ABSTRACT

The coronavirus disease 2019 (COVID-19) outbreak was first reported in a cluster of patients with fever and respiratory symptoms in Wuhan, China on 31 December 2019. The World Health Organization (WHO) declared the disease a Public Health Emergency of International Concern (PHEIC) on 31 January 2020 (WHO, 2020a) and designated COVID-19 a pandemic on 11 March 2020. By 11 March 2020, 116 countries had reported cases of COVID-19. Globally, as of 6 February 2023, there had been 754,367,807 confirmed cases of COVID-19, including 6,825,461 deaths, reported to WHO. The first reported case of COVID-19 was reported by Egypt on 14 February 2020.

The Skoll Foundation $4million grant to Sokoine University of Agriculture to support the activities of the SACIDS Foundation for One Health (SACIDS) and the East African Integrated Disease Surveillance Network (EAIDSNet), in providing expertise provision to the national public health authorities in their preparedness and response to the COVID-19 pandemic, which was then about to reach East and Southern Africa. This grant was linked to a separate grant by the Skoll Foundation to the Africa Centres for Disease Control and Prevention (Africa CDC) to facilitate collaboration and coordination of actions within the framework of the “African Continental Strategic Plan for COVID-19 Pandemic”, which included promoting evidence-based public health practice for surveillance, prevention, diagnosis, case management, and control of COVID-19 in Africa.

1.0 BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak was first reported in a cluster of patients with fever and respiratory symptoms in Wuhan, China on 31 December 2019. The World Health Organization (WHO) declared the disease a Public Health Emergency of International Concern (PHEIC) on 31 January 2020 (WHO, 2020a) and designated COVID-19 a pandemic on 11 March 2020. By 11 March 2020, 116 countries had reported cases of COVID-19. Globally, as of 6 February 2023, there have been 754,367,807 confirmed cases of COVID-19, including 6,825,461 deaths, reported to WHO.

COVID-19 is caused by a novel betacoronavirus, the 2019 novel coronavirus (2019- nCoV (Huang et al., 2020), later named as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Coronaviruses are enveloped non-segmented positive-sense RNA viruses belonging to the family Coronaviridae and the order Nidovirales which broadly infect humans and other mammals (Erles et al., 2003; Richman et al., 2016). Although some coronaviruses had been associated with severe disease in animals (Erles et al., 2003; Salajegheh Tazerji et al., 2020), human coronavirus infections were regarded as mild until 2003, when the epidemics of the two betacoronaviruses, severe acute respiratory syndrome coronavirus (SARS-CoV) (Ksiazek et al., 2003; Kuiken et al., 2003; Drosten et al., 2003) and Middle East respiratory syndrome coronavirus (MERS-CoV) (de Groot et al., 2013; Zaki et al., 2012) were reported to cause mortality rates of about 10 and 37%, respectively (Ramadan & Shaib, 2019). The causative virus for COVID-19, SARS-CoV-2, is the third coronavirus associated with severe disease in humans and has been responsible for a global pandemic. Clinically, COVID-19 is characterized by fever, cough and myalgia or fatigue (Huang et al., 2020). Severe COVID-19 is associated with cytokine storm, a life-threatening systemic inflammatory syndrome involving elevated levels of circulating cytokines and immune-cell hyperactivation triggered by SARS-CoV-2 infection (Fajgenbaum and June, 2020). Some complications may develop in COVID- 19 and may include acute respiratory syndrome, acute cardiac injury and secondary infections.

The increasing economic interaction between Africa and China led to African health authorities to regard the threat of COVID-19 spread posed by these interactions to be high. China’s investment in Africa in recent years has led to an increasing number of direct and indirect flight connections to the African continent from China (Brautigam et al., 2018; Wang et al., 2019). An estimated 2 million Chinese live and work in Africa. On the other hand, numerous Africans are increasingly travelling to China for study, business or leisure. On average, prior to the outbreak of COVID-19, eight flights a day operated between China and African cities (Kapata et al., 2020). Analysis conducted before COVID-19 introduction to Africa indicated that 13 nations with close links with China, including Nigeria, South Africa, Kenya and DRC, were at high-risk and were priority zones for proactive surveillance, detection and containing the spread of COVID-19 (Kapata et al., 2020). Seven African countries (Algeria, Cameroon, Egypt, Morocco, Nigeria, Senegal and South Africa) reported a case of COVID-19 by March 9, 2020. Concerted efforts needed to be made to prepare the region to deal with a potential outbreak of COVID-19. The first COVID-19 in Africa in February 2020 was reported in Egypt. The index cases in Tanzania, Democratic Republic of the Congo (DRC), Zambia and Mozambique, in March 2020, were linked to outbreaks in Europe, the Middle East and South Africa, rather than directly from China.

All index cases of COVID-19 reported in the WHO African Region were linked to travel history. Following the introduction of COVID-19, most African countries were characterized by high levels of vulnerability and there were increasing reports of community transmission. As COVID-19 spread grew exponentially in the African region, surveillance and risk assessment were critical for informed decision-making process to manage the pandemic.

Based on the movement network structure between African countries and other countries of the world, the risk of COVID-19 introduction to Africa remained high. Before and after the introduction of COVID-19 to Africa, SACIDS Foundation for One Health (SACIDS) (with its headquarters at Sokoine University of Agriculture in Morogoro, Tanzania) was on the frontline in the provision of technical expertise to countries to enhance the disease surveillance and risk assessment at different risk- points. The areas of focus included enhancing COVID-19 surveillance at the Port of Entry (PoE), sentinel surveillance, communities of high-risk cross-border ecosystems and self-reporting in the region. The SACIDS initiative was driven by its core conceptual strategy, focusing on addressing disease outbreaks at the source for Community-level One Health Security to progressively influence National, Regional and Global Health Security Agenda.

The Skoll Foundation linked grants to SACIDS, the East African Integrated Disease Surveillance Network (EAIDSNet) and Africa Centres for Disease Control and Prevention (Africa CDC) were timely and enabled us to collaborate and coordinate actions within the framework of the “African Continental Strategic Plan for COVID-19

Pandemic”, which includes promoting evidence-based public health practice for surveillance, prevention, diagnosis, case management, and control of COVID-19. To meet the surveillance objectives, high priority is given to (a) ensuring high-quality screening at ports of entry, among contacts of cases, and other high-risk settings, (b) enhancing existing influenza-like illness (ILI), severe acute respiratory infection (SARI), and event-based surveillance systems, (c) supporting the complete and prompt investigation of cases and tracing of contacts; (d) adapting health information systems for managing case and contact data; (e) monitoring and reporting numbers, characteristics, and outcomes of cases that are both clinically diagnosed and laboratory confirmed, and (f) investigating rumours and supporting prompt communication to debunk false stories.

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