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Old 03-31-2020, 11:05 PM
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Africa and COVID-19


Any African Dopers with perceptions from on the ground?

So far Africa as a whole is not getting hit hard at all. Egypt some but even they're at only 0.4 deaths/million population.

Overall about half of the continent's population is under 19. If it is true that kids are not very contagious with it then Africa might not get bad at all even with crowded conditions, much baseline malnutrition/disease, and a healthcare system with little capacity to take care of many very ill at once. If children functionally act more like Resolveds then it might not be able to spread very much there at all, even with tight multigenerational social networks as are common in many African cultures.

If they are very contagious then it may become very bad quickly.
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Old 04-01-2020, 07:48 AM
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I am not African but used to live there and follow events there via the news and personal contacts. COVID has not hit Africa particularly hard. It is probably under reported, but it's not nearly as bad as Europe or the United States, by far. There have been measures taken like school closings and some places have lockdowns and curfews.

Still, given the crowded living conditions and multigenerational residential lifestyles, it is a happy surprise that the disease has not spread more rapidly. The most likely reason is that the virus does not transmit as well in hot, humid climates.
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Old 04-01-2020, 09:10 AM
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No, but this article sounds discouraging.

https://www.theglobeandmail.com/worl...ough-new-test/
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Old 04-01-2020, 09:25 AM
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Under reported because of lack of testing would likely be the main reason. Places like Jo'Burg and Pretoria are more modern cities with better access to testing and better record keeping.
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Old 04-01-2020, 09:30 AM
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here is a population pyramid for the continent of Africa.

https://www.populationpyramid.net/africa/2019/

Compare that to a country like Itay

https://www.populationpyramid.net/italy/2019/

Hopefully their youth keeps many of them safe from death until herd immunity kicks in.
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Old 04-01-2020, 10:11 AM
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If it is true that kids are not very contagious with it then Africa might not get bad at all even with crowded conditions
I may have missed something, but is there any reason to believe that kids are not very contagious, as opposed to that they just exhibit few-to-no symptoms?
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Old 04-01-2020, 10:14 AM
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Under reported because of lack of testing would likely be the main reason. Places like Jo'Burg and Pretoria are more modern cities with better access to testing and better record keeping.
That would under report confirmed cases for sure. But a spike in deaths due to pneumonia, even if attributed to influenza or other clinically, would still be noticeable if it was taking off.
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Old 04-01-2020, 10:18 AM
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I may have missed something, but is there any reason to believe that kids are not very contagious, as opposed to that they just exhibit few-to-no symptoms?
No. The early data (heavily massaged) by the CCP and WHO seemed to indicate that in China, young people weren't catching this as much, and when they were they were mainly getting the mild version. But that doesn't seem to be the case anywhere else, so either it was an anomaly in the data, in Chinese physiology, or it was deliberate mis-information by the CCP. In this case, to be charitable, I'd say it was just an anomaly in the data. It certainly isn't being shown in Europe or the US.
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Old 04-01-2020, 10:28 AM
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Also has a long and recent history of dealing with epidemic out breaks like ebola and marburg.

So a lot of these quarantine and testing procedures are already familiar and in place.

Also the heat may be helping, though that is at best a guess now. Similarly, Vietnam, Loas, Cambodia and to some degree Thailand and the Philippines , all have far few cases than one would expect, despite a huge influx of Chinese tourists.

But I would think Africans after dealing with these previous epidemics are more prone to quickly adapt to measures, the Western countries thought were "extreme."
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Old 04-01-2020, 10:40 AM
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I may have missed something, but is there any reason to believe that kids are not very contagious, as opposed to that they just exhibit few-to-no symptoms?
Yes.

Case contact tracing done extensively in South Korea found many cases of kids getting infected by adults and none of adults from kids.

I am sure it happens some but that is a long shot different than the case with influenza and most other higher R0 infections. In general kids are the amplifiers.
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Old 04-01-2020, 10:45 AM
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Yes.

Case contact tracing done extensively in South Korea found many cases of kids getting infected by adults and none of adults from kids.

I am sure it happens some but that is a long shot different than the case with influenza and most other higher R0 infections. In general kids are the amplifiers.
Two dopers, two totally different answers.

I'd love a cite if you have one. Not that I'm disbelieving you (or XT), but would love to learn more.
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Old 04-01-2020, 10:49 AM
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There has been some suggestion that countries, where Malaria is endemic, have seen a reduced number of cases. Others have cast doubt on this hypothesis.
There is the weather transmission debate, which states that warmer weather inhibits COVID spread, which is still being debated but has a lot more evidence to back it up.
Another proposal put forward and linked with the malaria hypothesis is that Chloroquine, which is regularly prescribed and administered, is responsible for the surprising lack of cases. Again, not definitive. Still Despite popular belief, the fact Chloroquine has effects on viruses has been anecdotally reported for decades, Trump and the French didn't make it up. Its the reason why it was investigated in the first place for SARS and MERS.
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Old 04-01-2020, 11:05 AM
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Two dopers, two totally different answers.

