* Sub-Saharan Africa has confirmed more than 150 cases
* Officials are worried about transmission in poor
neighbourhoods
* Governments are drawing on experience fighting Ebola
By Josiane Kouagheu, Juliette Jabkhiro and Aaron Ross
YAOUNDE/DAKAR, March 17 (Reuters) - When a passenger
arriving from Brussels at Cameroon's Yaounde Nsimalen airport on
Saturday was found to have a temperature, health officials say
he was whisked to a hospital and diagnosed inside four hours as
the country's fourth case of coronavirus.
The central African country was doing more generalised
screening for disease long before China revealed the new virus
that has killed around 7,000 people globally. Along with other
countries on the continent, it hopes its experience guarding
against Ebola and other epidemics will help its health system
cope with a pandemic that could quickly overwhelm it.
"We have cases that were not caught by the measures in
France and Italy that were caught here," Georges Alain Etoundi
Mballa, who runs the health ministry's epidemic response, told
Reuters, describing the screening as a "spying network".
"Epidemics come and go, but we keep on the surveillance."
The virus now ravaging Europe has appeared in at least 26
out of 49 countries in sub-Saharan Africa. In most of them the
recorded cases are still in single figures and have come in from
abroad - notably Europe - rather than emerging at home.
The stakes are high - if the disease gets into Africa's
poorest areas, squalid, cramped conditions could cause it to
spread at lightning speed.
Hospitals are already overburdened with cases of measles,
malaria and other deadly infectious diseases, and conflicts have
displaced hundreds of thousands of people and destroyed
infrastructure.
Asking patients to self-quarantine at home is not practical
in many areas, where families cram into a single room, share a
communal tap or latrine, and survive on daily earnings.
"Africa should brace itself for a serious challenge," John
Nkengasong, head of the Africa Centres for Disease Control and
Prevention (CDC), said on March 11. "I still believe containment
is possible, but only with extensive testing and surveillance."
EBOLA EXPERIENCE
In some places that looks all but impossible.
In South Sudan, devastated by a five-year civil war, the
government has just 24 isolation beds, said Dr. Angok Gordon
Kuol, incident manager for the outbreak at the Ministry of
Health.
He said public officials were trying to encourage
hand-washing, but many in the impoverished East African nation
of 12 million people could not afford soap and did not have
running water.
The health ministry in Burkina Faso, which is under siege
from jihadist groups linked to Islamic State and al Qaeda, said
in a report last week that the country lacked the resources to
deal with the outbreak.
Its border crossings have no sites to isolate suspected
cases, and the West African country does not have enough skilled
health workers, the report said. "This can result in high
mortality rates and an increased risk of spreading the disease."
Ebola killed more than 11,000 people in West Africa between
2013 and 2016, mainly in Guinea, Liberia and Sierra Leone. It
devastated communities but provided valuable lessons.
The Africa CDC, set up by the African Union in 2017, has
been working with the World Health Organization (WHO) to
strengthen emergency coordination, improve testing and
surveillance, and equip treatment centres.
"We know the fragility of our system, and because of that,
when the outbreak was declared, the countries just went into
action," said Mary Stephen, technical officer at the WHO's
Africa office.
The number of countries with labs able to diagnose COVID-19
in the region increased from two to 39 in just over a month. But
that still leaves eight countries without.
Passengers arriving at major airports have temperatures
checked and are asked to fill out travel questionnaires, and in
Nigeria, a taskforce meets regularly to evaluate the risks.
"We will never be caught pants down," said Bamidele Mutiu,
who helped coordinate the West African country's Ebola response
and now runs a biosafety lab in Lagos.
With three confirmed cases, Africa's most populous nation is
scrambling to increase the number of isolation beds and provide
more specialized medical training and equipment at state
hospitals.
"Our health system is not as strong as we'd like it to be,"
said Chikwe Ihekweazu, head of the Nigeria Centre for Disease
Control. "It is because we are a bit worried about our capacity
to deal with a large outbreak that we are focused so intensively
on prevention and early detection."
Promoting good hygiene is a key part of that effort. But
that is easier said than done. Less than half the population in
34 African countries have basic hand-washing facilities in their
homes, according to a 2017 United Nations survey.
KEEPING CLEAN
In Senegal's capital Dakar, announcements ring out through
loudspeakers on passing cars urging people to wash their hands.
A group of school children in soccer shirts reels off highlights
from a recent lesson - a crash course in preventing COVID-19.
But in their suburb, Pikine, where more than a million
people live, the water is frequently cut off.
"Cleanliness is important, but here it's not easy," said
Marcelle Diatta, a 41-year-old mother of four who lives in a
two-bedroom apartment with four extended family members.
Khary Faye Sougou, head nurse at a local health centre in
Pikine, where donkey carts jostle with delivery trucks on sandy
alleyways, said she was encouraging residents to stockpile
bottles of water; but not everyone could afford to do so.
In Senegal, a West African country that has recorded 27
cases, medical staff said they had received limited protective
equipment beyond extra gloves and masks.
"If we have a case, maybe I'll go with a mask and my white
coat, and after the visit I'll throw them away," Sougou said.
Ousmane Gueye, head of the crisis unit at Senegal's health
ministry, said the government was deploying protective gear to
facilities that need it.
There are ample stocks of masks and gloves and enough beds
to accommodate dozens more patients, according to health
officials. However, there are no reserves of ventilators, which
are in short supply across Africa.
In South Africa, which has recorded 62 cases of the virus,
medical services could be "swamped" if it spreads within the
country's vast shanty towns, Susan Cleary, a health economist at
the University of Cape Town, said.
"Transmission in an informal settlement is a disaster, an
absolute disaster," she said.
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"Preparing for war": Africans scramble for groceries
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