Novel Coronavirus (2019-nCoV) Global Epidemic – 3 March 2020

Outbreak Update: Since the last brief, 9,611 new novel coronavirus (COVID-19) cases¹ and 426 new deaths have been reported globally. Thirty-six new countries, including five new African countries, are reporting cases (Algeria, Armenia, Azerbaijan, Austria, Belarus, Brazil, Croatia, Czechia, Denmark, Dominican Republic, Ecuador, Estonia, Finland, Georgia, Greece, Iceland, Indonesia, Iraq, Ireland, Lithuania, Luxembourg, Mexico, Monaco, Morocco, Netherlands, New Zealand, North Macedonia, Norway, Nigeria, Pakistan, Qatar, Romania, San Marino, Senegal, Switzerland, and Tunisia) and one new country (the United States) is reporting deaths for the first time. To date, 88,948 total COVID-19 confirmed cases, and 3,043 related deaths have been reported. Most cases (80,174; 90%) and deaths (2,915; 96%) have been reported from mainland China. Sixty-four different countries outside of China have reported 8,774 cases. To date 129 total deaths have been reported outside China from seven countries. The case fatality rate for COVID-19 has remained between 2-4% throughout the outbreak. For more detailed information on cases and deaths being reported outside of Africa, refer to the WHO daily situation reports.²

To date, 30 countries in Africa have reported persons under investigation (PUI) for COVID-19: Algeria, Angola, Botswana, Burkina Faso, Cameroon, Côte d’Ivoire, DRC, Egypt, Equatorial Guinea, Eswatini, Ethiopia, Gabon, Ghana, Guinea, Kenya, Lesotho, Madagascar, Mali, Mauritius, Morocco, Mozambique, Namibia, Nigeria, South Africa, Senegal, Seychelles, South Sudan, Sudan, Tunisia, Uganda, Zimbabwe. The only countries reporting PUIs with a positive test for SARS-CoV-2 over the last week were: Algeria (3), Egypt (1), Morocco (1), Nigeria (1), Senegal (1), and Tunisia (1).

Table 1. New confirmed COVID-19 Cases Reported in Africa (25 Feb – 03 Mar, 2020)

• Algeria: The first case reported in Algeria was seen in an Italian national visiting Algeria and becoming symptomatic while in Algeria; this person has since returned to Italy. The two newest cases being reported from Algeria are a mother and daughter who were recently in contact with two visitors from France that were diagnosed with COVID-19 upon return home. The two cases are currently under isolation in Blida province, just south of Algiers.
• Egypt: The first case reported in Egypt has since tested negative for COVID-19 by PCR, and completed a 14-day observation period on 27 February 2020. A second case was reported in Egypt this week and the Ministry of Health and Population is now investigating two additional symptomatic suspects that were in contact with this case. The Ministry is further in contact with a number of countries (Canada, France, and the United States) who have reported confirmed COVID-19 cases in citizens recently returning from holiday in Egypt.
• Nigeria: The first case reported in Nigeria was seen in a foreigner living in Nigeria with recent travel to Italy. The case in Nigeria is currently under isolation in Lagos; NCDC has  activated its public health emergency operation center (PHEOC) and deployed rapid response team to Lagos.
• Morocco, Senegal, and Tunisia reported their first confirmed cases of COVID-19 on 02 March 2020. Additional information on these cases and country response efforts is being obtained.

Africa CDC has been in contact with all affected countries and is mobilizing laboratory, surveillance, and other response support where requested.

Background: This is an on-going outbreak that was first reported from Wuhan, China and was identified as a novel coronavirus disease (COVID-19) on 10 January 2020. Preliminary analysis of viral genomes from China and other countries suggests that initial transmission from a zoonotic reservoir to humans could have occurred as early as late October. Human to human transmission has been documented, and healthcare workers have been infected. Like other coronaviruses, people may be infectious before showing any symptoms of the disease.

Coronaviruses are a large family of viruses. There are several known human coronaviruses that usually only cause mild respiratory disease, such as the common cold. However, at least twice previously, coronaviruses have emerged to infect people and cause severe disease: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). The cases in this outbreak tested negative for both SARS and MERS.

Africa CDC Response:

General activities

1. Africa CDC activated its Emergency Operations Center and its Incident Management System (IMS) for the COVID-19 outbreak on 27 January 2020. The second Africa CDC Incident Action Plan (IAP) for COVID-19 covering a one month period from 13 February to 12 March 2020 has been developed.
2. The Africa Union Ministers of Health gathered in Addis Ababa, Ethiopia, on 22 February for an emergency COVID-19 meeting where they agreed upon a joint continental strategy and guidance for assessment, movement restrictions, and monitoring of people at risk for COVID-19, including people being repatriated from China.
3. Africa CDC is holding weekly updates with national public health institutes in Member States and has formed working groups for high priority areas of coronavirus control, including: surveillance; laboratory diagnosis; infection prevention and control; clinical care; and risk communication.

Surveillance

4. Africa CDC collaborated with the World Health Organization on 22 February 2020 to train in-coming analysts in event-based surveillance using the Epidemic Intelligence from Open Sources platform. These headquarters will be working closely with the Regional Collaborating Centres and Member States to track and verify COVID-19 related events, providing critical information to inform Member States response and control efforts.
5. Africa CDC in collaboration with WHO provided two Training of Trainers events for participants from 18 countries: Burkina Faso, Cameroon, Chad, Côte d’Ivoire, Egypt, Ethiopia, Ghana, Kenya, Mauritius, Mauritania, Nigeria, Niger, Zambia, Rwanda, Sao Tome and Principe, South Africa, Tunisia and Zambia to enhance surveillance at points of entry for COVID-19. Additional training is planned for March and April targeting the remaining countries in Africa.
6. Africa CDC in collaboration with the U.S Centers for Disease Control and Prevention will be training 20 countries in event-based surveillance for COVID-19 starting in March 2020. The first training for 6 countries is being held in Kampala, Uganda this week.

