by World Health Organization · 2020 · Cited by 3 — On 27 June 2020, the WHO African. Region and South Africa recorded their highest daily case count of 10 421 and 7 210, respectively. The WHO.

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 2 Date of issue: 1 July 20 20 Data as reported by: 30 Ju ne 2020 as of 00 :00 A M ( GMT+1 ) The coronavirus disease 2019 ( COVID – 19 ) outbreak continue s to grow in the WHO African Region since it was first detected in Algeria on 25 February 2020 . S ince our last External Situation Report 1 7 issued on 24 June 2020 (f rom 24 to 30 June 2020 ) , a total of 67 077 new confirmed COVID – 19 cases (a 28% increase) was reported from 45 countries. Of the 67 077 reported new cases in the region, 43% ( 45 101 ) were recorded in South Africa. South Africa rem ains the epicentre of the COVID – 19 outbreak in the region, consistently register ing the highest daily case incidence , now standing at more than 6 000 cases daily in the past week. O n 27 June 2020 , the WHO African R egion and South Africa recorded their high est daily case coun t of 10 421 and 7 210 , respectively. The WHO African region also recorded the highest daily death toll of 172 on 30 June 2020. During this period, six countries in the region observed the highest percentage increase in incidence cases: Seychelles 636% (from 11 to 81 cases), Zambia 213% (from 509 to 1 594 cases), Namibia 182 % (from 72 to 203 cases), Botswana 155% (from 89 to 227 cases), Malawi 58% (from 803 to 1 265 cases) and Angola 5 0 % (from 189 to 284 cases) . Seychelles reported new co nfirmed COVID – 19 cases after 78 consecutive days of zero reporting. The confirmed case – patients were part of 207 sea crew arriving on two Air Seychelles chartered flights. Eleven crewmen turned positive on antibody test, of which three tested positive by p olymerase chain reaction (PCR) on 24 June 2020. This event occurred just as the Government was considering opening up commercial flights and tourism from 1 July 2020. Only Equatorial Guinea and United Republic of Tanzania did not officially submit reports indicating any confirmed cases in the past week . A total of 26 new health worker infections were recorded from thre e countries : Malawi (18 ), Sierra Leone (5) and South Sudan (3) . From 24 to 30 June 2020 , an additional 898 COVID – 19 related deaths ( 17 % incr ease ) were reported from 31 countries , with 62% ( 555) of the deaths recorded in South Africa . This was followed by Nigeria , which registered the second highest number of deaths, at 57 , followed by Algeria with 51 deaths . The other countries that reported n ew deaths include; Democratic Republic of the Congo (35), Ethiopia (28), Senegal (23), Kenya (20), Ghana ( 17 ), Mauritania (16), Central African Republic (10 ), Benin (8 ) , Côte d’Ivoire (8 ), Cabo Verde (7), Zambia (6 ) , Cameroon (5), Madagascar (5 ), Mali (5), Malawi (5), Sierra Leone ( 5 ), Guinea – Bissau (5 ), Congo (4 ), Eswatini (4), Guinea (4), Angola (3), Gabon (3 ) , South Sudan (3), Liberia (2), Mozambique (1), Sao Tome and P rincipe (1) and Zimbabwe (2). During the reporting period ( 24 to 30 June 2020), the cumulative number of COVID – 19 cases in the region exceeded 300 00 0, and is now at 303 986 cases , including 303 665 confirmed and 321 probable cases , reported across the 4 7 Member States . The probable cases have been reported from Sao Tome and Principe ( 32 0 ) and Democratic Republic of the Congo (1). A total of 6 155 deaths have been reported in 42 countries , giving an overall case fatality ratio (CFR) of 2. 0 %. F ive countries (Eritrea, Seychelles, Lesotho, Namibia and Uganda) have not registered any COVID – 19 related deaths since the beginning of the p andemic. T he current figures in the region represents 2. 9 % of confirme d COVID – 19 cases and 1. 2 % of deaths reported worldwide. Table 1 shows the list of affected countries and their respective number of cases and deaths. T he daily and weekly distribution of cases by date and week of reporting are presented in Figures 1 and 2 , respectively . The highest number of cases in the region have been reported from 10 countries: South Africa ( 151 209 ), Nigeria ( 25 694 ), Ghana ( 17 741 ), Algeria ( 13 907 ), Cameroon (12 592 ) , 9 214 ), Democratic Republic of Congo ( 7 039 ), Senegal (6 793 ), Kenya (6 366) and Ethiopia (5 848) , which collectively account for 84 % (256 401) of all reported cases . Deaths 100 1. Situation update Cases 303 986 COVID – 19 Deaths 6 155

