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Coronavirus and Africa - in the Democratic Republic of the Congo, Lessons Learned from Ebola Applied in the Fight Against Covid-19.

BLOG - 20 April 2020

The Democratic Republic of the Congo (DRC) had 332 confirmed cases as of April 20. The epidemic broke out in the country on March 10 and the government quickly set up a Multisectoral Response Committee. How could the sanitary situation evolve? Which measures have been implemented ? What lessons have the authorities learnt from their experience in managing the Ebola epidemic? What are the economic consequences? Eric Ntumba, Corporate and Investment Banker working in the Democratic Republic of Congo, who was part of the first promotion of Africa France Young Leaders, answers our questions.

What is the current health situation in the DRC? How could it evolve in the coming weeks?

The health situation in the DRC is critical in every respect. Existing medical infrastructures have long been in a state of advanced decay and the current crisis only serves to reveal to the population the extent of the health disaster that lies ahead, primarily because of this infrastructural deficiency. Indeed, the DRC has less than 100 respirators for a population of more than 80 million.

If we stick to the official figures, however, the situation appears to be under control. As of April 20, 332 confirmed cases and 25 deaths were reported (already the highest case-fatality rate of the virus in sub-Saharan Africa).

The picture becomes darker when the following parameters are taken into account.

  • This continent-like country of more than 2.3 million km2 only possesses a single test-processing centre, the laboratory of the National Institute of Biomedical Research (INRB) in Kinshasa.
  • For a long time, this laboratory has only been able to analyze 50 tests per day, even if the 100-test threshold was nearly reached on Thursday, April 9, which saw 98 tests performed (revealing 8 new case confirmations).
  • Total lockdown seems virtually impossible in a country where more than 70% of the population subsists from day to day and relies on its ability to generate a daily income in order to survive.
  • The barrier gestures are barely followed by the population, which is not entirely convinced of the existence of the pandemic, nor of its virulent nature, and which seems for the most part intent on continuing to live as if nothing was happening.

At this stage, and faced with this situation, we remain unable to grasp the true extent of the Covid-19 contamination in the DRC, as the sample of people already tested is insufficiently representative. Moreover, it is difficult to quantify the scale of what lies ahead in the coming weeks. All the more so considering that, while the strategies adopted in Europe were mainly aimed at flattening the curve so as not to overwhelm the healthcare system, in DRC, the healthcare system is inherently already saturated.

One of our greatest fears rests on the fact that, until now, malnutrition, whose effect on the immune system is well known, has not yet been listed among the risk factors.

At this stage, our greatest hopes come from Dr. Raoult's unconfirmed hypotheses from Marseille and the use of his protocol combining hydroxychloroquine and azithromycin. One of our greatest fears rests on the fact that, until now, malnutrition, whose effect on the immune system is well known, has not yet been listed among the risk factors. An increase in contamination in a country that is locally affected by hunger (recent cases of famine in the Kasai provinces) could prove disastrous.

What is the government's strategy to combat the epidemic? What lessons have the authorities learned from their experience in managing the Ebola epidemic?

The government reacted promptly to the first confirmed Covid-19 cases, drawing on the expertise of Professor Muyembe, a world-renowned virologist and co-discoverer of the Ebola virus in the 1970s, who directed the response to the latest Ebola resurgence in Eastern DRC. The authorities set up a Multisectoral Committee to lead the response, created an emergency fund, decided to isolate Kinshasa (the outbreak site) from the other provinces, closed the borders, suspended non-essential activities and trade and declared a state of health emergency.

The government has mainly been criticized because it has merely reacted to the crisis, whereas a proactive response would have been desirable in light of the development of the pandemic in Europe, especially considering the density of interactions between the African continent and its European diaspora.

Another object of criticism was the announcement, and then the withdrawal shortly before midnight - the day before it was meant to be enforced - of the  "intermittent total containment" of the city of Kinshasa, which blurred the message about the appropriate strategy in the face of the pandemic. The measure, meant to last for two weeks, was to alternate between four consecutive days of total lockdown and a free period of a few days to get fresh supplies. There is every reason to believe that taking a step back from this decision had more to do with security and public order imperatives than anything else. It has since been replaced by a progressive lockdown, limited at this stage to the wealthy area of La Gombe, where are located the main institutional and business headquarters of the country.

