The picture it paints is bleak. It shows that there have been excess deaths following Covid-19 critical care admission in Africa compared with the global average. And that the mortality of critically ill Covid-19 patients in Africa exceeded that of any other region in the world.

The bad news doesn’t end there. For every two Covid-19 patients referred for critical care treatment, only one was admitted to a high or intensive care unit. These patients in Africa have an excess mortality of between 11 and 23 extra deaths per 100 critical care admissions in Africa when compared to the global average. The mortality in Africa is 48.2%.

We suspect that these grim data probably provide an optimistic estimate of critical care outcomes on the continent. It is likely that the participating sites were relatively more resourced than other non-participating critical care units in Africa. Unfortunately, these data confirmed our fears when we set out on this project. Saving lives of critically ill Covid-19 patients in Africa is difficult for various reasons.

The grim reality

Our results show that even simple monitoring of patients was not universally available. One in ten hospitals could not provide pulse oximetry to measure arterial blood saturation to all critical care patients. Arterial desaturation is an important sign of a failure to adequately manage a severe respiratory disease such as Covid-19.

Pulse oximetry would be considered a basic requirement in critical care, and inadequate monitoring results in a delay to respond to deterioration. A delay in response is associated with mortality.

Secondly, there was insufficient equipment to provide advanced care at the participating sites. As a result, the ability to provide interventions (such as dialysis and proning (placing patients on their tummies)) was estimated to be delivered between seven and 14 times fewer than what would be expected for these patients based on the severity of their illness.

A commentary on our study also suggested caution when counting available equipment in Africa. It is well documented across Africa that a substantial amount of equipment doesn’t work. This is often because it has been donated and is not appropriate for the environment. There are also often no service contracts to maintain it.

The reality about scarce resources is that once a patient in the critical care unit is being given a particular therapy, such as dialysis, it is then unavailable to the other patients while in use.

These factors certainly would result in excess mortality.

Besides known risk factors for mortality in severe Covid-19 infection, our study also showed that HIV/AIDS was associated with an increased risk for mortality.

Finally, our findings confirmed that steroids are associated with survival benefit in our patients, consistent with the (RECOVERY) (Randomized Evaluation of Covid-19 Therapy) trial. Steroid therapy decreases the inflammatory response contributing to the severity of the illness. That’s why it’s essential that it’s readily available for critically ill Covid-19 patients.

Urgent next steps

This study has two important implications for policymakers.

Firstly, there is the immediate response. It is critical that vaccination is made a priority. Vaccination is an important intervention when it is impossible to provide safe and adequate critical care across the continent.

Vaccine inequality cannot be accepted, and it is important to accept that ‘we are not safe, until we are all safe’. It would be devastating to see a scenario similar to India play out in Africa due to insufficient vaccination.

Read more: TRIPS waiver: US support is a major step but no guarantee of COVID-19 vaccine equity

The second response for policymakers is a more long term strategy. Certainly, the data from the study suggest that regulations are needed for minimum resource requirements for critical care provision in Africa. The study shows that there is a need for a substantial increase in resources needed to provide an acceptable quality of critical care in Africa.

Lastly, we are very aware that the situation is more dire than the study shows. This is for two reasons.

The first is that only 10 countries out of 40 that were initially invited took part in the survey. It’s likely that the countries that did’t take part didn’t have the capacity to participate because of the demand on their clinical service delivery during the pandemic. And it’s likely that these sites may have worse outcomes than reported in the study.

Secondly, the participating hospitals were predominated by university and tertiary hospitals. These are better resourced than critical care units in hospitals of a lower level. They are, therefore, in a better position to provide more comprehensive care, with possibly better outcomes than non-participating sites.

In conclusion, outcomes for critically ill Covid-19 patients in Africa are poorer than any other region in the world. This is driven by resource-poor facilities. As long as the population of Africa remains unvaccinated, this has the potential for a catastrophic loss of life in Africa.

Source - The African Mirror 

NAIROBI (Reuters) - When Edith Serem received her COVID-19 vaccination last month at a hospital in Nairobi where she works as a doctor, nurses jokingly warned she might start speaking in a foreign language.

