Dr Michel Yao, Emergency Operations Programme Manager at the WHO's Regional Office in Africa, discusses Africa's next step now that COVID-19 has been declared a pandemic.

Now that COVID-19 has been declared a “pandemic,” Dr Michel Yao, Emergency Operations Programme Manager at the World Health Organization’s Regional Office in Africa, insists on the need for the continent to brace its health facilities for treating Coronavirus patients.

Although Côte d’Ivoire recently announced its first coronavirus case, bringing the total number of countries impacted on the continent to 12, overall Africa remains largely unaffected by the epidemic.

Nevertheless, health officials remain on high alert and the World Health Organization (WHO) (whose “Africa” region excludes Egypt, Eritrea, Libya, Morocco, Somalia, Sudan and Tunisia) is coordinating efforts to fight COVID-19 and attempting to help every country prepare for and, if need be, respond to its arrival.

Originally from Côte d’Ivoire and educated in Canada, today Dr Michel Yao heads WHO’s Emergency Operations Programme in Africa and has notably worked to combat recent Ebola epidemics. Currently, he is leading and consolidating efforts to prevent the spread of coronavirus throughout the continent.

TAR: In comparison to how the epidemic has progressed in China and other parts of the world, what stage is Africa currently in?

Michel Yao: Basing my observations on what I’ve seen elsewhere, we’re in the containment phase, i.e., we’re trying to detect any way in which the disease may be introduced and isolate what we refer to as “cluster” cases [an aggregation of cases in a given area] in order to take measures to prevent its spread. This is the first phase.

Do you believe the progression we’re seeing in other countries will inevitably occur in Africa?

No, I think we can avoid it and that’s been our priority since the beginning.

The continent has extensive experience in managing epidemics and we’ve learned a lot based on how the virus has played out in China: we know the general profile of those infected, the levels of infection (80% of cases are minor, 15% are severe and 5% are critical, with the elderly and people with chronic illnesses more likely to fall into this latter category).

We are at an advantage when it comes to being better prepared for the virus’s arrival, educating the population and taking appropriate measures. Today, there are some cases on the continent, but we still have the chance to respond to it in the right manner.

Do you think China has managed the crisis appropriately to mitigate the impact on the African continent? 

Their response hasn’t been perfect, but they’ve covered the essential bases. When you consider the size of China’s population and the ties most African countries have with the country, I think it’s likely that the containment measures prevented a large number of “exported cases.” Without these measures, the virus would probably have arrived earlier in Europe and in Africa.

In addition, scientific data was shared in a very efficient manner.

So China bought Africa some time to prepare for the virus? 

Yes. Unfortunately, not every country benefited from this because the problem wasn’t a priority for all of them. When it comes to diagnostic capacity, efforts paid off: some 30 laboratories got up to speed in a month’s time. However, I’m seeing less progress when it comes to adapting health facilities to treat Coronavirus patients. We need to be prepared to lead a swift response, like our Chinese counterparts.

Is the continent ready to face this epidemic?

Kenya very quickly moved to adapt existing health facilities to be able to treat Coronavirus patients, but other countries have only up to 10 or 20 beds available. Let’s say the virus spreads and we have 1,000 cases to treat. We know that 140 of these cases will be severe and 50 patients will be in critical condition.

Do Africa’s leading hospitals have the capacity to handle that many cases? And taking into account that these patients need to be isolated from other patients?

Some countries will be able to handle one or two cases, but if we were to enter the next stage, Africa would quickly be overwhelmed. This is why WHO is currently calling on countries to be better prepared and to adapt their health facilities accordingly to be ready to receive coronavirus patients.

Health facilities also need to take steps to protect against, monitor and prevent the spread of the disease (via specific response plans), such as medical staff familiarising themselves with protective equipment. We don’t do this routinely in Africa. Some countries learned to do this during Ebola epidemics, but not all.

Isn’t it too late to implement these measures?

No, there’s still time. To date, only 12 countries on the continent have been impacted, but we need to move quickly.

Do you agree with the idea that the problem with the Coronavirus is more related to its contagiousness than its dangerousness?

Yes, the problem is that it spreads rapidly by air. Our biggest fear involves cases arising in poor, densely populated neighbourhoods.

In this type of situation, if health facilities don’t have the appropriate capacity to treat patients, then the death toll could be significant. And what makes this even more crucial is that the Coronavirus could decrease our resources for treating other diseases such as malaria and for ensuring maternity and child healthcare.

We are concerned that the system could get so overwhelmed that there would be collateral effects, particularly on malaria patient treatment.

However, we shouldn’t underestimate the Coronavirus: a disease’s deadliness varies based on the quality of patient treatment, so much so that a situation that seems innocuous in Europe could have a much greater impact in Africa. We have to be careful about making comparisons.

Some doctors have criticised recommendations concerning the detection of Coronavirus cases. They say they are too vague and inefficient…

The method for detecting cases has changed. Early on, it’s true that the idea was to not risk overlooking a case, so the detection method was very broad. But later on, the method was adjusted.

For example, now that the virus is increasingly spreading within countries, health professionals are no longer basing their diagnosis on whether or not a patient spent time in an area with infected individuals or has travelled to China. The focus has shifted to symptoms.

Several major international institutions have announced the freeing up of billions of dollars in aid. Is this good news? Is it helpful?

Yes, it’s helpful. We’ve had experience with these kinds of financial contributions in the past, especially in DRC during the Ebola epidemics, where the response was in part funded by the World Bank.

However, for the money to be truly helpful, it has to be backed up by a plan. There has to be a programme in place that covers building and/or purchasing equipment, training, monitoring entry points, etc.

Some of this aid could be used to build facilities to treat patients suffering from communicable diseases like cholera and Ebola. It gives us the opportunity to take action in both the short and long term.

It’s a crucial point when we’re confronted with this type of disease. It helps involve populations and communities in efforts to fight the disease. If we were to be confronted with a large-scale epidemic, 80% of those infected would have to stay at home rather than go to a hospital, and it would be up to each community to manage this. There again, Ebola has taught us a lot.

We’ve regularly been hearing about teams of researchers that are discovering drugs which appear to be effective. Are you following these developments closely?

WHO is interested in all of this research, of course, but it’s still too early to tell. The treatment approval process takes a long time. That said, when tests appear to be conclusive, sometimes the “compassionate” use of a drug is recommended before its approval. This was the case for Ebola.

Some believe that the reason why there are so few cases in Africa to date is simply that a lot of cases haven’t been detected. What’s your take?

Given the measures put in place and the current situation, I think it’d be difficult for cases to go under the radar, unless we’re talking about people exhibiting little to no symptoms. People are informed all over Africa, so I don’t see how any major cases could be missed.