Africa, Intertwined With China, Fears Coronavirus Outbreak - The New York Times

There are no confirmed cases of coronavirus in Africa yet, but with steady traffic to and from China, experts worry that the epidemic could overrun already-strained health systems.

ADDIS ABABA, Ethiopia — As the 9 a.m. flight from Dubai arrived at the international airport in Ethiopia’s capital on Wednesday, four government health specialists in face masks and protective glasses worked their way to the line of incoming passengers to check their passports.

The health specialists found what they were looking for — two passengers who had just returned from China — and pulled them aside to check their temperatures to see if they might have been infected by the coronavirus.

The two passengers had normal temperatures, so were allowed to continue on their way, a government policy that does not account for an incubation period that is up to 14 days.

As the coronavirus wreaks havoc in China and has spread to countries around the world, experts are increasingly concerned that Africa is particularly vulnerable.

The continent’s health system is already fragile. It has few facilities even to test for the virus. Its doctors are already straining to contain deadly outbreaks of other diseases, like malaria, measles and Ebola.

And on top of that, Africa has large numbers of Chinese workers, many now returning to the continent after visits to China for the Lunar New Year. Meanwhile, some of the 81,000 African students who have been studying in China are now heading home. But while more and more countries tighten their controls over travel with China, Ethiopia has kept the door open and the planes flying.

If the coronavirus hits Africa, said Dr. John Nkengasong, director of Africa Centers for Disease Control and Prevention in Addis Ababa, “it will be massive.”

There have been 32 suspected cases of coronavirus in Africa, but none tested positive for the virus, according to the Africa C.D.C. But until this week, only two countries on the continent — South Africa and Senegal — had laboratories capable of testing for the coronavirus.

Most hospitals on the continent, other than large ones in capitals or regional seats, do not have the intensive care units that patients diagnosed with the coronavirus might require, experts say.

• Updated Feb. 5, 2020

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“If this happens in Africa it will be a huge struggle because the health services are quite overstretched dealing with ongoing diseases like malaria and measles and the current Ebola outbreak,” said Michel Yao, the World Health Organization’s Emergency Operations Program Manager for Africa.

Africa was largely spared in 2002 and 2003 when the SARS virus, which also originated in China, spread around the world, killing nearly 800 people and infecting more than 8,000, mostly in China and Hong Kong. Africa reported only one case, in South Africa.

But the risk is far greater now, experts say. China and Africa have become intertwined in the last two decades as China has expanded its political, economic, and military ties to Africa, funding large infrastructure projects and pledging tens of billions of dollars in investments and loans.

Chinese citizens have flocked to Africa, working in industries ranging from manufacturing and technology to health care and construction. Estimates of how many Chinese are now living in Africa range from about 200,000 to as many as two million.

Air travel between China and Africa has increased exponentially in the last decade alone, from one flight a day to an average of eight direct flights.

Ethiopian Airlines, Africa’s biggest and most profitable carrier, is the main gateway between China and Africa, shuttling up to 1,500 passengers each day between Addis Ababa and China on dozens of weekly flights. The airline has a center in the Addis Ababa airport to help Chinese travelers easily process their visas to dozens of African states. The Ethiopian airport itself was built in part with funding from China.

The Ethiopian carrier has continued operating its China routes while many other international airlines — including African carriers like Kenya Airways, Egypt Air, and Morocco’s Royal Air — have suspended flights to China.

The Ethiopian airline and government have now come under criticism in the midst of the coronavirus outbreak over speculation that China pressured the Ethiopian government not to halt the flights.

The office of the prime minister and Ethiopian Airlines both declined to comment, referring questions to the Ethiopian Public Health Institute, which is dealing with Ethiopia’s response to the coronavirus.

Lia Tadesse, Ethiopia’s state minister of health, said the decision to continue flights to China came not from her ministry but from “a higher government level.” But she denied there was any pressure from China.

Yet travelers between China and Africa can also arrive through hubs in other continents, providing further pathways for the virus.

So African countries and global health organizations are now scrambling to ramp up the capacity to cope with the epidemic.

Ethiopia has built isolation units at the airport in Addis Ababa, and designated specific intensive care units in hospitals, said Ms. Tadesse, Ethiopia’s health minister.

The W.H.O. said this week that four more countries — Ghana, Madagascar, Nigeria and Sierra Leone — can now conduct the tests. Ethiopia says it will have testing capabilities by the end of the week. But many other African countries will still have to send test kits elsewhere, delaying any response.

“Unfortunately, many disease surveillance systems throughout African countries are weak and most of the continent lacks diagnostic capability,” said Dr. Ngozi Erondu, associate fellow in the Global Health Program at Chatham House, an international affairs research group in London. “Identifying most cases and controlling the outbreak could be difficult, especially in the poorest and most resource-constrained countries.”

The World Health Organization is stepping up aid to 13 African countries that have direct links or a high volume of travel to China, working to improve early detection of cases and speed samples to labs that can do the tests. The agency has said it will need $675 million through April, primarily to assist poor countries in Africa and Asia with weak public health systems. The Bill and Melinda Gates Foundation on Wednesday committed $100 million to fight the virus, partly for at-risk populations in Africa.

With no cases yet confirmed in Africa itself, many Africans have focused their concern on the students who are living in China and may have been exposed.

About 4,600 African students and citizens live in the epidemic’s center, Hubei province, whose capital, Wuhan, is where the coronavirus first emerged, according to Development Reimagined, a consulting organization with headquarters in Beijing.

In all, more than 81,000 Africans were studying in mainland China in 2018, lured by generous scholarships, affordable tuition and the hope of becoming a bridge connecting their nations and an ascendant China.

The first African to be diagnosed with coronavirus is a 21-year-old Cameroonian student studying at Yangtze University in Hubei province.

The lockdown in Wuhan is taking a toll on students like Abdikadir Mohamed, a 23-year-old from Somalia who has been studying petroleum engineering at the China University of Geosciences in Wuhan.

Mr. Mohamed, who the Somali government said is one of 50 Somalis living in Wuhan, said that for nearly 20 hours a day, he doesn’t leave his one-bedroom apartment.

The experience is like being “stuck in a bad dream,” he said in a telephone call on Tuesday.

While other African countries, including Morocco, Mauritius and Egypt, have evacuated their citizens from China, Mr. Mohamed said that the Somali students’ pleas to their government to evacuate them have been futile.

“Our families are worried,” Mr. Mohamed said. “They are calling us every minute. If you don’t pick the phone at once, they panic.”

Simon Marks reported from Addis Ababa, and Abdi Latif Dahir from Nairobi, Kenya. Lynsey Chutel contributed reporting from Johannesburg, Ruth Maclean from Dakar, and Donald G. McNeil Jr. from New York.