Serem said some colleagues got the AstraZeneca shot after watching her closely for several days to see if she was okay, but others refused, still wary of possible side effects.

Health experts worry that public scepticism about taking the relatively small number of doses African countries have battled to procure could prolong a pandemic that has already killed more than 3.3 million people worldwide.

“I’m not an anti-vaxxer ... I have my children vaccinated up to date with everything out there, but this one? I’m not comfortable,” said a doctor in Kenya, who declined to be named as she was not authorised to speak to the media.

“If there is no data on long-term effects then we are all being guinea pigs. What happens in 10 years after this vaccine?”

So-called vaccine hesitancy is a global phenomenon. France and the United States are struggling with it and scepticism is on the rise in some Asian countries such as Japan.

In Africa, health experts say a combination of warnings about possible rare blood clots, the rubbishing of vaccines by some leaders and mixed messages over expiry dates have all contributed to the slow rollout across the continent.

COVID-19 has also not hit Africa’s 1.3 billion people to the extent it has ravaged some countries in Europe, Brazil, the United States and India, leaving some on the continent doubting the seriousness of the disease.

The official death toll in Africa now stands at 121,000, lower than the United Kingdom alone.

Last week, the head of the Africa Centres for Disease Control and Prevention (Africa CDC), John Nkengasong, again implored citizens to stay vigilant, calling India’s COVID-19 disaster a wake-up call.

ANGRY AND SUSPICIOUS

While Ghana and Rwanda have all but finished administering the doses they received last month, the rollout in some countries is so slow it could take years to use the limited shots they have, let alone inoculate their adult populations.

Kenya, for example, began vaccinating 400,000 frontline health staff and other essential workers in early March after receiving more than a million AstraZeneca doses from the global vaccine sharing scheme COVAX.

By April 25, Kenya had only vaccinated 152,700 health workers, health ministry data shows.

Chibanzi Mwachonda, head of Kenya’s main doctors union, said the government had now offered the doses more widely because of the slow uptake of the vaccines, which the United Nations says will expire on June 28.

Health workers were already angry and suspicious because the government had failed to provide enough protective equipment, Mwachonda said. Now, many felt the government had not adequately addressed concerns about possible side effects, he said.

Kenya’s health ministry did not respond to a request for comment.

Africa’s most populous nation, Nigeria, received its first consignment of 3.92 million AstraZeneca shots on March 2. By April 23, just over 1.15 million doses had been administered.

At that pace, it could take until mid-August to use the doses and nearly a decade to vaccinate the adult population. The shots will expire on July 9, a government official said.

Chika Offor, founder of the Vaccine Network for Disease Control advocacy group in Abuja, said the decision by some European governments to restrict or stop using AstraZeneca shots had compounded Nigerian fears.

In Ivory Coast, vaccination centres have been quieter than expected, raising fears that doses will be left unused when they expire in June, two health workers at the National Institute of Public Hygiene told Reuters.

The West African country vaccinated 105,110 people between March 1 and April 21 after receiving an initial shipment of 504,000 doses. At that rate, it would take more than two years to use the 1.7 million doses it has ordered from COVAX so far.

The health workers said some centres in Abobo, a suburb of the main city Abidjan, were only getting 20 people a day coming in for shots. In Treichville, a densely populated area of the city, Reuters saw health workers sitting idle with no patients.

Joseph Benie, director of the hygiene institute, said they had issued public statements about the vaccine’s safety.

PUBLIC CONFUSION

The Democratic Republic of Congo, meanwhile, received 1.7 million AstraZeneca doses from COVAX in early March.

It delayed its rollout after several European countries suspended the vaccine to investigate rare blood clots but 10 days after its drive inoculation drive got underway, only 1,300 people in a country of 85 million had received a shot.

The government is now returning 1.3 million doses to COVAX before they expire.

Africa CDC’s Nkengasong said the slow uptake in Congo did not surprise him as an Africa CDC survey found only 60% of Congolese wanted the vaccine compared with 90% of Ethiopians.

The World Health Organization (WHO) and Africa CDC have repeatedly advised that the benefits of the AstraZeneca vaccine outweigh the risks.

