Africa passes 1M confirmed virus cases; true number far more

Africa passes 1M confirmed virus cases; true number far more
Recently filled graves are seen in the Olifantsveil Cemetery outside Johannesburg, South Africa, Wednesday Aug. 5, 2020. The frequency of burials in South Africa has significantly increased during the coronavirus pandemic, as the country became one of the top five worst-hit nation. New infection numbers around the world are a reminder that a return to normal life is still far from sight. (AP Photo/Jerome Delay)

Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts say the true toll is likely several times higher, reflecting the gaping lack of testing for the continent's 1.3 billion people.

While experts say infection tolls in richer nations can be significant undercounts, large numbers of undetected cases are a greater danger for Africa, with many of the world's weakest health systems. More than 22,000 people have died of COVID-19.

The World Health Organization calls the milestone a "pivotal point" for Africa as infections in several countries are surging. The virus has spread beyond major cities "into distant hinterlands" where few health resources exist and reaching care could take days.

Immediately knowing they were at a disadvantage, African nations banded together early in the pandemic to pursue badly needed testing and medical supplies and advocate for equitable access to any successful vaccine. Swift border closures delayed the virus' spread.

But Africa's most developed country, South Africa, has strained to cope as hospital beds fill up and confirmed cases are over a half-million, ranking fifth in the world. The country has Africa's most extensive testing and data collection, and yet a South African Medical Research Council report last week showed many COVID-19 deaths were going uncounted. Other deaths were attributed to other diseases as people avoid health centers and resources are diverted to the pandemic.

Africa passes 1M confirmed virus cases; true number far more
In this April 29 2020, file photo, a resident from the Alexandra township gets tested for COVID-19 , in Johannesburg, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Jerome Delay, File)

It's all a warning for Africa's other 53 countries of what might lie ahead. While dire early predictions for the pandemic have not played out, "we think it's going to be here at a slow burn," the WHO's Africa chief, Matshidiso Moeti, said Thursday.

Just two African countries at the start of the pandemic were equipped to test for the virus. Now virtually all have basic capacity, but supplies are often scarce. Some countries have a single testing machine. Some conduct fewer than 500 tests per million people, while richer countries overseas conduct hundreds of thousands. Samples can take days to reach labs. Even in South Africa, turnaround times for many test results have been a week or longer.

"We are fighting this disease in the dark," International Rescue Committee expert Stacey Mearns said. In addition, Africa has just 1,500 epidemiologists, a deficit of about 4,500.

Africa passes 1M confirmed virus cases; true number far more
In this July 21 2020, file photo, funeral home workers in protective suits carry the coffin of a woman who died from COVID-19 into a hearse in Katlehong, near Johannesburg, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Themba Hadebe, File)

African nations overall have conducted just 8.8 million tests since the pandemic began, well below the Africa Centers for Disease Control and Prevention's goal of 13 million per month. Countries would love to increase testing if only supplies weren't being snapped up by richer ones elsewhere.

Africa CDC director John Nkengasong said estimating the true number of cases on the continent is "very tricky." Some 70% of infections are asymptomatic, he has said. Africa's young population also might be a factor. Without a dramatic increase in testing, "there's much we don't know."

But some experts are making their best guesses.

Africa likely has at least 5 million infections, said Ridhwaan Suliman, a senior researcher at South Africa's Council for Scientific and Industrial Research. He believes the true number in South Africa alone is at least 3 million. The country has conducted far more tests than any other in Africa—more than 3 million—but in recent days about 25% have come back positive. Because of shortages, South Africa largely limits testing to health workers and those showing symptoms.

