Going to townships: covid-19 threatens Africa

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Hello and welcome to the Intelligence on Economist Radio. I'm your host, Jason Palmer. Every weekday we provide a fresh perspective on the events shaping your world. The coronavirus pandemic has drawn a lot of attention to a previously little known bit of medical equipment, ventilators. We take a look at what they do, how many there are, and whether attempts to make more of them will actually help matters. And lots of Canadians feel pretty strongly about lichens, a kind of hybrid organism that's found all over the place. But does the country need an official national lichen? Given the explosion of interest in a vote that closes today, many seem to think yes. First up, though, Africa has not yet been hit the hardest by the coronavirus. But fear is mounting. The continent has recorded more than 2,400 confirmed cases, a number that's rising steeply. Last week, the World Health Organization issued a stark warning. The best advice for Africa is to.

Prepare for the worst and prepare today because we have seen how the virus really speeds up and accelerates in other continents or countries. So that's our advice, and I think Africa should wake up.

African governments have already leapt into action, announcing air travel bans, closing borders and shutting schools. Kenya has imposed a dusk to dawn curfew starting tomorrow. And in South Africa, President Cyril Ramaphosa announced a strict 21 day lockdown to start at midnight tonight.

Without decisive action, the number of people infected will rapidly increase from a few hundred to tens of thousands and within a few weeks to hundreds of thousands. This is extremely dangerous for a population like ours, which has a large number of people with suppressed immunity because of HIV and TB and high levels of poverty and malnutrition. COVID 19 is going to hit Africa incredibly hard. And the health and economic effects on the continent are also going to be somewhat different in how they manifest compared with the rest of the world.

John McDermott is our chief Africa correspondent reporting from Johannesburg.

To start with, African countries health systems are much weaker than what you would find in the rest of the world. There's only roughly one doctor for every 5,000 people in Sub Saharan Africa, compared with about one in every 300 in Europe. And then all the kit that you would need in hospitals is much scarcer. So there's perhaps one ventilator per a million people in, in a place like Mali or Mozambique. And it's probably right that there are more ICU beds in your average American hospital than you'll find in most African countries. So it's hard to marshal a medical response, but it's also hard to organize a social one as well. The types of social distancing and lockdowns that we've seen in western countries are much harder to do in African countries, especially in African cities, where roughly 40% of the continent lives. Of that share, roughly half are in slums. And you can only imagine how difficult it must be to stay apart from people when you're living four, five, six people to a room. There's no running water. My friends in Soweto, the township here in Johannesburg, are already saying, look, it's just going to be so practically hard to impose the type of restrictions that you're seeing in rich world capitals.

And how much is the continent already dealing with the coronavirus? And what sense do you have of how it's spreading, how it will spread?

43 of the 54 African countries have reported cases of COVID 19. There's at least 2,400 cases across the continent, roughly half of which are in Egypt and South Africa. The South African cases are more numerous than anywhere else. And so far it seems to be following a trajectory akin to somewhere like Britain or Italy, which suggests that across Africa as a whole, there's no evidence yet that this will not spread in ways that we have seen elsewhere in the world.

Well, if anything, based on what you say, it could in fact be much worse in Africa.

It could well be. There are some potential advantages that people point to. There's hope that hot and humid conditions, which are obviously common across Africa, may slow the march of the virus, although we are not seeing that really yet. Perhaps most positively for Africa is the demographic side of things. There are just 6 million Africans over the age of 80, we think, compared with about 40 million in Europe. So while the spread of the disease may not be much slower, perhaps the overall effects of it could be a little less harmful. And of course, Africa has a lot of experience with dealing with infectious Diseases, they pop up with regularity every year. And the lessons learned, in particular from the recent Ebola outbreaks have stood the continent in relatively good stead when it comes to knowing how to address pandemics.

And are people taking COVID 19 seriously? I mean, how are populations responding?