I'd love a cite if you have one. Not that I'm disbelieving you (or XT), but would love to learn more.
There are all sorts of articles on this, but I can't link to the one I'm looking at now as it's a special report. However, here is what the CDC says:

Quote:
Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date. You can learn more about who is most at risk for health problems if they have COVID-19 infection on CDC’s current Risk Assessment page.
The key there is 'do not appear to be at a higher risk' I think. In the US and Europe, there have been a higher rate of children getting infected that in several Asian countries. I don't know if anyone knows why. My gut feeling was that in China there was a lot of misreporting that may (probably did) skew a lot of the early reporting. Also, children don't seem to get (as much) the really sever version as adults do, but they are carriers. Here is a CNN article on that part:

Quote:
Children's coronavirus cases are not as severe, but that doesn't make them less serious

Are children getting sick?
Yes, children are catching the coronavirus, but they're generally developing mild cases of the illness.
Out of nearly 45,000 confirmed cases in China through February 11, there was only one death in someone younger than 20, according to the Chinese Center for Disease Control and Prevention, and no deaths among children younger than 10.

Out of 731 confirmed and 1412 suspected cases of Covid-19 in children in China, one child, a 14-year-old boy, died and nearly 6% of cases were severe, compared with 18.5% of adults experiencing severe symptoms, according to a new study that will be published in the journal Pediatrics in June. Also, only 6% of cases were severe, compared with 18.5% of adult cases.

...

"The evidence so far would suggest that children, at least in China, many children have gotten infected and have ... either had a very mild illness or not had any illness at all," Reingold told CNN, adding that's a pattern seen in many other respiratory viruses that are easily transmitted among children and by children.

There have been cases in the United States, similar to other countries, where children are getting sick. A high school student in Washington, a teenager in Georgia, an elementary school-age child in California and a three-year-old in Texas have all tested positive for the disease.

However, Reingold said, children are not developing as severe an illness from the coronavirus as older people.

"Children simply don't get very sick when they get this infection," he said. "So if they develop any symptoms at all, they're mild ... and so, severe illnesses and deaths, fortunately, are incredibly rare."
Basically, at this stage, take everything with a huge grain of salt. There seem to be a ton of unknowns still, though maybe 'dopers with expertise in disease theory or whatever could weigh in. I can't say I'm even a gifted armature on this, just someone who gets briefed on stuff and tries to follow what people more qualified are trying to tell me. A brief I attended at the end of last week had it in stuff about children and they were saying that the Chinese data may have masked a lot of the children infections there because they weren't as severe, and that the early data in Europe and the US seemed to bear that out. Now they seem to be shifting on that, but I don't know if there is enough data to really say at this point.
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Old 04-01-2020, 11:14 AM
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Two dopers, two totally different answers.

I'd love a cite if you have one. Not that I'm disbelieving you (or XT), but would love to learn more.
https://www.statnews.com/2020/03/06/...s-assess-risk/

Quote:
“Even when we looked at households, we did not find a single example of a child bringing the infection into the household and transmitting to the parents. It was the other way around,” Van Kerkhove said.
Nothing since that suggests otherwise.
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Old 04-01-2020, 11:17 AM
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Kids get infected. They just don’t get very sick so often and seems to be at most minimally contagious.
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Old 04-01-2020, 11:28 AM
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Here is another article, this one from the BBC:

Quote:
The evidence so far suggests that children are less vulnerable to the effects of the coronavirus, but they can still be infected. Why does the virus seem to affect children differently?
Quote:
Can children be infected with the coronavirus?

Yes. Just as with adults, children exposed to the coronavirus can be infected with it and display signs of Covid-19. “At the beginning of the pandemic, it was thought that children are not getting infected with the coronavirus, but now it is clear that the amount of infection in children is the same as in adults,” explains Andrew Pollard, professor of paediatric infection and immunity at the University of Oxford. “It’s just that when they do get the infection they get much milder symptoms.”

Data from the Chinese Center for Disease Control and Prevention reported that children under 19 years of age comprised 2% of the 72,314 Covid-19 cases logged by February 20th, while a US study of 508 patients, reported no case fatalities among children, with this group accounting for less than 1% of the patients in hospital.

“It could be that the virus has preferentially affected adults at the moment because there has been workplace transmission and transmission during travel,” says Sanjay Patel, a paediatric infectious diseases consultant at Southampton Children’s Hospital. “Now that adults are spending more time with their children we might see a rise in infection in children, but we might not.”
Quote:
How does the coronavirus affect children differently from adults?

