LAGOS, Nigeria – After President Donald Trump touted an anti-malaria drug called chloroquine as a possible treatment for coronavirus, thousands of Nigerians started taking the medicine, some of them overdosing in a rush to "prevent" infection.
In Mali, there is an estimated one ventilator per 1 million people – about 20 in all, according to the Africa Centers for Disease Control and Infection, which serves 31 of Africa's 54 nations. The devices are critical in helping to prevent the respiratory failure that has contributed to a worldwide coronavirus death toll of more than 23,000.
Kenya, a country of more than 50 million people, has 550 intensive-care-unit beds. Many sub-Saharan nations have few medical workers; some have no isolation wards.
As of March 27, the world's second-largest and second-most populous continent after Asia had just over 2,600 cases in 46 countries of COVID-19, the disease caused by the new coronavirus, according to the African Union, a pan-African organization that supports political and economic integration among its 55 member states that have highly varied populations, geographies, cultures, social mores and economies.
Yet infections are rapidly rising.
And even as the most modern and well-funded hospitals around the world are bracing for an onslaught of cases that will require hard-to-get life-saving equipment, public health officials worry that Africa's relatively weak health systems, already disproportionately affected by Ebola, HIV, tuberculosis and other infectious diseases, could be overwhelmed. This could further compound problems in a part of the world that has long grappled with conflict, humanitarian disaster and infrastructure inadequacies.
Africa's plight has grabbed little attention amid mounting global medical emergency scenarios stretching from Asia to Latin America despite data released March 25 by the African Union suggesting the continent's infection trajectory over the first 50 days is similar to Europe's. There, the coronavirus has deeply taken hold in Italy and Spain and there are more than 12,000 deaths – four times as many as in China, where the outbreak began in December. The U.S. death toll stands at more than 1,300.
"We need global solidarity now," said Matshidiso Rebecca Moeti, a Botswanan national who is the World Health Organization's regional director for Africa, in a Thursday online briefing about the unfolding coronavirus situation in Africa. Moeti said that unlike industrialized countries across the world, most African nations have virtually no means to manufacture the medical equipment governments are now rushing to procure.
"We need this help. It's urgent," said Moeti.
India's decision this week to lock down its 1.3 billion people means that about a quarter or more of the world's population is now living with some form of enforced restrictions on movement and social contact, according to various COVID-19 trackers, such as Oxford University's "COVID-19 government response gauge" and a manual count by USA TODAY of nations with lockdowns. Like elsewhere, many African nations have closed borders, shuttered schools and houses of worship, and told people to stay inside. They have also tried to adopt the outbreak prevention and management strategies that have proved successful in Asia: testing, tracing and quarantining those who are infected.
But as African countries prepare to battle the coronavirus on a much larger scale, they have far fewer weapons at their disposal than wealthy nations that have mobilized tens of thousands of health workers, dramatically ramped up testing, deepened essential health equipment inventories, deployed well-trained armies to keep order, sought the advice and resources of sophisticated technology sectors, and unveiled trillions of dollars in financial aid and economic rescue plans for businesses and employees.
Olaniyi Ayobami, a doctor at the main hospital in Nigeria's southwestern city of Ibadan, said that his city "lacks the capacity to even carry out diagnostic tests for the virus," let alone care for those who fall ill from a disease that can leave those infected with only mild symptoms or require invasive medical interventions.
"We have only one functional ventilator, which is not even in very good condition," said Collins Anyachi, a physician at a teaching hospital in Calabar, a Nigerian city in Cross River state that borders Cameroon. Anyachi added that fewer than 10 out of the approximately 600 doctors that serve the area's two million people have access to personal protection equipment, such as face masks and surgical gowns, that can make all the difference in terms of whether medical staff contract the virus.
In South Africa, which has more coronavirus infections than anywhere else on the continent – more than 900 as of March 26 – the government has prohibited all but essential workers from going outside, even for exercise or to walk a dog. Also forbidden: speaking in-person to a neighbor. But crowded townships, where services are basic at the best of times, make it harder for people to observe social distancing measures.
Mary Nxolo, 28, from Khayelitsha, a vast high-density, low-income outlying eastern suburb approximately 20 miles from central Cape Town, said that she was "terrified" about what the government's restrictions would mean for her family.
"I have an elderly mother, who is on a pension, and three kids. I am the only one earning anything. I don’t even know if I qualify as being an 'essential worker,' because I do domestic work ... I’m scared I’ll be arrested if I try to go to work," she said.