Until recently, at least, the COVID 19 virus has been seen as what you might call a mzungo disease, a white person's disease. And on top of that, you'll find in certain places quite unusual views of what is happening. A poll in Nigeria recently found that more than a quarter of people felt they were immune, mostly because they were children of God. In Ethiopia, there's been a surge in the price of garlic and ginger because the orthodox church has been touting those as cures for the virus. Obviously, people believe strange things everywhere, but the degree to which they spread in Africa because of the high numbers of religious adherents and the size of WhatsApp groups on the continent, means that they can often spread much more quickly.

I guess there's not much governments can do about that part. But what about the inevitable economic impacts of all this?

The economic damage to Africa is going to be huge, and the response by governments cannot be of the same scale that you've seen in the rest of the world. The biggest consideration is that so many more Africans live precarious lives than do people in the rich world. 85% of people on the continent live work in the informal sector. That means they probably have few savings and no regular salary. If you lock them down, they cannot go to work. At the same time, when considering how they can respond in policy terms, African governments also have far fewer resources on which to draw. So they both face a bigger problem and a smaller ability to deal with it.

So what would change the calculus here? What could the rest of the world do to mitigate the horrors that you think are coming?

Well, obviously, the rest of the world has its own issues with COVID 19, but it's going to have to start paying attention to what's happening on the continent as well. Unlike western governments, African ones can't borrow huge sums of money to throw at this problem. So ultimately, they're going to have to get it from abroad in some way. Abiy Ahmed, Ethiopia's prime minister, has written to the G20 asking for a package totaling $150 billion for. For sub Saharan Africa. It gives you a sense of the scale of the ask that's going to be coming from governments across the continent.

But as you say, the rest of the world very much has its Hands full. Do you think that these governments stand a chance of getting what it is they'll need in time?

I don't know. Ultimately, it's going to require politicians in rich countries to step up. And it's not just a question of altruism. This is not just another ask to help Africans who are struggling. If the financial package does not arrive at some point, it is likely that governments on the continent will have to give up their efforts to fight the virus. And that would mean that even if COVID 19 was eradicated or quelled in much of the rich world, it would still be present in Africa, posing a risk to the rest of the world.

John, thank you very much for joining us.

Thank you, Jason.

The COVID 19 pandemic has created unprecedented demand for lots of medical equipment, most obviously masks, but also ventilators. While African countries have shockingly few of them, every country lacks enough of them to handle a large outbreak. They're usually used during major surgery or in the case of lung failure, exactly what about a tenth of COVID patients experience.

So we get to a stage where the patient is unable to breathe for themselves and therefore somebody needs to breathe for the patient, otherwise the patient will die. And this is where the ventilators come in.

Dr. Helgi Johansen is a consultant anesthesiologist at Imperial College Healthcare NHS Trust. He uses ventilators as part of his daily practice.

The ventilator is the last resort before the patient dies effectively. So this is really, really important and it's a really important part of the treatment of COVID 19 infection.

Patients infected with coronavirus are dependent on ventilators for longer.

It seems from the experience in Italy and the experience in China, that even young, relatively fit patients will be on a ventilator for approximately 10 days, which is a really long time. Most young people will only need ventilation for a day or two with a normal critical illness on top of that. If you end up with a patient who is less able to fight the infection themselves, the time of ventilation is much, much longer and could even be months.

That makes the ventilator shortage even more serious. So world leaders have started pushing non medical companies to start producing them.

We really only have a few weeks to build literally thousands of ventilators that this country will need. And it's an amazing. The British industry manufacturers are responding to this challenge with incredible energy and determination.

In Britain, the government has ordered 10,000 ventilators from Dyson, which usually makes household appliances. The design is new and not yet medically approved and it's unclear when the devices will arrive, but even if more were to be built, their operators, like Dr. Johansen, are scarce.