“It is a remarkable observation, in the global literature that we have for coronavirus already, that even children with very serious medical conditions, who are on immunosuppressive therapies or on cancer treatments, are much less affected than adults, especially older adults,” says Andrew Pollard, head of the Oxford Vaccine Group, whose researchers have recently identified a vaccine candidate for Covid-19.

In general, children with Covid-19 experience milder symptoms than adults. But a 12-year-old girl from Belgium and a 13-year-old boy from London, UK, have both died in recent days, making them the youngest victims in Europe. A 14-year-old in China has also been reported to have died after being infected with the virus.
Quote:
Why do children infected with the coronavirus fare better than adults?

“The virus is so new that we don’t really know”, says Roberts, who is also director of the David Hide Asthma and Allergy Research Centre, in Newport, UK.

“One of the likely reasons is that the virus needs a protein on the surface of a cell (a receptor) to get into the inside of a cell and start causing problems,” he says. “The coronavirus seems to use the Angiotensin converting enzyme II (ACE-2) receptor for this purpose. It may be that children have less ACE-2 receptors in their lower airways (lungs) than in their upper airways, which is why it is their upper airways (nose, mouths and throats) that are predominantly affected.”
So, like I said, grain of salt on anything. The experts are still collating data on all of this, and some of the data is contradictory or seems to have changed over time. I don't think any definitive statement can be made about this, but to think children can't get it or can't transmit it seems incorrect. What does seem to be tentatively correct at this time is that children mainly seem to get the milder version, but with exceptions that don't always correlate to having pre-existing conditions.
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Old 04-01-2020, 11:44 AM
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None of your quotes addressed how contagious children are despite your assertion in your summary.
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Old 04-01-2020, 11:53 AM
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None of your quotes addressed how contagious children are despite your assertion in your summary.
I wasn't really trying to address this directly, except to say 'it's not really known at this time', but here, from the same article:

Quote:
Can children, with mild or no illness, transmit the Coronavirus to others?

Yes, they can.

“This is the big issue,” says Roberts. “Many think that children are at low risk and we don’t need to worry about them, and yes, that is true for children who don’t have chronic medical conditions like immunodeficiencies. What people are forgetting is that children are probably one of the main routes by which this infection is going to spread throughout the community.”

The coronavirus is transmitted from an infected person to a non-infected person through direct contact with the respiratory droplets of an infected person (generated through coughing and sneezing), and touching surfaces contaminated with the virus. This means that children infected with the coronavirus, with very mild or no illness, can transmit the infection to others, especially family members and elderly relatives.
Not sure I linked to it, but earlier I read that one of the reasons children don't seem (emphasis on the 'seem' part) to have been part of the early transmission vectors is because it was parents bringing it home from work or from going out initially, and that the spread was mainly due to adult actions (work and travel, not from the schools), but that this may be changing now that we are in a social distancing situation where adults are home. Also, as noted, young children seem to predominantly have a milder case. So, they may not be being reflected in the numbers, since kids get runny noses, fevers and coughs all the time, and if it's not sever they may not even be being counted in many cases. There have been a few cases where kids got more sever cases, but mainly, at least at this time, it SEEMS like kids predominantly get the milder case...or are even totally asymptomatic. Unless you test all the seemingly healthy kids, we aren't going to know really how many of them have it...and how many times they have been vectors.

Again, grain of salt. Not only am I definitely NOT any sort of expert or even really knowledgeable on this but I think even those who are don't have definitive answers at this point. There are a ton of things they are still finding out about this every day, and my WAG is that will continue for months to come.
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Old 04-01-2020, 11:53 AM
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I would hope that many factors are responsible possibly including children getting milder disease, warmer weather inhibiting the virus etc. However, I fear that the reason is simply that Africa was infected later. They seem to be about a month behind the US and with limited testing so the initial disease is not being reported. I have a terrible feeling that one month for now we are going to see an overwhelming spike in severe disease and death in Africa (and also in South America).
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Old 04-01-2020, 12:05 PM
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I
Again, grain of salt. Not only am I definitely NOT any sort of expert or even really knowledgeable on this but I think even those who are don't have definitive answers at this point. There are a ton of things they are still finding out about this every day, and my WAG is that will continue for months to come.
Right, it's just even this last quote just said "yes they can" - he would be crazy to say that it's impossible. He says "probably" they are a major vector because that's how a lot of other viruses are spread. But the person DSeid quoted was talking about findings from the extensive case tracking done in South Korea.

Last edited by CarnalK; 04-01-2020 at 12:09 PM.
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Old 04-01-2020, 12:19 PM
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Right, it's just even this last quote just said "yes they can" - he would be crazy to say that it's impossible. But the person DSeid quoted was talking about findings from the extensive case tracking done in South Korea.
I get that, and am not saying that DSeid's quote is wrong. But it seems like as we go on, they are finding things that contradict those earlier findings, so there might be things that were missed, even if it was an 'extensive case tracking' study. I doubt that South Korean (or Chinese who found similar things) physiology is that different from European (though my take is 'humans are humans' after all, as, again, I'm not expert, so maybe there is some fundamental difference that I'm clueless about), yet there seems to be some large differences in things as we move forward. South Korea is one of the really hard hit countries that also seems to have done a remarkable job of dealing with the virus very early on, though they maybe starting to see their second wave.

