African countries are lifting lockdowns even as COVID-19 cases across the continent reached a grim new milestone, topping 200,000 cases.

The pandemic took only 19 days to reach 200,000 cases in Africa, while it took 98 days to reach the first 100,000 cases.

Yet carefully easing lockdown orders in Africa may be the right move according to former United States CDC director Tom Frieden, who is currently president and chief executive officer of Resolve to Save Lives, an Vital Strategies initiative.

“There’s a real risk that lockdowns could kill many more people than the COVID-19 epidemic would, if it was spreading,” said Frieden in response to a query from Health Policy Watch. “That means that countries need to find the balance.”

Many African countries, such as South Africa, were early adopters of stay-at-home orders and physical distancing measures when COVID-19 cases were detected within their borders. Yet the heightened risk of food insecurity, and disruption of essential health services for other killers such as malaria and tuberculosis, have led many countries to begin reopening their economies.

“The need to balance between saving lives and protecting livelihoods is a key consideration in this response, particularly in Africa,” said WHO Africa Regional Director Dr Matshidiso Moeti in a press release. “Stay-at-home orders and closing of markets and businesses have taken a heavy toll, particularly on the most vulnerable and marginalized communities.”

South Africa, along with Nigeria, Sudan, Egypt and Algeria, have the highest number of coronavirus deaths in the African continent – but the figures still pale in comparison to the death toll in the United States and Europe.

How Lifting Lockdowns Could Help Africa

While lockdowns in North America and Europe have prevented many deaths from the coronavirus, Frieden says that the same moves may exacerbate conditions in Africa.

“Africa, and other parts of the world including lower income parts of Asia, have several features that make the calculation [around enacting lockdowns], very different,” said Frieden.

For example, populations in Africa are on average younger than populations in North America or Europe, so the risk of dying from COVID-19 is lower in those populations.

“The strongest risk factor for death in COVID-19 is age,” said Frieden. “In the US in some communities, 24% of our population are over 60 or 65 years of age. In Africa, it can be 3% to 5%. That means the number of people at risk for dying is dramatically lower in society.”

Additionally, said Frieden, the risk of dying from other conditions, such as HIV/AIDS, tuberculosis, or malaria, due to the disruption of essential health services, is much higher in the Africa region.

“The competing mortality… from other stuff you might die from is much more likely,” said Frieden. “Your risk of dying if you don’t get health care for malaria, for measles, for tuberculosis, in lower income countries is quite high.”

In such cases, controlled of easing lockdown restrictions, while making sure testing and treating capacities are in place to detect new cases, may be a beneficial move.

South Africa Lifts Lockdown Amid Pandemic Acceleration

South Africa, one of the countries hit hardest by the pandemic on the continent, is making difficult decisions to lift lockdown measures even as case numbers continue climbing.

“They’ve said we’re going to loosen up on some of the physical distancing interventions because people need to get health care, they need work, they need food,” said Frieden.

The country was among the first to detect COVID-19 in the Region, and also the first to enact stay-at-home orders to slow the spread of the virus.

The lockdowns were used mainly to slow the spread of the virus so that the health system could prepare for a peak in cases, penned South African President Cyril Ramaphosa in his weekly letter to the public.

The country, which reports 25% of the continent’s cases, entered Phase 3 of reopening on June 1st, allowing limited religious gatherings including funerals, school attendance, some work meetings, non-contact sports, and alcohol sales to resume.

Citizens are urged to stay home as much as possible, and wearing a mask while out in public is required.

And amidst an alarming uptick of cases in the Eastern and Western Cape, Ramaphosa reminded citizens that non-essential travel between provinces is still restricted.

Image Credits: WHO Africa Regional Office, Africa CDC, Government ZA/GCIS.