This does not mean that we necessarily have the people to run those ventilators. This is a highly skilled thing to do, certainly not something that you could learn in an afternoon, probably somewhere around the same as pilots and operating aeroplanes. This is going to be our challenge, particularly if staff starts to get ill and start to get the infection themselves and go off duty because of it.

The truth is, actually no one really knows fully how many ventilators there are available for healthcare systems to use across the world.

James Francham is a data journalist at the Economist.

So, for example, in America, the last survey of ventilators took place in 2009, and at that time there were an estimated 62,000 ventilators available to intensive care units, ICUs.

But whatever the number is, it's potentially not going to be enough kind of anywhere.

That's the danger. Yes, of course. So obviously we're not totally sure about the path of the likely virus and how it will spread. In America, for example, they're quickly trying to do another survey and to find out what the current number of ventilators is. One key thing from this is that not all ventilators are the same. So I would split them broadly into three categories. The the first is those that are used in the kind of home care market for people with existing health problems and perhaps with sleep apnoea. And the second would be non invasive ventilators which are used perhaps by ambulances. And then the third, which are the ones that really do kind of help people when they're in the severe stages of pneumonia, are invasive ICU type ventilators. I think in sum, whatever the number of ventilators America does have at present, it's unlikely to be enough, sadly, given the current path of the virus. Even if it were, say 200,000, it's likely that the number of ICU ventilators would be at capacity within about four weeks.

So the question then is about making new ones, as you say, or fashioning them in terms of making, I mean, how many are produced every year?

We don't know for sure. One company based in Sweden, Getinga, estimate that the total market for ICU ventilators is just 40,000 units a year. They say they have about 25% market share of that. So they produced 10,000 units last year and will increase capacity by about 60% this year. I spoke to a number of ventilator makers, some of which are large multinational Conglomerates which also do other healthcare products. Others are small firms which are specialists in ventilators, but pretty much across the board they're talking about increasing capacity by about 50 to 60%. There is a bit of a wrinkle there insofar as that Germany has two ventilator manufacturers that have fulfilled orders, will fulfil orders over the next kind of six to eight weeks for 16 and a half thousand ventilators for Germany alone. And that contrasts quite starkly with Italy, who has just one domestic manufacturer of ventilators, Sayare, but it's much smaller, so it will be increasing capacity from 125 ventilators a month to 500. Italy has also had to rely on aid from China, so they had a delivery of some thousand ventilators or so in order to increase capacity in the country there.

And there has been talk in Britain and elsewhere about the prospect of getting them essentially made on a contract manufacturing basis. Getting firms that don't normally make them to make them.

Yes, that's right. So about 10 days ago there was a call by the Health Minister and then subsequently by the British Prime Minister, Boris Johnson, to try to get companies such as Honda, Dyson, Rolls Royce, big UK manufacturers to start producing ventilators. And subsequent to that call they were sent a blueprint. It was reported, with a link to a YouTube video and an academic paper detailing out how this ventilator would be made.

But I mean, these are in some cases extremely complex medical devices. I mean, is that going to be, will that kind of thing work if companies that don't normally make them are even given the blueprints?

Yeah, they are tricky devices. I mean, they're not the most complicated machines, it's not rocket science, but they do have kind of a combination of mechanical and electronic parts. And I spoke to an expert, Helen Mess, at the Institute for Mechanical Engineers, and she pointed out that, you know, there's a lot that can go wrong with these things and that getinga, for example, in Sweden. So it takes them approximately two years to research and develop a machine and then a further two years to actually get the regulatory approval in order to sell it on the market. So you have to take a somewhat skeptical view of the idea that Britain's manufacturers can be sent a blueprint on one day and then six weeks be delivering these units to hospitals to be used in the time of a pandemic.

It sounds as if even if companies were able to, in a fleet footed way, start making these things as fast as they could, that might still not be enough to meet the demand.

