30,394

Nigeria 879 0.4 43,151

Sudan 746 1.8 11,644

Cameroon 391 1.6 17,255

Morocco 353 1.0 24,322

Kenya 341 0.7 20,636

Ethiopia 274 0.3 17,530

DR Congo 215 0.3 9,070

Senegal 205 1.3 10,232

Ghana 182 0.6 35,501

Mauritania 157 3.6 6,310

Zambia 151 0.9 5,963

Mali 124 0.6 2,535

Malawi 114 0.6 4,078

Madagascar 106 0.4 10,868

Ivory Coast 102 0.4 16,047

Somalia 93 0.6 3,212

Equatorial Guinea 83 6.3 4,821

Liberia 75 1.6 1,186

Chad 75 0.5 936

Libya 74 1.1 3,621

Niger 69 0.3 1,134

Zimbabwe 67 0.5 3,169

Sierra Leone 67 0.9 1,823

Central African Republic 59 1.3 4,608

Djibouti 58 6.0 5,084

Congo 54 1.0 3,200

Burkina Faso 53 0.3 1,106

Angola 52 0.2 1,148

Tunisia 50 0.4 1,535

Gabon 49 2.3 7,352

Guinea 46 0.4 7,308

South Sudan 46 0.4 2,322

Eswatini 41 3.6 2,648

Mayotte 39 15.0 2,962

Benin 36 0.3 1,805

Guinea-Bissau 26 1.4 1,981

Cape Verde 23 4.2 2,451

Tanzania 21 0.0 509

Togo 19 0.2 941

Sao Tome and Principe 15 7.1 871

Lesotho 13 0.6 604

Mozambique 11 0.0 1,864

Namibia 10 0.4 2,129

Mauritius 10 0.8 344

Gambia 9 0.4 498

Comoros 7 0.8 378

Rwanda 5 0.0 2,022

Réunion 4 0.5 660

Uganda 3 0.0 1,154

Botswana 2 0.1 804

Burundi 1 0.0 387

Western Sahara 1 0.2 10

Eritrea 0 0.0 279

Seychelles 0 0.0 114

This information is regularly updated but may not reflect the latest totals for each country.

** The past data for new cases is a three day rolling average. Due to revisions in the number of cases, an average cannot be calculated for this date.

Source: Johns Hopkins University, national public health agencies and UN population data

Figures last updated: 1 August 2020, 10:26 BST

The WHO says this could be partly because of the relatively young population in Africa - more than 60% under the age of 25. Covid-19 is known to have a higher mortality rate for older age groups.

In terms of what proportion of people who get Covid-19 go on to die, there are ten countries with rates comparable with or higher than the most recent global average rate of 4%.

The top five are:

Chad (8.1%)

Sudan (6.3%)

Liberia (6.1%)

Niger (6.1%)

Sao Tome and Principe (5.6%)

But Githinji Gitahi, the head of Amref Health Africa, an NGO which specialises in health matters, says the higher fatality rates could be an indication of much higher infection levels not being captured because of low levels of testing.

The fewer tests you carry out, the fewer cases you find, and so the number of deaths appears relatively high.

Different methods of recording deaths attributed to Covid-19 may also affect the number.

How much testing is done in Africa?

Ten countries account for about 80% of the total tests conducted - South Africa, Morocco, Ghana, Egypt, Ethiopia, Uganda, Mauritius, Kenya, Nigeria and Rwanda.

There are wide variations in testing rates, with South Africa doing the most and Nigeria doing relatively few, according to Our World in Data, a UK-based project which collates Covid-19 information.

By 28 July, South Africa had done nearly 48 tests per 1,000 people, compared with 134 in the UK and 162 in the US.

Nigeria had achieved 1.3 tests per 1,000 people by 28 July, and Kenya 5.2. Ghana had done 12.3 tests per 1,000 people by 26 July.

"There is still a lot of work to do to scale up the testing and appreciate the true situation," Dr Matshidiso Moeti, the WHO's Africa director, says.

It's also worth pointing out that for some African countries, it is impossible to know what exactly is happening due to a lack of any data or data being incomplete.

In Tanzania, President John Magufuli has voiced doubts about the validity of virus testing results at the national laboratory, and has allowed only limited data on infection rates and testing to be made public.

Equatorial Guinea had a row with the WHO after accusing its country representative of inflating the number of Covid-19 cases. For a while it held back its data, but has now started sharing it again.

Note: The graphics in this page use a different source for figures for France from that used by Johns Hopkins University, which results in a slightly lower overall total. US figures do not include Puerto Rico, Guam or the US Virgin Islands.