Yet some African leaders have denounced the shots, including Tanzania’s recently-deceased president, Nigerian state governors and the head of a South African nurses union.

Mixed messaging about vaccine expiry dates has added to the confusion.

The WHO and Africa CDC urged African countries not to waste donated vaccines after Malawi said it would destroy more than 16,000 AstraZeneca doses stamped with an April 13 expiry date.

Nkengasong said an analysis by the Serum Institute of India, which made the doses, showed they could be used until July 13 - but WHO’s Africa director, Matshidiso Moeti, said they should be stored until more information was available.

“Haphazard vaccine rollout is dangerous,” said Irungu Houghton, executive director of Amnesty International Kenya. “Public confusion at this time really feeds into vaccine scepticism.”

Source - Reuters 

DRAW the dose up into a syringe, expose the upper arm, administer the jab: it takes a few seconds to give someone a COVID-19 vaccination.

But securing a dose in the first place, and getting in front of a nurse with a needle and a freezer full of vaccines, varies widely depending on where you live and what you do for a living.

In Britain, a global frontrunner in the vaccination race, registering online for the jab has been no more complicated than booking a dentist appointment, while in India, where COVID-19 cases are surging, some people have roamed city hospitals for days in search of a spare dose.

With millions of people around the world being immunised, what impact could differing experiences have on global efforts to reach herd immunity?

The Thomson Reuters Foundation asked five people on three continents how and why they got a coronavirus vaccine and what they learned from the experience.

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Margaret Oruko, 62, midwife, Nairobi, Kenya

‘We hear reports of people paying bribes at vaccination centres in order to jump the queues’

I’m a midwife and live in an informal settlement called Kawangware in Nairobi. Because of my age, the nature of my work and the fact that I live in an overcrowded area where it is difficult to social distance, I’ve been very anxious to get the vaccine.

I work part-time in a private maternity hospital and also have patients from the community visiting my house daily for check-ups. It makes me very scared being exposed to so many people, yet not having any protection.

The government started giving the vaccine to people in March – and being over 58 and a health worker, I thought I would be notified by authorities to come for the vaccine.

But there’s been a lot of confusion about who it’s for and where to get it.

Neighbours told me about some hospitals but said there were long queues where people are waiting the whole day, so I’d been putting off going as I might catch the virus while waiting.

We have also heard of reports of people in some places paying bribes at vaccination centres in order to jump the queues – it made me think that I won’t be treated fairly if I go there.

Some people in the community are scared of the links between vaccines and rare blood clots, but as a health worker I believe in science and think the AstraZeneca vaccine, which is being offered in Kenya, is safe.

After weeks of wondering what to do, I approached the chief in my area and he sent my name to the authorities and directed me to Kenyatta Hospital.

I arrived there are 8 o’clock in the morning and there was already a small queue of about 15 people forming. Surprisingly, I didn’t have to wait too long. After about 30 minutes, I was called into the room and given the jab.

I do feel relieved to have got the first shot – I just hope that the second shot will be available in time.

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Stella Franceskides, 63, filmmaker, London, UK

‘I’ve very aware that minority communities are bearing the brunt of the pandemic.’

The main reason I got vaccinated was so I could visit my mother who lives in Cyprus. It’s her 99th birthday this month.

With two doses I’ll be able to travel and see her without COVID-19 tests or having to quarantine.

I’ve recently spent 400 pounds ($555) getting tests to visit her. I’ve no idea who could afford to do that on a regular basis. Only very wealthy people, I guess.

I was reluctant to get the vaccine at first (I don’t believe any of the conspiracy theories, I’ve just never bothered with them in the past).

While I was looking into getting inoculated, the news emerged about the risks of blood clots associated with the AstraZeneca vaccine.

I know the risks are tiny but for me it was still concerning: the idea you could have a vaccine and die from the side-effects.

My doctor said: “You should have it, there are more pros than cons.”

When I arrived at the Tessa Jowell Center, a newly opened health facility in South London, there were masses of volunteers running the operation.

An elderly man directed me towards the nurses. He was so polite, it felt like he was hosting an event that he was proud of. He patiently repeated the same instructions to each person who came in.

