Experts are reluctant to name the increase in COVID-19 cases in African countries a second wave, following lockdown relaxations in South Africa, Kenya, Ethiopia, Angola and Uganda.

It is argued that the disease has so far mostly been an urban outbreak in Africa, and what is now being observed is an increasing spread in rural areas.

“What we are seeing is a likely continuation of the pandemic with cases rising as restrictions are eased,” said Ifedayo Adetifa, a clinical epidemiologist at the KEMRI-Wellcome Trust Research Programme in Kenya.

South Africa, the country with the highest incidence on the continent, has experienced significant increases in new infections throughout October – as have Kenya, Ethiopia, Angola, Algeria and Uganda. These countries each eased lockdown restrictions around one month ago.

In  South Africa, 725 new cases were recorded on 21 September. A month later, the number had jumped to 2,156 new daily cases, according to the global online Corona Tracker.

Meanwhile, Kenya recorded a low of 53 new infections on 28 September but recorded 1,494 new cases on 4 November.

Kenya’s increases could also be because the country has changed its testing strategy, Adetifa also said.

“Testing is now happening more within the population as opposed to testing being carried out among the sick. When this happens you are likely to capture more infected people, including the asymptomatic ones,” said Adetifa, who is also an associate professor at the London School of Hygiene and Tropical Medicine.

WHO puts the total Kenyan COVID-19 cases at 58,587 but, in October, the test positivity rate averaged at 16%. This is in comparison to 4% before restrictions were eased in September, according to President Uhuru Kenyatta.

Some 730,548 cases had been confirmed in South Africa by 5 November, as well as 19,585 deaths, according to WHO.

The new infections had followed a “different trajectory” when compared to the current trend in Europe, said Dr Ngoy Nsenga, WHO-Africa’s COVID-19 incident manager.

“The virus remains the same and unchanged. There have been no mutations so far and the biology surrounding it has not changed,” he asserted.

But people had started to relax their behaviour and urgent interventions were needed at country and at sub-country levels where incidents were beginning to grow, Nsenga advised.

Kenya Reports Decrease in Bed Capacity

Kenya has already tightened some of the restrictions it had relaxed in September, with President Kenyatta reducing operating hours for bars and eateries, and adding an extra hour to the current curfew. People failing to wear a mask in public also face a fine of up to US$200.

“Our COVID-19 bed occupancy has also gone down by 60% and we had flattened the curve to below the 5% positivity rate recommended by WHO,” said President Kenyatta in an address to the country on 4 November.

“This is what gave us the courage to re-open and ease our COVID measures. But 38 days later, we have experienced a reversal,” he added. “If COVID bed occupancy had gone down by 60%, giving us comfort to re-open in September, the same has now gone up by 140% during the 38 days of easing COVID measures.

“COVID-19 positivity rate has also shot up from 4% in September when we re-opened, to an average of 16% in October. This is four times what the rate was in September. If one person was positive in September, four became positive in October. That is the literal interpretation of these statistics,” he added.

Kenyans seem to have backtracked from their “good’ COVID practices since the September re-opening, he added.

The month of October was the worst for Kenya, with more than 15,000 new infections, according to WHO. Nearly 300 deaths were also recorded according to the National Multi-Agency Command Centre on COVID-19.

‘Heavy Blow’ to African Health Services

Meanwhile, WHO-Africa director Dr Matshidiso Moeti said that the pandemic had dealt a “heavy blow” to key health services across the continent, including immunisations, maternal health care, and malaria treatment.

A preliminary analysis of five essential health service indicators – including outpatient consultation, inpatient admission, skilled birth attendance, treatment of confirmed malaria cases and the provision vaccines in 14 countries – had revealed a sharp decline in uptake of the services between January and September, she disclosed.

The gaps were the widest between May and July when many countries had put in place movement restrictions and other measures to check the spread of the virus.

“During these three months, services in the five monitored areas dropped on average by more than 50% in the 14 countries compared with the same period in 2019,” Dr Moeti said in a statement.

“Now that countries are easing their restrictions, it’s critical that they implement catch-up vaccination campaigns quickly,” said Dr Moeti. “The longer, large numbers of children remain unprotected against measles and other childhood diseases, the more likely we could see deadly outbreaks flaring up and claiming more lives than COVID-19.”

Image Credits: Twitter: @WHOKenya, WHO African Region.