Are there differences in Africa’s responses to Ebola and Covid-19?

Fewer cases of Covid-19 have been reported in Africa compared with the United States and Europe (see Figure 1). It has been suggested that this is a result of the lessons learned from the fight against Ebola during the 2014-16 outbreak (predominantly in West Africa).

For example, the two viruses have different causes and consequences, which Africa’s responses to Covid-19 have taken into account. In addition, it seems that precautionary measures were implemented quickly following the announcement of the coronavirus pandemic, particularly when compared with the earlier Ebola outbreak.

Figure 1: Daily new confirmed Covid-19 cases per million people

Source: Roser et al (2020)

What do we know about the history and epidemiology of Ebola and Covid-19?

• Both are viral diseases and therefore infectious.
• Ebola emerged in 1976 in the Democratic Republic of the Congo and Sudan (now South Sudan). Covid-19 was first detected in Wuhan City, Hubei Province, China, on 31 December 2019.
• The sources of both outbreaks are still unknown, although there are suggestions that they might have a ‘zoonotic’ origin (passed from an animal to humans).
• The largest Ebola outbreak occurred in West Africa between March 2014 and June 2016. Its spread was somewhat limited, primarily affecting Guinea, Liberia and Sierra Leone. In contrast, by February 2020, more than 50% of the world’s countries had reported a case of Covid-19 infection. The outbreak was assigned pandemic status by the World Health Organization (WHO) on 11 March 2020.
• Ebola is transmitted through contact with an infected person’s fluid, while coronavirus is more easily transmitted via infected aerosols.
• Ebola virus kills faster than Covid-19. The mortality rate of Ebola, at 50%, far exceeds that of Covid-19, at 3.4% (Fox, 2020). Hence Ebola stands out as one of the deadliest infectious diseases, killing around a half of the people it infects.
• The reproduction rate of coronavirus (2.8) is higher than that of Ebola (1.9), which implies that Covid-19 infections spread faster in a population than Ebola (Fox, 2020).
• The prevalence of asymptomatic cases is lower with Ebola, at 25%, than with Covid-19, at 40% (Zhang and Jain, 2020). This means that Ebola victims are quickly bed-ridden, which, in turn, reduces contagion risk compared with coronavirus.
• Covid-19 can be transmitted asymptomatically, whereas the Ebola virus doesn’t spread until the victim shows symptoms. 
• The contagion process of the current pandemic has been perpetuated through three waves. There are suggestions that the third wave may be the deadliest given the new variants of the virus (Washington Post, 2021). The Ebola outbreak came in two waves, the second reportedly deadlier in some communities.
• There is considerable difference in where has been most affected by the two outbreaks. Ebola is prevalent in developing countries due to their agrarian economies. In contrast, it appears from Figure 1 that Covid-19 is more pronounced in developed countries.
• Ebola affects children more than adults, while the reverse is true for coronavirus (WHO, 2019; Avery et al, 2020). While this is confirmed by scientific studies, from an epidemiological standpoint there is no agreement on why one sub-population is more immune to one virus and less to the other.
• As Ebola affected a smaller area – primarily Guinea, Liberia and Sierra Leone – the implementation of social restrictions were essentially limited to these three worst hit countries. Covid-19 has had a more global impact, requiring simultaneous worldwide containment policies and responses.

Are there differences in the socio-economic effects of Ebola and Covid-19 on Africa?

To compare the socio-economic impacts of the two outbreaks effectively, it makes sense to look at Guinea, Liberia and Sierra Leone, as it was here that the Ebola outbreak was most prevalent. This will help to assess whether Ebola-hit countries were better prepared for the current pandemic. These countries are also representative of the continent of Africa, as more than 90% of Ebola cases occurred in them.

Figure 2: Cumulative Ebola cases and deaths (29 August 2014 to 23 March 2016)

Source: Ebola data from WHO (2021)

Figure 3: Cumulative Covid-19 cases and deaths (22 January 2020 to 9 February 2021)

Source: Covid-19 data from The New York Times repository

Figures 2 and 3 show a clear disparity in the numbers of cases and deaths in the two outbreaks (note the different numbers on the axes). These discrepancies follow from differences in the viruses’ epidemiology, as highlighted in the previous section.

Starting from Week 1, which refers to the week in which the first cases were reported in the countries, Figure 2 shows that by Week 31, the curves (cumulative cases and deaths from Ebola) had flattened out in Sierra Leone. This occurred even earlier in the other two countries.

In contrast, Covid-19 was still on the rise even 45 weeks after the first case. The descriptives in Figures 2 and 3 show that the impacts of the two outbreaks differ for these three countries and, by extension, Africa, as also seen in Table 1.

Coronavirus may have more devastating and more enduring effects on Africa’s economies compared with those of Ebola virus. Table 1 shows the human costs of both Ebola and Covid-19. In nominal terms, the costs of the Ebola virus outbreak to the economies of Guinea, Liberia and Sierra Leone in lost output and revenues are significant.

Some studies suggest that the effects of Ebola on these worst-hit countries, estimated to be between $82 and $89 million, are both temporary and negligible when compared with the likely impact of coronavirus on the aggregate economies of Africa, which is projected to be about $70 billion in lost output (Population Council, 2015; Rasul et al, 2020). The cost of containing Covid-19 is much higher than Ebola due to the former’s pervasive nature – leading to more infections and more deaths as shown in Table 1.

Table 1: Human costs of Ebola and Covid-19 in Africa

Sources: *Amadeo (2020), ** Coronavirus Worldometers (2021) at 05:25 GMT on 16/01/2021

What was the timeline of Africa’s response to the Ebola outbreak of 2014-16?

