Adaptive resilience to face a mutating and wavy warring style of tactical retreat and overwhelming ambush

COVID-19 has awakened Africa to the compelling need to cultivate renewed public policy resolve for adaptive resilience, complete with a focus that goes beyond “flattening the curve.”

Recently, the world has come to know disease and disaster governance as a serious matter of public policy with borderless geopolitical implications. Despite their small number of COVID-19 cases relative to the rest of the world, African countries are still on a voyage to a highly uncertain future. The closure of learning institutions in a region devoid of adequate technology infrastructure is enough to tell how the extensive impact of COVID-19 can shake the very foundation of long-term societal transformation.

Like a tough adventure involving groping in the dark, the uncertain future of COVID-19 has prompted country policy responses to take on divergent paths. From the experience of the countries that have battled with COVID-19 longer, the pandemic displays a mutating and wavy warring style of tactical retreat and overwhelming ambush. This attack mode positions adaptation through communal behaviour change as the first among equals in the array of practical containment measures. As such, flattening the COVID-19 curve is just a means to an end in this convoluted warfare.

A lucid argumentation

Already ravaged by locust invasion, floods, famine, and endemic diseases, Africa bears the brunt of the pandemic with greater underlying vulnerabilities. Co-morbidity among the underprivileged majority aggravates the cases. From this experience, there is a growing body of argumentation against the dominant focus of African governments on COVID-19. The arguments in favour of this school of thought stress that the continent is already hardened with endemic problems like malaria and AIDS, which continue to kill millions more than COVID-19.

A logical explanation

To shed more light on this matter, the following viewpoints offer key points of reference. First, we live in a hyperconnected and socially active world. Second, COVID-19 is more infectious than the well-known endemic cases and it is indiscriminate in its vicious attack, complete with a borderless impunity that spares no nation or class — the rich and the poor alike. Third, COVID-19 exposes the instinct of self-preservation among political and social elites, who for too long have disregarded the plight of the underprivileged members of our society as long as they can use the influence of power and money to erect strong barriers that keep them far removed from the floods, famine, deprivation, and diseases ravaging the poor in their obnoxious geographical spaces. The equalising effect of COVID-19 has breached such barriers to make no one safe anywhere as long as anyone is infected somewhere. Thus, the immensity of attention governments are compelled to give this pandemic finds its logical explanation.

Calibrating policy to navigate a global uncertainty

Universally, the prudent strategic choice when facing uncertainty is to reduce it into quantifiable risks by applying knowledge- and evidence-based models. Decisions arising from thoughts are basic examples of modelling, being derivatives of mental models. Models which are based on sound data, knowledge, and valid reasoning make for effective tools of behaviour change. Such tools are required to contain COVID-19. 

Understanding the proxemics that accompany social behaviour across various geographical, environmental, cultural, and socioeconomic settings is key to calibrating a country’s COVID-19 containment policy. Spatial data from ground surveys as well as airborne and spaceborne technologies should offer rich resources for mapping out strategies and monitoring location-based outcomes in Africa (e.g. satellite data has been used to analyse changing community mobility trends due to COVID-19: link to the full article). Continuous research, however, must guide the calibration of policy responses in an evolving engagement cycle in which local communities are empowered as key stakeholders and active change agents.

Contrasts in Africa can be seen in the strict and swift action Uganda took, a departure from the relaxed tempo in the neighbouring Tanzania. While it is too early to judge who is getting it right or wrong, the growing volume of data from all over the world is already forming a strong body of evidence and argument in favour of exercising extra caution through social distancing and effective testing for COVID-19 prevalence.

A glimpse of global COVID-19 rates and African equivalents

As at May 9, 2020, the cumulative global total had hit 4 million cases, as earlier projected in this study series based on the simulation equation:  . Assuming the global trends maintain, the projections as per this equation give a figure of 4.6 million cases by mid-May and 6 million cases by the end of May. By May 12, the global case fatality rate was 7% with a recovery rate of 36%, figures that differ from the general experience in Africa.

Africa’s COVID-19 cases had started rising sharply with mass testing. South Africa has been leading in Africa followed by Egypt and Morocco, all with cases near or above ten thousand cases by May 12. Sudan had over 1,500 cases, much higher than Kenya’s 715 cases as at May 12. Lesotho had registered no case yet by May 12, 2020.

Case fatality rates for African countries just before May 12 were mostly lower than in European countries and North America. Russia was an exception at 0.9% fatality by then. Case fatality rates were still zero in Madagascar, Rwanda and Uganda, 0.4% in Ghana, 3% in Nigeria, 5% in Kenya, as opposed to 4% in Germany, 6% in the USA and China, 7% in Canada, 10% in Spain, 14% in Italy, 14% in the UK, and 15% in France.

By May 12, Africa’s high recovery rates of about 50% and above have been registered in Madagascar, Rwanda, and Uganda. South Africa, Ethiopia, and Senegal have registered about 40% and Kenya about 35%. Nigeria and Ghana have registered lower recovery rates in Africa of between 10% and 20%. These figures in Africa have mostly been lower than the rates in China (94%), Germany (83%), Spain (65%), Italy (46%), and France (32%). The USA (17%) and Russia (14%) were still registering lower recovery rates by this date.