There are problems upstream too, and that's the supply chain. So obviously the coronavirus began in China. It completely shut down in January and February. As a result, its industrial production of equipment fell by 26% in January and February. So there is going to be unfortunately a shortage of component parts such as printed circuit boards and valves for these ventilators as they're manufactured in Germany and China and America and elsewhere.

James, thank you very much for your time.

Thank you, Jason. My pleasure.

The COVID 19 pandemic is bringing immense uncertainty to citizens, governments and the global economy. Economist Radio is drawing on the expertise of our international network of correspondents to report on the crisis. On the science.

The more you understand about the mechanism of a virus, the more places there.

Are that you can glue it up on the economics.

The banks are in a really interesting position for this crisis because last time they were maybe the cause of turmoil and this time they could be one of the arms through which the impact of the crisis is dulled.

And on the politics of COVID 19.

Some worst case scenarios have a very large number of people dying. That is going to trigger very, very grave conversations about whose fault this is.

For the latest on the pandemic and more, join us on Economist Radio. Listen wherever you get your podcasts. Canada has a national tree. No surprise there. It's the maple. The country also has a national animal, the beaver, and even a national horse, the creatively named Canadian horse. But campaigners say what the country really needs is a national lichen. And today, after a gripping contest, online voting for one will close.

Lichen. They don't fit very well into kind of any ecological box.

Peg Fong is our Vancouver correspondent.

There are multiple species working together. Two fungi and algae are cyanobacteria. So it's fungus that has transformed into a greenhouse and really it's its own species.

What sort of ecological niche do they fill?

They're small, they hang off moss, they're smaller than other organisms, they're good for the soil. And if you walk outside, you can see them on your concrete. They hang off trees. They're a bit like moss. And first nations in Canada have been eating them for generations. You have to cook them first, of course.

And why is it that people believe that Canada needs a national lichen? A champion lichen?

Canada probably has more species of lichen than almost anywhere in the world. Russia may have similar number of species, but I like the definition of one lichenologist. I like what he said. He said, you know, lichens are a lot like Canadians. They're underappreciated and often overlooked. So that is why a lot of people who are fans of lichen and there seems to be many of them in Canada, they say, you know, we, we need a national lichen.

And do any other countries indulge this love? Have they picked a national lichen themselves?

No other country has a national lichen. California has a state lichen and for some reason lichen has been put on a number of stamps before. So a number of countries have put their lichen on stamps. But if Canada does get a national lichen, it will be the first.

Right. So how does the contest actually work? Where are things at the moment?

Well, it's very democratic. They had a field of experts in lichen choose the seven lichens that they believe that Canadians should vote on. And so there are seven contenders out there. And the vote started at the end of February and it's going to be extended because it's been so popular. I don't think they were expecting so many people to vote for a national lichen.

And do you have a vote yourself? Do you feel strongly about this?

I actually do. You know, I didn't know as much about lichen as I did before I started researching and looking into what lichen is all about. And I think they do, they do represent Canadians in many ways. Some lichens are very bright and some of them are very showy. But being dark haired myself, one lichen, the horsehair lichen, has been compared to brunette tresses hanging in the wind. And so I think that is my favorite lichen.

Once it happens, whether it's horsehair or any other. What happens once one is chosen? It goes on billboards, the currencies, stamps.

Well, the people who are the lichen experts hope that it will just make people appreciate Canadian lichens even more. There is hope that it might be designated officially by the Canadian government that we can have a national lichen that will be put on maps, put on flags, whatever. But the Canadian government said that they're not at this time considering a national lichen. So the people who are behind the vote think, you know what, as long as we get more people aware of lichen, that's good enough.

They're, they're liking what they're hearing.

It's a grassroots movement.

Thank you very much for joining us.

Thanks, Jason.

That's all for this episode of the Intelligence. If you like us, give us a rating on Apple podcasts and you can subscribe to the economist@exter.com radio offer 12 issues for $12 or 12 pounds. See you back here tomorrow.