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 3 Of the 303 986 COVID – 19 c ases reported, 154 274 ( 51 %) have recover ed from across all the 47 countries in the region . As of 30 June 2020 , the countries reportin g high number s of deaths are: South Africa 2 657 ( 4 3 % ) , Algeria 912 ( 15 %), Nigeria 590 ( 9.6 % ) , Cameroon 313 ( 5. 1 % ) , D emo cratic Republic of the Congo 169 ( 2. 8 % ), Kenya 1 4 8 (2. 4 %), Mauritania 1 28 (2.1 %) , Mali 11 6 (2. 0 %), Senegal 112 (1. 8 %) , Ghana 112 (1.8%) and Ethiopia 103 (1. 7 %) . South Africa, Nigeria, Algeria and Cameroon account for 7 3 % of the total deaths reported in the region . T he highest case fatality ratios were observed in seven countries : Chad * (8. 5 %), Algeria ( 6.6 %), Niger (6. 2 % ), Burkina Faso ( 5. 5 %) , Mali ( 5. 3 ) , Angola ( 4 . 6 %) and Liberia ( 4.6 %) * . Figure 3 shows the distribution of cases and deaths by week of notif ication in the 12 most affected countries. A significant number of h ealth workers have been affected by COVID – 19 , with 6 066 ( 20 %) being infect ed in 38 countries s ince the beginning of the outbreak . Overall , South Africa has been the most affected , with 2 084 (34%) health workers infected, followed by Nigeria (987), Ghana (351), Cameroon (325), Niger (184), Guinea – Bissau (181 ), 5 ), Senegal (147) and Guinea (134) . The other 28 cou ntries that have recorded health worker infections are shown in Table 1 . Niger 17% (184/1 075) and Burundi 14% (24/170) have the highest country specific proportion of health workers. According to the available data on age an d gender distribution ( n = 7 454 ), t he male to female ratio among confirmed cases is 1. 7 , and the median age is 3 6 years (range: 0 – 105). M ales ( 6 2 %) in the 31 – 39 an d 40 – 49 age – groups are more affected than females ( 3 8 %) across t he same age – groups . The distribu tion of cases by age and s ex is presented in Figure 4 . Currently, 30 (64%) countries in the region are experiencing community transmission, nine (19%) have clusters of cases and eight (17%) have sporadic cases of COVID – 19. The region has also observed increased incidences of impor tation of cases from affected countries within the region , largely fueled by long – distance truck dr ivers and illicit movement through porous borders . As of 30 June 2020 , t he seven African countrie s in the WHO EMRO Region reported a total of 99 706 confir med COVID – 19 cases: Egypt (68 311), Morocco ( 12 533 ), Sudan (9 258), Djibouti ( 4 682 ), Somalia (2 924), Tunisia (1 174) and Libya (824). Additionally, a total of 3 971 deaths has been recorded from Egypt (2 953), Sudan (572 ), Morocco (228 ), Somalia (90), T unisia (50), Djibouti (54) and Libya ( 24). A cumulative total of 403 692 confirmed C OVID – 19 cases 101 26 deaths (case fatality ratio 2.5%) with 192 364 cases that have recovered have been re ported in the African continent . * Chad and Liberia are implement ing community mortality surveillance that could have attributed to high case fatalit y ratios. Country Total Cases Total Deaths Recovered Cases Probable Cases Health Workers Proportion of Health Workers (%) South Africa 151 209 2 657 73 543 0 2 084 1. 4 Nigeria 25 694 590 9 746 0 987 3.8 Ghana 17 741 112 13 268 0 351 2.0 Algeria 13 907 912 9 950 0 0 0.0 Cameroon 12 592 313 10 100 0 325 2.6 Côte d’Ivoire 9 214 66 3 996 0 179 1.9 Democratic Republic of the Congo 7 039 169 1 801 1 158 2.2 Senegal 6 793 112 4 431 0 147 2.2 Kenya 6 366 148 2 039 0 64 1.0 Ethiopia 5 846 103 2 430 0 87 1.5 Gabon 5 394 42 2 420 0 57 1.1 Table 1. Number of confirmed COVID – 19 cases in the WHO Afri can Region, 25 February 30 June 2020 ( n = 303 986 )

