As cases in Africa pass one million, Nigeria has tested less than 1% of its population. Here's why.
Posted August 7, 2020 3:55 p.m. EDT
Updated August 7, 2020 4:50 p.m. EDT
CNN — More than one million people in Africa have been infected with the novel coronavirus but health experts say the numbers do not give a "full picture" of the outbreak on the continent.
As of early Friday morning, Africa had recorded a total of 1,008,154 cases, and more than half of these are in South Africa.
Dr. Matshidiso Moeti, of the World Health Organization, said the cases are a small fraction of the global count but low testing in many African countries means infections have been under-reported.
The health agency said while testing facilities have increased in some countries compared to when the outbreak began in February, Africa still fell behind the global benchmark.
In Tanzania, the government claims it has defeated coronavirus and has not released any official data since May, and in Nigeria, the WHO is concerned that testing is not available at the grassroots level.
"The challenge is how to decentralize these tests available in states and in countries like Nigeria where we need to get to people in the local governments," the agency's program manager for emergency response for Africa, Dr. Michel Yao told CNN.
Long test result turnaround time
Nigeria, the African nation with the largest population, has tested less than one percent of its 200 million inhabitants as of Friday, and some in the country say getting a coronavirus test can be challenge.
While testing is free in state-owned laboratories, there are few of these facilities and they are in major cities. And sometimes, health officials have had to transfer samples to other states to confirm results due to a shortage of kits.
The state of Lagos is the epicenter of the virus in Nigeria, with 15,580 cases. It has recently closed health centers specifically created to treat Covid patients.
On Monday, the state's governor, Babajide Sanwo-Olu, announced that worship centers can accommodate half their capacity during services and restaurants are back in business, citing a steady decline in cases.
There are concerns that people there are self-managing their symptoms at home. Lagos has tested 66,431 samples so far, a fraction of its 20 million residents.
One resident told CNN he waited for two weeks to get a test at a government laboratory after he fell ill in June.
"I was going there many times, and it was not until my daughter made many calls, and I ran into a doctor friend who was at the hospital that day that I was able to do the test," Segun Bello-Osagie said.
Patient turned back
Bello-Osagie said a nurse turned him back at the first hospital where he sought treatment when he became sick.
"I was not allowed into the consulting area, and the nurse was shouting that I should not come in even though I was wearing a face mask, and she was dressed like an astronaut," Osagie-Bello told CNN.
"She said, 'We can't help you here, we don't attend to Covid people here,' even though I hadn't even been tested."
She referred him to a government hospital in the city attending to coronavirus cases. Osagie-Bello said he went home instead, fearing he may not endure the long drive and traffic to the hospital.
He said he began using herbal therapies that many claimed had helped them when they had similar symptoms while he self-isolated at home.
Osagie-Bello says that even though the government has proactively deployed measures to check the virus spread, the delays patients face could discourage them from going to hospitals.
"I know some people who have had symptoms suspected to be Covid-19 gave up on getting testing," he told CNN. He added that some hospital officials may tell patients to come back the next day.
Chike Ihekweazu, director of the Nigerian Center for Disease Control, acknowledged the slow turnaround time for testing and said the response was partly due to the challenge the country faced initially trying to repurpose its laboratories to test for the virus.
Ihekwaezu said South Africa in contrast, which has the highest numbers of testing on the continent and the highest numbers of cases, was able to easily do this.
Ihekweazu said the agency has been able to address problems sourcing kit reagents. But he was forced to turn to Twitter in April to seek testing material. He posted a message saying that the agency was "desperately" looking for more RNA extraction kits to expand testing in the country.
"We recognise that improving access to testing for COVID-19 is a major priority. We will continue to work closely with other stakeholders and partners to ensure that Nigerians can be tested in a timely manner that will also contribute to the control of this outbreak," Ihekweazu told CNN.
Another barrier to testing is cost, according to Mobihealth International CEO Funmi Adewara, whose organization is among those assisting laboratories with Covid-19 test sample collection, says.
Private facilities charge $132 for tests in addition to the cost of processing the tests. The fee, she says, is prohibitive for a majority of Nigerians without health insurance. Many hit by the economic impact of Nigeria's five-week lockdown to tackle the pandemic.
"How many people have that kind of money to pay for this test?" Adewara said.
She add that Nigeria's testing model excludes asymptomatic carriers, a critical data point that could give health officials a clearer insight into the outbreak in the country.
"We haven't tested enough to the point that we have data to interpret the pattern of infections if we're only testing those with symptoms, but the good thing is that the mortality rate seems low going by official figures," Adewara told CNN.
Dealing with a new virus
In the early days of the coronavirus outbreak, only two laboratories -- one in Senegal and one in South Africa -- had the capacity to test for the novel coronavirus. It took more than a week to confirm a positive case as samples were taken from different countries to these labs.
There are now more testing facilities but Yao with the WHO said the global demand for test kits has limited Africa's testing capabilities as international suppliers prioritize requests from countries in Europe, Latin America and the US with larger caseloads than most African countries.
But the African Union in partnership with aid organizations, including the WHO and the Jack Ma Foundation, has launched an initiative to aggregate demand across African countries to mobilize suppliers to produce more kits, according to Yao.
"We need to test wider and wider, not only those who are sick to be more confident so we're not swimming in the dark," Yao said