In much of Africa, this strategy is absurd, because no amount of home quarantine will flatten the curve enough to let everyone have a turn at one of three ventilators. “It’s pointless to try,” says Tom Peyre-Costa of the Norwegian Refugee Council. “Flattening the curve implies having a minimum of health-care capacity.” With few exceptions, African nations’ domestic surge capacity is nonexistent. In the past, when patients in very poor African countries needed intensive care, they effectively had two options: a hospital overseas (an option available to the rich), or the graveyard. Now that other countries (including the wealthier African countries) have closed their borders and maxed out their own hospitals’ resources, the first of these options is gone. The surge capacity for some countries was, in effect, France—which is itself flooded with COVID-19 and unable to help.
At least a few small mercies might make endemic COVID-19 more bearable. Having relatively few international connections has given Africa a window of time to prepare, Antara said, and preparations—subject to the extreme limitations—have been intense. Being in the last continent without widespread outbreaks has given African countries the opportunity to witness how bad those outbreaks can get, and to plan accordingly. Rwanda shut its borders when it still had only a handful of cases. It would not have done so if it hadn’t seen Italy and Iran suffering first. (Peyre-Costa notes that the lack of international connections has serious drawbacks, too. In some countries, the health sector is largely foreign-led and humanitarian, and as long as supply chains and human movement are disrupted, foreign health-care workers will have trouble getting in.)
When community transmission begins, it may move more slowly than it has elsewhere. Most Africans live in cities, but the traffic between those cities is less than in other parts of the world. CAR, for example, has no domestic airline or railway, or even a domestic bus network. People move around much less, almost as if they were practicing social isolation avant la lettre.
Most of all, Africa will enjoy the advantage of youth. COVID-19 kills mostly the old, and Africans are relatively young, with a median age of 18.9. (The median age in the United States and China is 38.) That means, in effect, that about half of Africans who get COVID-19 will have a low risk of death. In an aged population such as Japan’s, 2 percent of those infected might be expected to die. In Africa (following the figures here), only 0.3 percent would die, or about 3.8 million people, if everyone were to be eventually infected.
A further possibility—however remote—is that Africa will be an exception. Already the case numbers are showing some anomalies. In Rwanda, for example, the confirmed COVID-19 cases are all mild. Not one of the 110 patients has required a ventilator. Indeed, none has even been admitted to an ICU. (Here is a video of a Rwandan COVID-19 patient dancing.) The median age of COVID-19 patients there is 36, so age alone does not explain the good luck. The low numbers in Kenya and Ethiopia—both of which have major international airlines that kept flying well into the pandemic—are also puzzles. One possibility, says Jeffrey Griffiths, a physician at Tufts University who works in Africa, is that some level of endemic immunity already exists in Africa, because of similar viruses whose effects are too mild to have warranted notice. (Griffiths thinks the catastrophe is still coming, but holds out immunity as an option that any remaining optimists can cling to.) And COVID-19 may transmit less readily in warm weather, like the common flu. These would all be incredibly lucky breaks. Perhaps the “Third World,” once a net recipient of pity, will begin to export it to Europe and America.
We cannot count on catching a break. Any situation whose most likely bright side is the death of 3.8 million people is a dire situation indeed. The United States will, for the next month at least, be preoccupied with its own miseries. But we should prepare for a second and potentially worse wave of catastrophe in Africa.