South Africa is one of the most medically advanced countries in Africa. Public health officials and hospital administrators say it is likely the best positioned of all African nations to meet the demands of coronavirus. It has about 7,000 intensive-care beds and around 3,000 ventilators, according to Kerrin Begg, a public health specialist who is advising South Africa's government on the crisis. South Africa has 60 million people.
Nandi Siegfried, an epidemiologist who helps advise South Africa's COVID-19 government task force team, said that social distancing in South Africa will be "effectively impossible" for many people crowded together in urban developments.
Still, President Cyril Ramaphosa has imposed one of the world's strictest lockdowns, with alcohol sales banned and citizens told to stay sober for 21 days.
In Zimbabwe, there have only been three confirmed coronavirus cases, but already one death, that of a locally well-known TV personality who was infected in New York City. The World Bank estimates that more than a third of Zimbabweans live in extreme poverty; in the hardest-hit rural areas, half of all children face daily food shortages.
The Democratic Republic of Congo, a nation the size of Western Europe, has significant mineral wealth, but is riven by political turmoil and open conflict on its eastern borders.
It also has one of Africa’s weakest health systems after battling another global health emergency, a long-running Ebola outbreak. That outbreak seems all but over, but now Congo faces both a major measles outbreak and increasing coronavirus infections.
More than 2,000 miles to the north, the first coronavirus case in Libya, most of whose terrain lies in the Sahara desert, was reported on March 25. But the country has been engulfed in violent chaos for nearly a decade, since the ouster of its longtime ruler Muammar Gaddafi. Libya's health system, gutted by years of escalating hostilities, may be one of the least well prepared on the planet to deal with the coronavirus pandemic.
Tom Garofalo, the Libya country director for the International Rescue Committee, a humanitarian organization, said that almost 20% of Libyan hospitals and primary health facilities are closed and that only 6% offer a full range of health services.
"The country is ill-prepared for an outbreak of the magnitude of COVID-19," he said.
In fact, the situation for many African countries mirrors circumstances for underdeveloped countries from Venezuela to Pakistan, were millions of vulnerable people live in massive slums with poor sanitation and no or rudimentary plumbing.
But while these factors and others could complicate Africa's ability to respond to the pandemic, countries across the region may also have relative advantages including that the average age in Africa, according to the United Nations, is 20 years old.
While the coronavirus can infect anyone, children rarely get sick and most young adults appear to mostly suffer milder symptoms compared to the elderly or those with underlying health issues such as cancer, diabetes and hypertension.
The median age in Italy, where more people have died from the virus than anywhere else – more than 8,000 – is 47, compared to 37 in China and 38 in the United States.
A few early scientific studies appear to indicate that warmer weather and higher humidity levels may help slow the disease, although the findings are far from conclusive and Australia, which is experiencing late summer in the Southern Hemisphere, has seen a sharp rise in infections. Africa's climate also varies from cool to cold winters.
Africa's experience fighting infectious disease may also prove "painfully useful," said Moeti, the World Health Organization's Africa director. "We think that some of the Ebola lessons learned in the Congo, about talking to people at the community level" about what they should be doing to limit transmission will be relevant, she said.
But the continent may struggle to cope with a huge coronavirus outbreak for other reasons connected to misinformation, cultural superstition and unfounded theories.
"I almost got my two-year-old son killed," said Sarah Lukman, a 21-year-old woman who lives in a refugee camp in Maiduguri, in northeastern Nigeria, a region blighted by years of insurgency by the Boko Haram jihadist terrorist organization.
Lukman had given her son chloroquine, the anti-malaria drug, after she heard President Trump say it had proved to be effective in fighting the coronavirus. A few minutes after taking the medicine, her son fell unconscious before a medic was able to revive him.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has said there has only been anecdotal evidence the drug was helpful for combatting the virus. It is currently being studied and tested in clinical trials.
Last week, in Egypt, a country that links northeast Africa to the Middle East, authorities forced a journalist from Britain's Guardian newspaper to leave the country after she reported on a research paper that questioned the country's low tally of cases.
The West African nation of Senegal declared a state of emergency on Monday and imposed a curfew in response to the coronavirus pandemic. The health ministry has been raising awareness of the virus by teaming up with well-known musicians. The Y’en a Marre rap group has recorded videos about washing hands and avoiding crowds.
But Cmda Ba, 32, who works for a recycling company in Dakar, Senegal's capital, was not convinced that he needed to do anything to protect himself against the virus.
"I think the body systems of black people are stronger than other races," he said.
Hjelmgaard reported from London, Erasmus from Cape Town, South Africa