The response timeline of critical control and containment measures during the Ebola crisis of 2014-16 in Guinea, Liberia and Sierra Leone is presented in Table 2.

Table 2: Initial control/response actions to Ebola Virus Disease in the worst hit West African countries of Guinea, Liberia and Sierra Leone in 2014-16

Sources: Bullard (2018); World Education Service (2015)
Note: N.A. – Not available

There are suggestions that the actual first incidence of Ebola in Guinea might have occurred in late December 2013 (Lo et al, 2017). Still, it took around 11 weeks before the first official alerts were issued by the Guinea Ministry of Health about an ‘unidentified’ disease on 13 February 2014 (WHO, 2015). Four additional weeks passed before the WHO formally declared an Ebola outbreak, on 23 March 2014.

The timeline of the discovery of first cases in Liberia and Sierra Leone – on 26 and 29 March 2014, respectively – suggests that the ‘unidentified’ disease could have been in these countries much earlier than these dates.

Table 2 also shows the long time lag between the formal declaration of an Ebola outbreak and the subsequent critical response actions. This response lacked the urgency required in dealing with a deadly epidemic. For example, while Guinea was relatively quicker in closing its schools (within a few weeks of the formal declaration of the Ebola outbreak in March 2014), its land borders were not closed to its neighbours, Sierra Leone and Liberia, until after approximately 20 weeks on 9 August 2014.

Worst still, the outbreak was not declared a national emergency in Guinea until 13 August 2014 – also 20 weeks after the confirmation of the country’s first case. Sierra Leone and Liberia were also slow to react. Consequently, the flattening of the epidemic curve, signifying that transmission was slowing, did not commence until after the Week 20, as displayed in Figure 2.

What have been the responses of African countries to the coronavirus pandemic?

Africa’s responses to the current pandemic have been similar to those of other countries worldwide. A critical look at the details and timings of responses in Ebola-hit countries suggests that their experiences in the earlier outbreak informed their actions this time around. Compared to other countries, particularly those outside the continent of Africa, it appears that lessons were learned from the Ebola experience, which influenced the timing and specifics of Covid-19 responses in those (Ebola-hit) countries.

Table 3: Initial control/response actions to coronavirus pandemic (Covid-19) in selected countries (January to March 2020)

Source: Oxford University Covid-19 Government Response Tracker

Table 3 reveals that the selected countries embarked on public information campaigns about coronavirus within the first few weeks of January 2020, after the outbreak in Wuhan City became global knowledge on 31 December 2019. In the weeks that followed, each put in place some forms of testing policies to confirm if anyone showing the known symptoms of Covid-19 had the disease. It should be noted that while other countries tested selectively, both Guinea and Sierra Leone embarked on universal testing of any individual showing the symptoms.

Table 3 also shows that Guinea, Liberia and Sierra Leone were pro-active in putting in place some control on international travellers before confirming the first cases. Countries like South Africa (with the highest number of cases in Africa as of 1 March 2021), Egypt (which had the first documented case in Africa) and the United States all began their control measures on international travellers after recording their first cases. In the UK, no (strict) containment measure was imposed on international travellers within this early period of the pandemic (January to March 2020). Instead, international arrivals were advised to self-quarantine as soon as they landed in the country.

The case of Hong Kong is unique. It is a Special Administrative Region under China with a high volume of travel between the two territories. Still, on 3 January 2020, it pro-actively put in place a thermal imaging screening system to detect anyone arriving with any symptom of coronavirus, especially from mainland China. It did this almost as soon as the outbreak became global knowledge on 31 December 2020.

In Guinea, Liberia and Sierra Leone, critical containment measures (including school closures and restrictions on internal movement – lockdowns) were announced almost immediately after recording their respective first cases of the disease.

In other countries, similar control and containment measures were slower to be implemented. Many were not put in place until a few weeks after their first cases were documented (March 2020). The containment measures in Hong Kong began immediately after the first case was discovered. But there was no total regional lockdown within the period under review as the disease was effectively under control.

Conclusions

Overall, African countries that had previously experienced the Ebola outbreak were swifter and more comprehensive in their responses when Covid-19 emerged.

Partly, this could be attributed to the difference in knowledge about the two diseases at the time they struck. Lessons leaned from the Ebola outbreak may have informed the response to the current pandemic.

The differences in the responses of African countries to both Ebola and coronavirus have contributed to the varied effects of these diseases on their populations. More research is still necessary to explain these differences fully.

Apart from the African countries that were most affected by Ebola, the other place that took quick and decisive action in early 2020, as shown in Table 3, was Hong Kong. The success of the region’s pro-active measures is likely to be connected to the well-established national surveillance system developed during the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003. Hong Kong was the second most affected country by SARS after China (Hung, 2003).

This indicates that countries with previous experience of epidemics were more cautious and responded faster to the coronavirus pandemic.

Where can I find out more?

• The Oxford COVID-19 Government Response Tracker (OxCGRT) collects information on government responses to Covid-19.
• The WHO gives an insight into the cross-government responses to Ebola outbreak.
• The World Bank Blogs contain several write-ups on how the pandemic is affecting developing countries.
• The Nature details some socio-economic effects of Ebola and Covid-19 on Africa.

Who are experts on this issue?

• Imran Rasul, UCL
• Lotanna Emediegwu, University of Manchester
• Samuel Cohn, University of Glasgow

Authors: Lotanna Emediegwu and Emmanuel Oluwole Oni

Photo: EU Humanitarian Aid & Civil Protection on Flikr