The fast-spreading Omicron variant, already declared a variant of concern, has introduced new unknowns and containment challenges in the fight against COVID-19, dashing hopes for declaring early victory against the pandemic even as vaccination rates increase across the world. Already in December 2021, the unprecedented surge in COVID-19 cases due to the dominance of the Omicron variant was evident across the world. No part of the world has been spared the fast-spreading variant, first detected in South Africa. This is a graphic case of encountering a new battlefront, surprises and headwinds just at the door of victory. To a world that was hopeful of ending the year with an assurance of victory against the pandemic due to the encouraging tailwinds pushing vaccination rates closer to herd immunity, this new development reinforces the fact that the pandemic is a wily, wavy warrior we must be ready to confront with long-term measures, behaviour change for compliance with containment measures being critical.

As of 4^th January 2022, the total COVID-19 cases globally had topped 294.5 million. The total cases in Africa were nearing 10 million with more than 3.4 million cases in South Africa and a total of 302,134 cases in Kenya. The case fatality rate in Kenya of 1.8% and recovery rate of 86% were lower compared to Africa’s average of 2.3% and 89%, respectively.

What lessons does the new surge in COVID-19 infections due to the more infectious Omicron present to Africa, a region with the world’s lowest COVID-19 vaccination rate?

Key Highlights

• As of 4^th January 2022, just half (51%) of the global population had been fully vaccinated, the lowest percentage in Africa with just 13.6 percent of the population receiving at least one dose of a vaccine (Covid World Vaccination Tracker — The New York Times (nytimes.com).
• The lower vaccination rates in Africa as of 4^th January 2022 could partly explain the higher case fatality rate (2.3%) in Africa, more than the global average (1.9%). Lately, less than 2% case fatality rate has been recorded in Oceania (0.6%), Asia (1.5%), and Europe (1.7%). South America has, however, been recoding a higher case fatality rate, of 3%.
• On balance, a strong and strict combination of self-discipline, policy enforcement, and compliance monitoring is justified to contain the current surge of cases in Africa and elsewhere.
• Increased voluntary uptake of COVID-19 vaccines is justified from the regional and country outcomes in this review, which show lower case fatality rates in the regions with high vaccination rates despite having older demographics and more predisposing geographical factors than Africa.
• Though the Omicron variant may be associated with fewer severe cases than the Delta variant, the pending unknowns about mutations and other variants, and vulnerable populations in regions with poor health systems justify extra care and caution against the spread of COVID-19 to avoid a tsunami of caseloads.

Insights into the Trend of Severe COVID-19 Cases

The likelihood of developing severe cases of COVID-19 is a crucial metric. The severe cases are either serious or critical, requiring ICU attention. This metric is calculated here as a simple mathematical probability, in terms of the severe cases as a percentage of the total cases reported. The metric has been noted to be varying across regions, from 0.02% in Africa to 0.04% in North America. As of 4^th January 2022, the likelihood of developing severe COVID-19 cases still remained lower in Africa (0.022%) than in North America (0.037%), South America (0.032%), Asia (0.032%), Oceania (0.030%), and Europe (0.025%).

Given the wide variance in the vaccination and testing rates across these regions, geographical and demographic factors must be a key part of the explanation for these differences. A large share of the countries in the northern latitudes, beyond 30⁰ N, are currently experiencing very cold winters. The global North also has populations with a higher median age, over 40 in Europe for example.

A look at a country example in the tropics, Kenya in particular, can expose additional crucial insights. Kenya’s score on this probability metric was 0.017% as of 4^th January 2022, more than double the observed rate of 0.006% as of 23^rd December 2021. This observed increase in the likelihood of developing severe cases in Kenya along with the surge in the COVID-19 wave, attributed mainly to the more infectious Omicron variant, is a pointer to the need for extra care and caution in containing the pandemic even across the regions that have been recording lower percentages of severe cases.

Lessons from the Evident COVID-19 Surge

All regions have realised a surge in new COVID-19 cases since the Omicron variant was detected.

Global scenario

Globally, in 2021, the total reported COVID-19 cases rose from more than 243 million on October 21 to more than 278 million on December 23, 2021. The trend in early January 2022 is soon leading to 300 million total cases globally. The fast rise in cases has accompanied the entry of the Omicron variant.

Snapshot from Africa

In Africa, the surge has pushed the total cases reported from more than 8.5 million cases on October 21 to more than 9.4 million cases on 23^rd December 2021. South Africa recorded a surge with more than 21,000 new cases on 23^rd December 2021 to lead Africa with 3,374,262 total cases. The case fatality rate in South Africa on this date was 2.7% with 92% recovery rate. The testing rate in South Africa had increased to 528 tests per million people per day, up from 421 on May 8, 2021.

With a case fatality rate of 2% and a recovery rate of 91%, Kenya recorded an all-time high of 3749 new cases on December 25 with an equally all-time high positivity rate of more than 32%. The testing rate had increased to 82 tests per million people per day, up from 74 on May 8, 2021. The surge in cases in Kenya after the entry of the Omicron variant was evident from December 7, with positivity rates increasing fast from 1.1% to more than 2% within two days, then sustained at double digits from 14^th December 2021 onwards with a peak of 37.6% on 27^th December 2021. As of 4^th January 2022, the positivity rates  were still sustained in double digits, 22.6% on the very date.

