The coronavirus pandemic has begun spreading into some of Africa’s most impoverished communities, leaving the continent facing a huge test: whether it can contain the virus in overcrowded settlements where water and sanitation are scarce.
Slowing the expansion of the virus is crucial because many African countries have severe shortages of ventilators and intensive-care beds. But government responses have been erratic, ranging from ambitious new mobile testing programs to more extreme measures, including curfews and crackdowns by security forces that have led to deadly abuses.
South Africa, which has more confirmed COVID-19 cases than any other African country, announced this week that the virus had spread into several of its poorest communities: the townships of Khayelitsha and Mitchells Plain, on the edge of Cape Town, along with Soweto and Alexandra townships in Johannesburg.
At least eight cases have been confirmed in those informal settlements, where distancing is difficult because many people live in crowded shacks, often lacking a piped water supply, often with eight or 10 people in a house, unable to isolate themselves because their income depends on daily work.
"This is an area that we've been really concerned about,” Health Minister Zweli Mkhize told a media briefing on Tuesday night. “We need to make sure we act quite swiftly to reduce the internal spread.”
He announced a plan to send 10,000 field workers to towns and villages across the country, screening people for symptoms and using mobile testing labs to accelerate testing.
The project was launched on Tuesday in the streets of Alexandra, one of the poorest communities in Johannesburg. One of its residents has already tested positive, but he fled from a quarantine order until he was later caught in a neighbouring province. On Tuesday, more than 100 of his neighbours were tested – including some who had used the same shared toilet and water tap.
“We’ll go to hotspots, we’ll go to every patient who is positive and target the areas where they were identified and look for people with symptoms and triage them,” Dr. Mkhize said.
South Africa has 1,353 confirmed cases of the coronavirus, almost a quarter of the 5,500 cases in Africa, and it has reported five deaths.
One of South Africa’s leading HIV researchers and vaccine scientists, Gita Ramjee, was among those who have died from COVID-19. Her death was disclosed on Tuesday night.
South Africa could be particularly vulnerable to the pandemic. It has the world’s largest number of people living with HIV – about 7.7 million people, of whom nearly three million are not on antiretroviral treatment and could have weakened immune systems.
About 54 per cent of South African households do not have piped water in their homes, making it harder for them to follow the advice on washing hands to prevent infection.
Community groups have been creating videos and social-media messages to help the millions of South Africans in informal settlements. The videos show them, for example, how to wrap their hand in toilet paper to turn on water faucets and to open the doors of shared toilets, to ensure that they do not become infected by the coronavirus.
Coronavirus cases are spreading rapidly in many of Africa’s poorest countries. As of Tuesday, there were 261 confirmed cases in Burkina Faso, 193 cases in Cameroon and 175 cases in Senegal.
Six cases have been confirmed in the Central African Republic – an impoverished and war-torn country where the health system is so fragile that it has only three ventilators. “Three ventilators in a country of five million people is setting the country up for catastrophe,” said David Manan of the Norwegian Refugee Council in a statement on Tuesday.
Stellah Kwasi, a researcher at the Africa-based Institute for Security Studies, warned that the issue of overcrowded cities and informal settlements could be a “ticking time bomb” for many countries.
“Ways must be found to incentivize poor and vulnerable communities to stay at home to avoid further spread of the disease,” Ms. Kwasi wrote this week.
But instead of providing financial support to help poor people stay home, some African governments have opted instead for a heavy-handed security crackdown.
In Uganda this week, two construction workers were shot and injured by police when they were heading to work on a motorcycle, allegedly violating a travel-ban order.
In Kenya, 13-year-old Yassin Hussein Moyo was standing on the balcony of his home on Monday night when he was shot and killed by police who were raiding his neighbourhood to enforce a nightly coronavirus curfew.
In South Africa, three people have reportedly been killed by police who were enforcing a national lockdown. One was a man who was shot with rubber bullets in his own home, allegedly after the police had raided a tavern where people were drinking.