The first confirmed case of coronavirus disease 2019 (COVID-19) in Africa was reported in Egypt on February 15, 2020 (1). As of April 4, 2020, 50 days after the first confirmed case was reported, a total of 7,405 confirmed cases and 305 deaths had been reported from 51 countries across Africa (2). In the 50 days since the first case was reported in Africa, COVID-19 spread relatively slow, especially in the first 20 days with 22 confirmed cases reported in 6 countries. However, by Day 23, the number of confirmed cases reported started increasing every day. By Day 30, 24 countries had reported a total of 251 confirmed cases; by Day 40, a total of 2,245 confirmed cases had been reported in 44 countries; by Day 50, the cumulative number of confirmed cases reported in 51 countries had grown rapidly to 7,405 (3) (Figure 1).
The cumulative number of reported COVID-19 cases varied among the 5 regions of Africa with the number of cases growing most rapidly in Northern Africa, which, as of April 4, 2020, reported 3,382 confirmed cases and accounted for 45.31% of the total reported cases in Africa. The number of cases reported in Central Africa and Eastern Africa increased more slowly, with 473 and 669 reported cases and 6.34% and 8.96% of the total reported cases in Africa, respectively (2). The 5 countries with the highest total numbers of confirmed cases are South Africa (1,505 cases), Algeria (986 cases), Egypt (985 cases), Morocco (844 cases), and Tunisia (495 cases), and they cumulatively reported a total of 4,815 confirmed cases, which accounts for 65.02% of the total reported cases in Africa. (2)
With an increase in the number of reported cases of the COVID-19 in Africa, there is extreme concern for whether Africa will reach a level of emergency that Europe reached, which as of April 4, 2020, the cumulative number of reported cases of the COVID-19 in Europe has reached 541,171 (2). The first confirmed case in Europe was reported by France on January 25, 2020 (4), and by Day 36 after the first case was reported, more than 1,000 cases were reported (5) and more than 5,000 cases were reported by Day 42 in Europe (6). Comparing the epidemic development in Europe, Africa reported more than 1,000 cases on Day 37 after the first case was reported (7) and more than 5,000 cases by Day 46 (8).
From the first case report to Day 35, the number of reported cases and the growth rate were almost identical in Europe and Africa. However, after Day 35, the growth of the number of reported cases in Europe began to accelerate when compared with Africa, and by Day 50, Europe reported 36,264 cases while Africa reported 7,405 cases. By Day 60 (9), the cumulative number of the reported cases in Europe had reached nearly 200,000 (195,262 cases) and by Day 70, it had reached well over 500,000 (541,171 cases) (10) (Figure 2). Epidemic trends in Europe remind us that the next three to four weeks will be a crucial time for the development of the COVID-19 epidemic in Africa. Will Africa experience a sudden and rapid increase in the number of reported cases as Europe did?
The World Health Organization (WHO) classified the transmission modes of the COVID-19 as imported cases only, local transmission, and community transmission. The imported cases only classification indicates locations where all cases have infections acquired from outside of the reporting location. Local transmission indicates locations where the source of infection is within the reporting location (2). The changes in transmission modes of COVID-19 in 54 countries in Africa and 53 countries in Europe are almost identical. As the number of countries reporting COVID-19 cases increases, so does the number of countries that are changing from imported cases only to local transmission. As of April 4, 2020, 66.67% (36/54) of countries in Africa were classified as having local transmission and 25.93% (14/54) were imported cases only (2,11) (Figure 3A); but by this time, 96.23% (51/53) of countries in Europe were classified as having local transmission and only 3.77% (2/53) were imported cases only (2). In Europe, 60 days after the first case was reported, more than 90% of countries with COVID-19 were classified as having local transmission, and the cumulative number of reported cases also increased rapidly to nearly 200,000 (195,262 cases) (9-10) (Figure 3B).