As the risk of a surge in COVID-19 cases increases, African countries must urgently boost critical care capacity to prevent health facilities from being overwhelmed. This comes as vaccine shipments to the continent grind to a near halt.

Weak observance of preventive measures, increased population movement and interaction, as well as the arrival of winter in southern Africa, have heightened the risk of COVID-19 resurgence in many countries.

In the last two weeks, Africa recorded a 20% increase in cases compared with the previous fortnight. The pandemic is trending upwards in 14 countries and in the past week alone, eight countries witnessed an abrupt rise of over 30% in cases.

South Africa is reporting a sustained increase in cases, while Uganda saw a 131% week-on-week rise last week, with infection clusters in schools, rising cases among health workers and isolation centres and intensive care units filling up. Angola and Namibia are also experiencing a resurgence in cases.

The increase comes as COVID-19 vaccine shipments continue to slow down. Burkina Faso this week received just 115 000 doses from the COVAX Facility, while Rwanda and Togo each received around 100 000 Pfizer vaccine doses. Nearly 20 African countries have used up more than two-thirds of their doses. The COVAX Facility is in talks with several manufacturers, as well as with countries that have vaccinated their high-risk groups to share doses.

“The threat of a third wave in Africa is real and rising. Our priority is clear – it’s crucial that we swiftly get vaccines into the arms of Africans at high risk of falling seriously ill and dying of COVID-19,” said Dr Matshidiso Moeti, the World Health Organization (WHO) Regional Director for Africa.

“While many countries outside Africa have now vaccinated their high-priority groups and are able to even consider vaccinating their children, African countries are unable to even follow up with second doses for high-risk groups. I’m urging countries that have reached a significant vaccination coverage to release doses and keep the most vulnerable Africans out of critical care.”

Altogether, 48.6 million doses have been received and 31.4 million doses have been administered in 50 countries in Africa, where around 2% of the population have received at least one dose of the COVID-19 vaccine, while globally 24% have been vaccinated.

As the continent struggles with vaccine shortages, the care of critically ill COVID-19 patients is also lagging behind other parts of the world. While Africa has 2.9% of cases globally, it accounts for 3.7% of deaths.

A WHO survey carried out in May found that in many African countries, crucial equipment and the health workforce required to handle severely ill COVID-19 patients fall far short of needs. Of the 23 countries responding to the survey, most have fewer than one intensive care unit bed per 100 000 population and will require an increase of between 2500% and 3000% to meet needs during a surge.

Among the countries providing information on ventilators, only a third of their intensive care unit beds are equipped with mechanical ventilators.

High-income countries such as Germany, Luxemburg or the United States of America that have been able to cope with COVID-19 surges have over 25 beds per 100 000 population.

“Many African hospitals and clinics are still far from ready to cope with a huge rise in critically-ill patients. We must better equip our hospitals and medical staff to avert the worst effects of a runaway surge,” said Dr Moeti. “Treatment is the last line of defence against this virus and we cannot let it be breached.”

Since the onset of the pandemic, WHO has worked around the clock and in collaboration with countries to ramp up COVID-19 treatment capacity by delivering essential medical supplies as well as health worker training.

The number of oxygen concentrators, for instance, has increased to over 6700 as of April 2021 compared with 2600 in April 2020, with WHO providing around 3700 of the medical equipment to countries in addition to shipping about 680 ventilators.

The Organization has also deployed 21 experts in COVID-19 treatment to eight countries to assist in the clinical care of critically ill patients and share expertise with national health workers.

To further reinforce COVID-19 critical care services, WHO recommends that every district hospital should have a high-dependency unit, while those at the regional or provincial level have an intensive care unit and higher-level health facilities set up 2—3 intensive care units. All intensive care units must be adequately equipped.

Dr Moeti spoke during a virtual press conference today facilitated by APO Group. She was joined by Professor Daye Ka, Infectious and Tropical Disease Expert, Member of COVID-19 task force, treatment pillar, Senegal, and Dr Norbert Ndjeka, Director, Drug-Resistant TB, TB & HIV, Department of Health, South Africa.

Also on hand to answer questions were Dr Richard Mihigo, Coordinator, Immunization and Vaccines Development Programme, WHO Regional Office for Africa, and Dr Thierno Balde, Team Leader, Operational Partnerships, WHO Regional Office for Africa.