Key lesson 1: Over the period January 10 — May 9, COVID-19 recovery rates have been increasing significantly as observed in the countries which have implemented containment measures longer such as China (94%), Germany (83%), Spain (65%), and Italy (46%). Case fatality rates tend to be lower in the beginning but can increase, though the figures have been confined to stay within the bracket of 1% — 15% before levelling off over time to about 6%.

Effectiveness of testing and gains in combating COVID-19

The best practice is to calibrate containment policy and strategy using the intelligence acquired from testing for COVID-19 prevalence. By May 9, the normalised testing rates which factor in country-specific populations and length of time were as high as 413.3 tests per million per day in Spain, 400.4 in Italy, 344.7 in Russia, 316.3 in Germany, 240.3 in the UK, 236.4 in the USA, and 198.3 in France. As expected, the recent increase in the testing index of the UK and Russia has yielded a surge in their total COVID-19 positive cases, lately surpassing France and Germany by a wide margin. Canada’s index was 269.5%, higher than India’s 11.7.

Kenya’s normalised testing rate had improved from 7.2 tests per million people per day before May, to a performance index of 8.1 by May 3, and 9.6 as at May 8, 2020. Kenya’s index, however, had by May 9 responded to the record-high number of tests and improved slightly to 10.1 tests per million people per day (compare Ghana’s 83.2, South Africa’s 79.8, Rwanda’s 55.4, Uganda’s 22.6, Senegal’s 16.7, Ethiopia’s 5.0, and Nigeria’s 1.6 by May 9). Improved testing rates are attributed to mass testing, which together with contact tracing and scenario models constitutes the key source of intelligence essential to averting the complacency of ignorance about the hidden danger of the highly infectious pandemic within the community clusters. Three quarters of the cases confirmed in Kenya have been asymptomatic and this has been the general experience in the region. 

In a clear demonstration of policy divergence in containment approaches and update schedules, Tanzania had not updated her full COVID-19 status by May 12, 2020. Rwanda and Uganda were leading Eastern Africa on the normalised measure of effectiveness in testing their populations while registering no case fatality so far, accompanied by their high recovery rates.

Key lesson 2: Countries that have not been testing for COVID-19 effectively have to muster the courage and preparedness to face the reality that increased testing rates will unearth more COVID-19 cases within their communities. This inconvenient truth is the pill they must take to avert any silent but eventually dangerous complacency of ignorance.
 
Uganda, Madagascar, and Ghana: Telling COVID-19 recovery rates

Uganda, Madagascar, and Ghana registered zero to less than 1% case fatality rates by May 12, 2020. As shown in the plot below, Rwanda, Uganda, and South Africa had enhanced normalised testing rates and had registered medium to high recovery rates by May 9, 2020. Madagascar’s lower testing score by May 9 of 3 tests/million/day fades in comparison to Ghana’s higher testing rate of 83 tests/million/day. Since by May 9 these two countries were worlds apart in recovery rates, 53% against 8%, it can be said that Ghana’s very low recovery rate by then was more representative of the actual recovery rate in her population than Madagascar’s.

All the representative countries in Europe and North America have recorded high normalised COVID-19 testing scores. These high scores give a more representative picture of the actual recovery rates among their populations and lend credence to the high recovery rates reported in China, Germany, and Spain. The observed variance in recovery rates shows that regions will continue to witness country-specific COVID-19 experiences as determined by the quality of their healthcare systems as well as different political, sociodemographic, and environmental factors. 

Key lesson 3: Consistent and targeted testing of a sizeable proportion of a country’s population makes statistical sense and reinforces the reliability of the reported statistics of recovery and case fatality rates. Unlike Ghana and South Africa, Madagascar, Ethiopia, Senegal, Kenya, Nigeria, and similar African countries which have reached a normalised index of at least 50 tests/million/day still have a long way to go in testing a sizeable proportion of their populations to establish their most representative COVID-19 recovery rates.

Conclusion

With the low testing rates and low COVID-19 numbers across Africa, the continent is still on a voyage of uncertainty. More testing is still required to establish the local prevalence of COVID-19 and arrive at better representations of country-specific fatality and recovery rates. Adaptive management is crucial as learning the true nature of the pandemic is still on course. The wavy attack trajectory of COVID-19 means that the warfare is not a sprint with a definite finishing line in sight, but a relay marathon that summons collective leadership and intergenerational responsibility. Countries must pursue informed policy responses calibrated by the idiosyncrasies inherent in their healthcare systems, sociocultural factors, and geographical settings including proximity to borders and countries which are already COVID-19 hotspots. Without taking extra caution, the first countries to reach high-performance scores may eventually be the last in combating the pandemic, and vice-versa.

Research supported by sound modelling of scenarios is critical to informing the government’s role in reducing the COVID-19 uncertainty into quantifiable risk areas. The outcomes should be used to guide a phased easing of restrictions to open up and revive various sectors, education being key among the worst-hit sectors. A renewed resolve of public policy in Africa should, therefore, seek out ways of developing adaptive capacity for resilience in disease and disaster governance, a long-term strategy that goes beyond flattening the COVID-19 curve.

By Nashon Adero, 

The author is a geospatial expert, policy analyst and university lecturer at Taita Taveta University - Kenya, who has written extensively on applying data-driven models and spatial intelligence to inform combat strategies against COVID-19, globally and in Africa. 

Email: nashon.adero@gmail.com