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COVID-19 and development in Africa

of this relationship was often observed, that is to say, that the underprivileged social strata became more affected because the
privileged strata became more aware of danger, practiced prevention more effectively, and benefited earlier from medical
treatment (Hajizadeh, Sia, Heymann, et al., 2014; Wojcicki, 2005).
The relationship between the coronavirus epidemics and socioeconomic development in Africa has not yet been
investigated. This virus, officially called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in China
at the end of 2019, was quickly identified, and notified to the World Health Organization (2020) (WHO) on January 14,
2020. Since then, it spread across the world, affecting virtually every country in a matter of months. The virus belongs to the
β-Coronavirus group; it is new to humans and therefore considered as an emerging disease. The virus is very contagious,
it is transmitted in several ways: From person to person by aerosol, especially following the cough it causes in the infected
person, and it can be maintained for several hours in a confined atmosphere, as well as by direct or indirect contact (hands,
hugs, polluted surfaces, etc.). The disease has various clinical manifestations, ranging from asymptomatic infection, to mild
illness, to severe illness requiring hospitalization and may cause death, especially in the elderly or in people with peculiar
risk factors (diabetes, obesity, hypertension, etc.) (Velavan and Meyer, 2020). The fact that it often causes asymptomatic
infections, especially among young people, makes it difficult to detect the virus in the general population. The diagnosis
is usually made by detecting the virus by reverse transcriptase-polymerase chain reaction in a nasal sample, taken among
subjects with clinical forms, among contacts traced in contagion studies, or among people wishing to know their infectious
status. The more serious the clinical form, the greater the chances of detecting the virus, and in fact, many diagnoses, which
are the source of statistics on the epidemic, are done in hospitals and other health structures, as well as in special case/
contact surveys or in systematic screening (retirement homes, schools, health centers, travelers, etc.). The statistics available
in the general population, therefore, depend on medical diagnostic capacities and, in particular, on hospital infrastructures,
health personnel, and their training, as well as on the availability of screening kits. Statistical data are usually collected by
specialized institutions (ministry of health, health agency, etc.) and must be transmitted to WHO daily as a notifiable disease.
Scientific output on this emerging disease is outstanding, with thousands of articles published in just 6 months, in
one form or another, often in electronic pre-publication form. Most of these publications deal with the Far-East, Europe,
America, but few with Africa. A search on Medline database on “coronavirus disease 2019 (COVID-19) epidemiology”
on November 07, 2020, gave 687 references for Africa out of 20,373 in the world (3.4%) (Medline, 2020). There are
several reasons for this difference: Africa was affected somewhat later than other continents, the medical infrastructure
and research are less developed there, and it seems that, at least so far, the virus is less prevalent and less lethal than
elsewhere (WHO database 2020).
The purpose of this study is to review the COVID-19 epidemics in Africa 6 months after onset (from mid-February
to mid-August 2020) by documenting cases and deaths at country level first, and then linking the observed dynamics to
economic development, demographic transition, population patterns, and health infrastructure, all important determinants
of the dynamics of infectious diseases in the general population, as well as of the quality of statistics. Africa is indeed
a particularly heterogeneous continent, with high-income and low-income countries, more densely and less densely
populated countries, countries ahead (as South Africa) or backward (as Niger) in the demographic transition, countries
with well-developed health infrastructure, and others with weak infrastructure.
Several determinants of COVID-19 epidemiology were analyzed: demographic characteristics (population density,
urbanization, geographic distribution, progress in the demographic transition, and age structure of the population); economic
characteristics (gross domestic product [GDP] and air traffic intensity) because the more developed is a country, the more
frequent exchanges are, and the greater the risk of contamination; and public health characteristics (screening, intervention,
prevention capacities for incidence, and health system performance for case fatality). The study does not deal with the important
question of the effectiveness of prevention policies because, on the one hand, necessary data are lacking (the population coverage
of preventive measures taken in each country is not available); and, on the other hand, because of reverse causality: The more
infected is a country, the more it will tend to implement aggressive policies to fight the disease (as case for example in South
Africa). A study of the impact of prevention would require a different methodology than the one proposed here, which is based
on the empirical correlations between parameters of the epidemic and parameters of economic and social development.

2. Data and Methods

2.1. Country Databases

Data on the epidemics (reported cases and deaths) are those transmitted to WHO, published in the daily reports (WHO,
2020). The cumulative numbers of cases and deaths were used each week from February 16, 2020, to August 15, 2020,

2 International Journal of Population Studies | 2020, Volume 6, Issue 2