At any rate, that's the best I gots. I can only relate what I've been told and what I've read, I don't really know this stuff that well...it's not even tangentially related to my own areas of expertise. Sadly, I've had to try and learn a lot of this stuff on the fly recently.
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Old 04-01-2020, 12:31 PM
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Well, if you find something that actually contradicts Dseid's cite, from the head of the World Health Organization’s emerging diseases and zoonoses unit, I'd like to see it. Because what you quoted wasn't a finding of anything, it was a pediatrician's opinion.
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Old 04-01-2020, 03:36 PM
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There are some real reasons to worry even if the disease has not spread as far to date.

Africa has the majority of worldwide cases of HIV. That is a lot of people at higher risk of death.

Lagos, Nigeria is the largest city on the continent. A look at their situation as they transitioned into a 14 day lockdown highlights some red flags. When you have a decent chunk of your population living in poverty, with zero social safety net, and in many cases not having access to drinking/washing water in their home, mitigation measures can be difficult.

Libya is in the midst of a civil war and shares a border with Egypt. Fighting was expected to ramp back up again this year. The leaders of the warring parties probably face higher personal risks of death if they lose that fight than from the pandemic. Dying from pneumonia sucks. Being beaten, sodomized with a bayonet and then shot multiple times like Gadaffi also sucks. Controlling the pandemic may not be priority number one. It may not even be on the priority list. Maybe the various nations that were supporting the warring parties are so distracted the risk of fighting drops enough to let priorities shift to the virus..maybe.

Libya is at the northern tip of the land route taken by refugees, especially those fleeing fighting in the Sahel, on their way to Europe during what has been a large refugee crisis. The refugee numbers might drop but I would be surprised if they stop. The risks of dying on the trip or being sold in Libyan slave markets didn't stop the flow. That produces what has been mostly a one way flow that can reasonably be expected to simply ignore things like legal declarations against travel. To the extent that nations on the route get better at enforcement and turning people back it can turn the flow into mixing function to spread the disease. Refugees from multiple nations mix as they travel with limited opportunity for hygiene and lots of physical stress weakening their immune systems. Then they deal with security forces that they might infect. If turned around they can carry the virus back along the route as far as they make it.

That refuge route to Libya is also a smuggling route. It, along with routes towards the middle east, is an important part of the logistics for the insurgent groups in the Sahel. Those are two way routes traveled by people that already ignore and avoid government attempts to stop their travel. There is a whole lot of transmission across international borders that is possible because of the instability in the Sahel.

Quote:
Originally Posted by DSeid View Post
That would under report confirmed cases for sure. But a spike in deaths due to pneumonia, even if attributed to influenza or other clinically, would still be noticeable if it was taking off.
If the deaths themselves are being reported in the first place, let alone classified as pneumonia.

Many of the countries in Africa have relatively weak governance. Despite recent high urbanization rates in Africa in the last few decades, the majority of people on the continent still lives in rural areas. Many are far from routine government intervention. Mix the two and reporting, especially of rural deaths, may not be very accurate.

Then there the failed states of Libya and Somalia. We should not expect the competing claimants to power to be very good about reporting anything. They have bigger problems and limited spans of control.

There are also a number of functioning states in Africa that have their reach limited by currently active insurgencies. Parts of those countries function under government control. In some parts the mere existence of the government officials responsible for the area can be in question. Just an example from the March report by the UN Secretary General on the mission in Mali
Quote:
During the reporting period, the percentage of civil administrators present at
their duty stations in northern Mali remained stable, at 23 per cent, with 60 per cent
of governors, 42 per cent of prefects and 16 per cent of sub-prefects deployed. In
Mopti Region, central Mali, as at 31 January, the number of civil administrators
present at their duty stations had decreased to 27 per cent, from 30 per cent in
November 2019. Officials present included the governor, 75 per cent of prefects and
19 per cent of sub-prefects.
For some of the parts of Africa where the official government data is suspect the estimate is also likely suspect. The estimate you propose is probably fine if you just want to check to see if Egypt is trying to cover things up. For the countries of the Sahel region, Libya, and Somalia it risks being an exercise in GIGO (Garbage In, Garbage Out.)

Last edited by DinoR; 04-01-2020 at 03:40 PM.
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Old 04-01-2020, 04:05 PM
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I don't have the link but the decrease in tourism thru Covid has lead to an increase in poaching for horns, killing Pangolins etc.

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