One nurse asked me questions while the other put the needle in my arm. The whole thing was very efficient. I was in and out in less than 20 minutes.

If I’d had the choice, I would have got the Pfizer vaccine but it wasn’t available.

My next jab is at the end of May.

I’m very aware that minority communities are bearing the brunt of the pandemic and I’m frustrated with the British government. They spent billions on a COVID-19 track and trace system that went nowhere.

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Sachin Ratnaparkhi, 55, researcher, Mumbai, India

‘I covered 35km (21 miles), five vaccination centres over three hours for the vaccine’

I had been planning to get the vaccine since April 1 when the government opened it up for those aged over 45 years.

Last week restrictions were imposed again in Mumbai and I was back to working from home and decided to take time out to get the shot.

When I logged onto the government’s contact-tracing app to book an appointment for my vaccination, it didn’t throw up any available centres.

So my wife and I set out on my motorcycle to a nearby hospital where they were giving out vaccines on a first-come first-serve basis.

We went in the afternoon, hoping to avoid the morning rush, only to find a “vaccines out of stock” notice displayed at the hospital.

Health officials directed us to a mass vaccination centre about 8km (five miles) away.

We drove there only to find the vaccine was out of stock but we were determined to get inoculated.

There is so much vaccine hesitancy here and people are being misled by posts on social media about its side-effects.

I know the vaccine may not give me full immunity, but the chances of fatality are much lower after vaccination.

I was determined to get the shot for my own safety and I wanted to start building resistance to the virus.

We decided to try another mass vaccination centre about 15km (nine miles) away. When we reached it, there was a crowd outside arguing with security guards. No vaccines there, either.

On our way back home, I stopped at two private hospitals to check if we could get inoculated, but had no luck.

In the scorching Mumbai heat, my wife and I covered 35 km (21 miles) and five vaccination centres over three hours.

I returned to the municipal hospital on Monday and this time fortunately both me and my wife got the shot. It wasn’t crowded and it took about an hour-and-a-half to register and get vaccinated, followed by 30 minutes of staying under observation.

I am not angry or upset with the system.

Our country is so vast that, however good a system is, it may fall short.

While it is easy to criticise, I do not have any complaints.

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Amos Mawoyo, 64, retired teacher, Mutare, Zimbabwe

‘There have been issues of some rogue health authorities in the country making money through selling vaccination cards’

When the Chinese Sinovac vaccines were rolled out to the masses a few weeks ago, I was sceptical about the side-effects of the jab as we had little information in both urban and rural areas.

My fears were that I would fall ill after being vaccinated.

But my brother convinced me to get inoculated, saying the risk of not vaccinating far outweighed the known risks of doing so.

My brother, his wife and I woke up early in the morning around 6.30 a.m. to trek to a clinic in Dangamvura, one of the high-density suburbs in Mutare, which is Zimbabwe’s third-largest city.

Upon arrival, I was surprised to see a short queue.

There were only about 10 adults, almost all my age. The vaccination took a bit of time mainly due to logistical problems. They told us they had run out of vaccination cards.

There have been issues of some rogue health authorities in the country making money through selling these vaccination cards so the cards are now a security issue and are not kept in huge numbers at clinics.

After getting inoculated with my first dose of the Sinovac vaccine I was asked to wait to rest for 30 minutes before returning home.

The uptake at the clinic was surprisingly low and this could be attributed to poor education on the significance of vaccines as well as the side-effects.

I admit that at first I was caught up in all the misinformation surrounding Sinovac, like rumours that we are being used by other countries and drug companies as guinea pigs, but in early May I will go back to get my second dose.

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Jocelyn Guinto, 52, nursing attendant, Manila, Philippines

‘I am worried every time I go to work’

I’m a nursing attendant. I haven’t been vaccinated. I had some hesitation but I really want to be vaccinated now.

I work inside the clinical area, I assist nurses in their jobs such as bathing the patients, changing diapers or taking the patients to the procedure areas like for their CT scans.

There are times that I will be called into the COVID-19 wards. We have three wards of COVID-19 patients, with about 100 beds.