  • Africa passes 1M confirmed virus cases; true number far more
    In this June 3, 2020, file photo, children run down a street past an informational mural warning people about the dangers of the new coronavirus, in the Kibera slum, or informal settlement, of Nairobi, Kenya. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Brian Inganga, File)
  • Africa passes 1M confirmed virus cases; true number far more
    In this July, 22, 2020, file photo, an open truck carries farmers wearing face masks on the first day of the curfew in Harare, Wednesday, July, 22, 2020. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Tsvangirayi Mukwazhi, File)
  • Africa passes 1M confirmed virus cases; true number far more
    Workers prepare for a burial at the Olifantsveil Cemetery outside Johannesburg, South Africa, Thursday Aug. 6, 2020. The frequency of burials in South Africa has significantly increased during the coronavirus pandemic, as the country became one of the top five worst-hit nations. New infection numbers around the world are a reminder that a return to normal life is still far off. (AP Photo/Jerome Delay)
  • Africa passes 1M confirmed virus cases; true number far more
    In this April 16, 2020, file photo, pallbearers wearing personal protective equipment suits lift the casket containing the remains of Benedict Somi Vilakasi for his burial ceremony at the Nasrec Memorial Park outside Johannesburg, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Jerome Delay, File)
  • Africa passes 1M confirmed virus cases; true number far more
    In this April 22, 2020, file photo, an ad spreading awareness against coronavirus is seen in Rabat, Morocco. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Mosa'ab Elshamy, File)
  • Africa passes 1M confirmed virus cases; true number far more
    Recently filled graves are seen in the Olifantsveil Cemetery outside Johannesburg, South Africa, Wednesday Aug. 5, 2020. The frequency of burials in South Africa has significantly increased during the coronavirus pandemic, as the country became one of the top five worst-hit nation. New infection numbers around the world are a reminder that a return to normal life is still far from sight. (AP Photo/Jerome Delay)
  • Africa passes 1M confirmed virus cases; true number far more
    In this July 10, 2020, file photo, COVID-19 patients are treated with oxygen at the Tshwane District Hospital in Pretoria, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Jerome Delay, File)
  • Africa passes 1M confirmed virus cases; true number far more
    In this May 21, 2020, file photo, a lab technician performs Covid-19 testing at a clinic in the Moutse Valley, 160 kms (100 miles) north east of Johannesburg, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. (AP Photo/Jerome Delay, File)
  • Africa passes 1M confirmed virus cases; true number far more
    In this July 29, 2020, file photo, a woman wearing a face mask to protect against the spread of the coronavirus, walks past ribbons tired onto the fence to represent South Africans who have died from COVID-19, at St James Presbyterian church in Bedford Gardens, Johannesburg, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. Whatever Africa's real coronavirus toll, the church has quietly been marking the country's "known" number of deaths by tying white ribbons to its fence. The project's founders say each ribbon really stands for multiple people. (AP Photo/Themba Hadebe, File)
  • Africa passes 1M confirmed virus cases; true number far more
    In this July 29, 2020, file photo, Silva Cossa, the caretaker, ties ribbons onto the fence to represents a South African who has died from COVID-19, at St James Presbyterian church in Bedford Gardens, Johannesburg, South Africa. Africa's confirmed coronavirus cases have surpassed 1 million, but global health experts tell The Associated Press the true toll is several times higher. Whatever Africa's real coronavirus toll, the church has quietly been marking the country's "known" number of deaths by tying white ribbons to its fence. The project's founders say each ribbon really stands for multiple people. (AP Photo/Themba Hadebe, File)

Experts see South Africa as an indication of what's to come elsewhere.

Sema Sgaier, an assistant professor of global health at Harvard and director of the while poorer ones scrape by on just hundreds of tests a day.

Moeti also worries about a related danger for which even less data exists: the number of deaths from diseases such as malaria, HIV and tuberculosis as resources are diverted to COVID-19.

Whatever Africa's real coronavirus toll, one South African church has quietly been marking the country's "known" number of deaths by tying white ribbons to its fence. The project's founders say each ribbon really stands for multiple people.

Already, the Rev. Gavin Lock wonders about what to do when the length of fence runs out. Maybe they'll change the ribbons' color to represent 10 people, or 50.

"It's a work in progress," he said.

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