Laboratory

7. From 6-8 February 2020 in Senegal, Africa CDC in collaboration with Institute of Pasteur, Dakar, trained 16 African laboratories to diagnose SARS-CoV-2 using PCR: Côte d’Ivoire, Cameroon, DRC, Egypt, Ethiopia, the Gambia, Gabon, Ghana, Kenya, Nigeria, Morocco, Senegal, South Africa, Tunisia, Uganda, and Zambia. A second training for 12 additional African laboratories was held in South Africa in collaboration with the National Institute for Communicable Diseases and Roche Diagnostics for Angola, Botswana, Burundi, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Sudan, Tanzania, and Zimbabwe. Each went with a kit which allows screening of 192 suspects and confirming 96.
8. Africa CDC is coordinating with partners to establish sequencing capacity in six African reference laboratories, as well as external quality assessment and proficiency testing for all laboratories with COVID-19 testing capacity.
9. Member States can use WHO’s existing specimen referral network for influenza to ship their specimens to laboratories with capacity to test for COVID-19. For a full list of laboratories in Africa and how to submit specimens, Member States should contact the WHO country office and Africa CDC at yenewk@africa-union.org.

Healthcare Preparedness

10. Africa CDC has been working with Member States to build infection prevention and control capacities in healthcare facilities and with the airline sector to support screening of travelers. The first two IPC trainings, targeting 22 Member States took place between from 20-25 February 2020 in Abuja, Nigeria for Cameroon, Côte d’ivoire, DRC, Ethiopia, Gabon, Ghana, Kenya, Madagascar, Malawi, Mali, Mozambique, Namibia, Senegal, Sierra Leone, South Africa, South Sudan, Sudan, Tunisia, Uganda, Zambia, and Zimbabwe.

Risk Communication

11. Africa CDC completed a risk communications training in Tunis, Tunisia from 27-29 February 2020 for 13 Member States including: Cameroon, Côte d’ivoire,, DRC, Ethiopia, Gabon, Nigeria, Sahrawi Arab Democratic Republic, Senegal, South Africa, Tanzania, Tunisia, Uganda, Zambia. A second training for an additional 12 countries will be completed this week.

Recommendations for Member States:

1. All Member States should enhance their surveillance for severe acute respiratory infections (SARI)³ and to carefully review any unusual patterns of SARI or pneumonia cases. Examples of enhanced surveillance include:
   1. Adding questions about travel and testing for coronaviruses to existing influenza surveillance systems;
   2. Notifying healthcare facilities to immediately inform local public health officials about persons who meet the case definition for SARI and recently traveled to Wuhan (or other affected countries).
2. All Member States should a) activate their Emergency Operations Centers and rapid response teams for COVID-19, b) exercise their emergency response systems for readiness.
3. Member States that receive direct or connecting flights from affected countries should screen incoming passengers for severe respiratory illness and a history of recent travel to any country/area or territory reporting local transmission. Member States should be prepared to expand questions about recent travel to additional countries as the outbreak evolves.
4. Notify WHO and Africa CDC immediately if suspected or confirmed cases of infection with novel coronavirus are identified. Africa CDC should be notified by emailing AfricaCDCEBS@africa-union.org.
5. Prepare to collect specimens from patients suspected of having novel coronavirus infection. Interim guidance on specimen collection and handling is available from WHO at https://www.who.int/health-topics/coronavirus/laboratory-diagnostics-for-novelcoronavirus.
6. Provide guidance to the general public about seeking immediate medical care and informing healthcare providers about recent travel in anyone who develops symptoms of severe respiratory illness and recently traveled to Wuhan or one of the affected areas.

Resources for more information:

• Africa CDC. http://www.africacdc.org/press-centre/fact-sheets-and-brochures/
• China CDC. Coronavirus overview. http://www.chinacdc.cn/yyrdgz/202001/t20200109_211159.html
• European Centre for Disease Prevention and Control. Novel coronavirus overview. https://www.ecdc.europa.eu/en/novel-coronavirus-china
• National Health Commission of the People’s Republic of China. http://www.nhc.gov.cn/xcs/yqtb/list_gzbd.shtml
• Shanghai Public Health Clinical Center & School of Public Health. 10 January 2020. Initial genome release of novel coronavirus. http://virological.org/t/initial-genome-release-ofnovel-coronavirus/319
• US Centers for Disease Control and Prevention. 14 January 2020. Novel Coronavirus (COVID19), Wuhan, China. https://www.cdc.gov/coronavirus/novel-coronavirus-2019.html
• WHO. Coronavirus overview. https://www.who.int/health-topics/coronavirus
• WHO. Technical Guidance. https://www.who.int/emergencies/diseases/novel-coronavirus2019/technical-guidance

Endnotes

1. Per WHO, effective 17 February 2020, ‘confirmed’ cases include both laboratory-confirmed and clinically diagnosed (Hubei province, China only).
2. WHO coronavirus disease (COVID-19) situation reports: https://www.who.int/emergencies/diseases/novelcoronavirus-2019/situation-reports
3. WHO SARI case definition: anyone with an acute respiratory infection with history of fever (or measured fever of ≥ 38 C°) and cough with symptom onset within the last 10 days that requires hospitalization. https://www.who.int/influenza/surveillance_monitoring/ili_sari_surveillance_case_definition/en/