The government's experience in managing the Ebola epidemic is noticeable in the speed with which a response strategy and structure was put in place, but more importantly in the clear clarification of who would lead the effort. Indeed, the fight against Ebola had been hampered by structural and ego wars, which were finally clarified by the President in July 2019 when he appointed Professor Muyembe leader of the response effort, which led the Minister of Health at the time to resign. A clear chain of command for the response is a tremendous help in channelling efforts. Also noteworthy is the level of local expertise of healthcare personnel already familiar with epidemic control practices and having worked in tackling Ebola in DRC and Western Africa.

Does the population support the measures adopted by the government?

As far as possible, yes. But it is impossible for some citizens to respect the measures of social distancing advocated. This is the case, for example, of the rule prohibiting more than 20 people in a small space, which is difficult to respect for a group of 40 people living in a cramped place. The same is true regarding public transport, where people have no choice but to pile up on each other, or in market places, where promiscuity is a constant reality.

The Congolese or the Kinshasan populations cannot be analyzed as a coherent whole.

We must face the obvious fact that the Congolese or the Kinshasan populations cannot be analyzed as a coherent whole. On the one hand, the elite and the middle class have embraced the measures adopted and have often pleaded for the government to act faster and go further by imposing a binding framework for social distancing and lockdown. This section of the population immediately adopted the wearing of masks, stocked up on supplies in anticipation of the lockdown, withdrew their children from schools (even before the official measure was taken), etc. This is a very positive development. But this category of the population, which lives and breathes in a Parisian or New York pace of life, is not representative of the life of the average Congolese, who perceives these measures as a double punishment. In fact, deprived of the possibility to travel, ordinary Congolese did not contribute to the importation of contaminated cases, yet they must face a strict lockdown that threatens their daily survival.

A hopeful note, however, is the commitment of those who have understood this public health issue and who are striving to popularize barrier gestures, to donate masks and hand sanitizers, and to conduct awareness campaigns aimed at all audiences without expecting anything from the government, which has subsequently done its part.

Is the healthcare system resilient enough to deal with the epidemic?

The health system in the DRC has been in agony for a long time. The long adopted deceit by the wealthy, often politically connected classes, has been to outsource this responsibility first to the West, and more recently to India or South Africa. For a long time, there were emergency evacuations to Europe, trips for regular check-ups, operations or births abroad. Having the necessary resources was enough to consider that the decay of the healthcare infrastructure in the DRC was not really their concern.

Faced with Covid-19, there is no possible exile, and we will all have to make do with our 50 ventilators, oxygen shortages, and the non-existence of organized emergency services

This pandemic will have had the merit of completely shattering this myth, bringing us face to face with our irresponsibility and the need to change things in the future. Faced with Covid-19, there is no possible exile, and we will all have to make do with our 50 ventilators, oxygen shortages, and the non-existence of organized emergency services (such as paramedics).

This system needs to be rebuilt.

What will be the economic impact of the coronavirus in the DRC?

The economic impact will be significant. While the government is doing its best in trying to mitigate the effect on small businesses, bankruptcies and job losses will nonetheless happen.

The extroverted nature of the Congolese economy will have a severe impact on its already precarious balances and on the government's ability to generate the revenue needed to implement its budget. Indeed, the DRC imports everything it consumes and exports mainly raw materials without local processing. In addition, its trade is particularly concentrated with China, whose growth rate has significantly declined, the direct consequence being a reduction in its demand for the minerals that the DRC exports. The Congolese government will therefore find it difficult to cope without an intervention, even temporary, by the IMF and other donors. The constraints on local businesses, individuals, and households imposed by the fight against the epidemic will surely reinforce these effects (working from home, low demand, difficulty in fulfilling orders), especially with regards to the informal part of our economy, which is by far the largest.

The lesson will be the same on a global scale everywhere, albeit to varying degrees: to reduce dependence on supply chains or outlets that are too far away, by giving priority to the development of local production, to ensure the extraction of maximum local added value through the processing of our raw materials before export, and to guarantee the emergence of a regional market based on short circuits. It is undoubtedly time to push the African Union's agenda on the African Continental Free Trade Area (AfCFTA), so that we are collectively less vulnerable in the future.

What are your recommendations to the Congolese population and decision-making bodies?

My only possible recommendation to the public would be to respect the barrier actions and measures advocated by the government. Only a collective effort could allow us to limit the damage caused by the pandemic. I wish Congolese authorities great courage in these difficult times, and hope they will dare to take decisions in spite of the lack of information regarding this ill-understood virus. My recommendation is that they should start thinking about the future immediately. We will emerge from this crisis, it is inevitable, and we must already think about the roadmap needed to initiate a rapid recovery and begin the necessary reforms to ensure that we never fall back to this level of health vulnerability again.

 

 

Copyright : ALEXIS HUGUET / AFP

 

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