Last year I was infected with COVID-19. I was hospitalised for 14 days.

When the first batch of the vaccines arrived here in the Philippines (in late February), it was the Sinovac vaccines. The priority was for healthcare workers but I did not register.

It is not that Sinovac is not effective, but I read that it has low efficacy rates. As healthcare workers, we need high efficacy rate vaccines.

After several weeks here comes the AstraZeneca vaccines. I registered for it but unfortunately the night before my vaccination I saw on the TV news other European countries have suspended it because of blood clots so I backed out.

So until now, I haven’t been vaccinated.

But now, if there are any vaccines available again, I will grab the opportunity regardless of the brand. There has been a surge of COVID-19 cases in the Philippines. Even if the efficacy rate is low, it’s better than nothing at all.

For now, all I can do is worry. I have to do my job. Even though there are risks, it is my job to attend to COVID-19 patients. All I can do is to pray and worry for myself and for my family.

The lack of vaccines here in the Philippines affects me. Not all Filipinos can get vaccinated now because of the limited supply. It affects us, as healthcare workers. I’m worried every time I go to work.

We should be given the priority and the government should give us vaccines with high efficacy rates, just like the vaccines being used in other countries.

I hope these world leaders can listen to us in the poorer countries that we want more vaccines. This is a global pandemic, every country should be helping each other.

Reporters: Beh Lih Yi, Nita Bhalla, Roli Srivastava, Farai Shawn Matiashe, Kim Harrisberg
Text editing: Tom Finn, Kim Harrisberg and Helen Popper
Producer: Amber Milne

• Thomson Reuters Foundation

Sub-Saharan Africa is expected to rebound this year as the continent's economic drivers pick up momentum after activity was halted by the coronavirus pandemic, despite a slower pace of vaccinations compared with the rich world, a Reuters poll found.

Medians in a Reuters poll taken in the past week showed sub-Saharan Africa was expected to recover in 2021, growing 3.3% after contracting nearly 2% last year.

The International Monetary Fund forecast growth for the region at 3.4% this year from an estimated contraction of 1.9%.

Rafiq Raji, associate with the Africa programme at the Centre for Strategic and International Studies, expects a recovery as economies ease restrictions and activity in crucial sectors such agriculture, manufacturing, and tourism picks up.

However, "slow vaccine rollouts and rising COVID-19 cases are expected to weigh on the recovery", said Raji.

The World Health Organization's Africa office said on April 8 that Africa had given fewer than 2% of vaccinations administered globally.

Growth was expected this year from all the major economies with Angola at 1.6%, Ghana at 4.9%, Kenya at 5.1%, 2.0% for Nigeria, South Africa at 3.7% and 2.0% for Zambia.

South Africa, the continent's most industrialised economy, together with Angola and Nigeria contribute around 50% to sub-Saharan Africa's economic engine. Much healthier commodity prices are likely to buoy growth there, economists said.

Still, economists warned some growth rates were calculated from a very low base and might not be sustainable in the following two years, particularly in South Africa where growth is expected to slow to 2.1% and maintain that pace.

Thanks to a diversified continent, growth for the sub-Saharan Africa region (SSA) is likely to stick to 3.3% percent next year and grow 4.1% the following year.

"SSA inflation expectations are expected to remain high in 2021, owing to increased spending, higher commodity prices and country-specific factors. Still, the average SSA inflation rate is expected to moderate to about 10% in 2021, from about 11% in 2020," said Raji.

Inflation in South Africa is likely to moderate, seen just below the midpoint of the central bank's 3%-6% comfort level this year - and the following two years - despite risks skewed more to the upside over the coming year.

"Most of the upside risks to the inflation outlook in South Africa stem from exogenous forces - in particular fuel prices," said Jeffrey Schultz, economist at BNP Paribas.

The South African rand has been resilient in past months, helping to keep interest rates stable.

Economists expected security challenges in Nigeria -- Africa's biggest economy -- to likely continue to make food expensive, owing to slowed agricultural activity and logistical issues.

Hard currency shortages and monetary financing also pose significant risks to the Nigerian inflation outlook.

(For other stories from the Reuters global economic poll )

 

 

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