Unusually high new cases have also been reported in other African countries, some examples of surging new cases reported on 23^rd December 2021 in: Zambia (3380), Mozambique (2445), and Uganda (710). Uganda’s testing rate had increased from 54 tests per million people per day on May 8 to 68 on December 23, 2021.

Snapshot from the Americas

On 23^rd December 2021, the USA recorded more than 91,000 new cases to top 52.6 million total cases. USA’s normalised testing rate had increased from 2899 tests per million people per day on May 8 to 3396 on December 23, 2021. Brazil had recorded more than 22 million cases, coming third, after India, in the global ranking of total cases. Argentina came twelfth with more than 5.4 million total cases.

Snapshot from Europe

On 23^rd December 2021, the UK reported more than 119,000 new cases to top 11.7 million total cases with a normalised testing rate of 8318 tests per million people per day up from 5157 on May 8, 2021. France also recorded more than 91,000 new cases on this date to top 8.7 million total cases, with an increase in the testing rate from 2551 tests per million people per day on May 8 to 3995 on December 23, 2021. In Germany, the new cases were more than 34,000 to reach a reported total of more than 6.9 million cases. In Germany too, there was an increase in testing rates, from 1146 tests per million people per day on May 8 to 1526 on December 23, 2021.

Snapshot from Asia

India had by 23^rd December 2021 topped 34.7 million cases to retain the second place after the USA, increasing the testing rate from 465 tests per million people per day on May 8 to 690 on December 23, 2021. China was far down at position 114, two positions behind Rwanda, with more than 100,000 total cases.

Lesson 1

The lower probability in Africa (0.02%) of developing severe (serious or critical) cases out of the total reported COVID-19 cases contrasts sharply with the higher probabilities of 0.03% or more in the other regions. Geographical and demographic factors are likely the most important factors in explaining this key difference, given the wide variance in vaccination and testing rates across the regions.

As of 23^rd December 2021, the recovery rates in Asia (97%), South America (95%), and Africa (90%) were higher than the rates in Europe (87%), Oceania (85%), and North America (79%). The younger demographic in the first three continents must be a key explanatory part of the recovery equation. By the same date, however, the case fatality rates still remained higher in South America (3.0%) and Africa (2.4%), than in North America (2.0%), Europe (1.8%), Asia (1.5%), and Oceania (1.0%). This outcome calls for heightened care and caution in Africa and South America despite the youthful demographic advantage.

Lesson 2

The higher case fatality rates in South America (3.0%) and Africa (2.4%) than in the other regions show that they post a higher likelihood of death from the reported COVID-19 cases despite having a lower share of severe cases. The much lower vaccination rate in Africa could explain the higher chances of death from the few severe cases. This finding firmly supports the call for enhanced vaccination rates and health management systems in Africa.

New Model Scenarios for Kenya

Carrying on the tradition of converging on Kenya, this modelling series has simulated the likely scenarios of the cases in Kenya from 7^th December 2021 to January 7, 2022. The Kenyan model used here, which has been developed and applied to predict cases since April 2020, has established that the COVID-19 wave has a period of about four months. The last model predicted that November was the month to watch, which is four months after the fourth wave of July. The December wave has not come too far from November. The graphs below show the likely case growth scenarios in in Kenya.

From the simulated scenarios, the following key points emerge:

1. The optimistic scenario yields a total of only 275,429 cases in Kenya on 7^th January 2022 with a flattening on 8^th February 2022. This is only possible if the daily mean of new cases reduces to 52, a far cry from the thousands Kenya is recording currently.
2. The business-as-usual (BAU) scenario projects a total of 360,152 cases on 10^th January 2022. With increased testing, this scenario is possible with the fast-spreading Omicron variant and the observed pandemic fatigue with a lowering of guard across Kenya.
3. The pessimistic scenario projects a total of 450,508 cases on 10^th January 2022. Total avoidance of containment measures can still lead to this worst-case scenario, noting that a daily mean of more than 9,500 new cases has been realised in other parts of Africa and the world.

Summary and Containment Implications

The observed surge in new cases across the world, Africa not spared, is a testament to the rapid spread of the Omicron variant of Coronavirus. Over time, the observed higher case fatality rate in Africa, despite the lower likelihood of developing severe cases in the region, confirms the need to enhance vaccination rates on the continent as well as case management with improved healthcare systems. This will help reduce the share of vulnerable people with comorbidities and the unvaccinated cases who can succumb to the virus.

The model of likely scenarios in Kenya, especially due to the festive season with increased community movements, portends the likelihood of topping far above 300,000 total cases in Kenya by 10^th January 2022. The country may experience the fifth wave with more cases than ever before unless containment measures are strictly complied with.

Following are the key recommendations on COVID-19 containment.

1. On balance, a strong and strict combination of self-discipline, policy enforcement, and compliance monitoring is justified to contain the current surge of COVID-19 cases in Kenya, Africa, and beyond.
2. Increased voluntary uptake of COVID-19 vaccines is justified from the regional and country outcomes in this review, which show lower case fatality rates in the regions with high vaccination rates despite having older demographics and more predisposing geographical factors than Africa.
3. Though the Omicron variant may be associated with fewer severe cases than the Delta variant, the pending unknowns about the variant, unpredictable random mutations, and the presence of vulnerable populations in regions with poor health systems justify extra care and caution against the spread of COVID-19 to avoid a tsunami of caseloads in Africa.

By Nashon J. Adero

A geospatial and systems modelling expert, lecturer, youth mentor and trained policy analyst, who applies system dynamics to model complex adaptive systems.