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 4 Guinea 5 391 33 4 326 0 134 2.5 Mauritania 4 237 128 1 497 0 0 0.0 Central African Republic 3 745 47 787 0 1 0.0 Madagascar 2 214 20 994 0 2 0.1 Mali 2 181 116 1 474 0 0 0.0 South Sudan 2 007 38 279 0 97 4.8 Guinea – Bissau 1 654 24 317 0 181 10.9 Zambia 1 594 24 1 329 0 111 7.0 Sierra Leone 1 462 60 974 0 155 10.6 Congo 1 329 41 486 0 49 3.7 Malawi 1 265 16 260 0 122 9.6 Cabo Verde 1 227 15 629 0 40 3.3 Benin 1 199 21 333 0 2 0.2 Niger 1 075 67 943 0 184 17.1 Equatorial Guinea 1 043 12 208 0 53 5.1 Rwanda 1 025 2 447 0 0 0.0 Burkina Faso 962 53 838 0 90 9.4 Mozambique 889 6 232 0 93 10.5 Uganda 889 0 819 0 27 3.0 Chad 866 74 781 0 75 8.7 Eswatini 812 11 408 0 17 2.1 Liberia 780 36 324 0 65 8.3 Sao Tome and Principe 714 11 236 320 40 5.6 Togo 643 14 401 0 25 3.9 Zimbabwe 591 7 163 0 2 0.3 United Republic of Tanzania 509 21 180 0 1 0.2 Mauritius 341 10 327 0 30 8.8 Comoros 303 7 200 0 0 0.0 Angola 284 13 93 0 1 0.4 Botswana 227 1 28 0 3 1.3 Namibia 203 0 24 0 3 1.5 Eritrea 203 0 56 0 0 0.0 Burundi 170 1 115 0 24 14.1 Seychelles 81 0 11 0 0 0.0 Gambia 49 2 27 0 0 0.0 Lesotho 27 0 4 0 0 0.0 Total ( n =45) 303 986 6 155 154 274 321 6 066 2 0

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 5 * Week 2 7 includes partial data for two days Figure 1. Daily number of confirmed COVID – 19 cases in the WHO African Region by country, 25 February 30 June 2020 ( n = 303 986 ) Figure 2. Weekly number of confirmed COVID – 19 cases in the WHO Africa n Region by country , 25 February 30 June 2020 ( n = 303 986 )

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 6 Figure 3. Epicurves showing distribution of confirmed cases and deaths with case fatality ratios of COVID – 19 in the top 12 reporting countries: South Africa, Nigeria, Ghana, Algeria, Cameroon, C ôte Congo, Senegal, Kenya, Ethiopia , Gabon and Guinea, 25 February 30 June 2020 ( n= 261 795 )

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 8 emerged from an animal species , as has been the case for other coronaviruses. The exact extent of the outbreak remains unknown. On 30 January 2020, the WHO Director – General declar ed the COVID – 19 outbreak a public health emergency of international concern (PHEIC), with temporary recommendations issued for all countries. On 28 February 2020 , WHO raised the risk assessment for the COVID – high”. The WHO Regional Office for Africa (AFRO) is working closely with its 47 Member States, as well as partners, in order to implement several outbreak preparedness and response interventions. Coordination The WHO AFRO COVID – 19 Incide nt Management Support Team (IMST) is supporting countries with priority for hot spots and countries with major change in their case pattern including risk factors; response performance and other gaps or challenges. The team is advising and supporting count ries to streng then routine health service delivery program me s even during the COVID – 19 pandemic. To that effect, the AFRO IMST focal points are linking with WRs to assign focal persons to focus on improving continuity in routine health services. Su r vei llance The Surveillance Pillar of the IMST continues to provide technical support to Member States to improve active surveillance, including alert management systems, case investigations and contact tracing. During the reporting week, technical support was provided to many countries . A mechanism for tracking of cases in neighboring countries in order to report confirmed cases during cross – border screening is being established to avoid missing cases from the country of origin or duplication of notifications in two countries. An a nalysis is being carried out on the imp act of the lockdown on the current epi – situation (joint analysis on the lower trend of COVID in Africa) . A rapid assessment of the status of COVID – 19 surveillance was initiated in the 47 countrie s of the region to inform targeted technical support and guidance . Infection Prevention and Control (IPC) WHO AFRO supported eight countries, including Angola, Democratic Republic of the Congo, Senegal, Sout h Africa and Tanzania. In these countries, 1 131 IPC trainers are now available, along with 9 381 trained health workers. At the same time 3 658 households of COVI D – 19 confirmed patients were disinfected, along with 513 healthcare facilities and 133 COVID – 19 treatment centres were assessed. T he IPC monitoring and evaluation framework was developed and will start receiving data from 45 of 47 countries next week. Lab oratory The AFRO laboratory team validated R apid D iagnostic T ests evaluation protocols in Se negal and Burkina Faso and also supported Burkina Faso in study implementation. A webinar on – was organized for all countries in the region. A laboratory database has also been developed. The team i s regularly monitoring and analyzing influenza data to see the impact of COVID – 19 response measures including lockdown on influenza . Support to countri es that are conducting surveillance for seasonal and pandemic influenza is also ongoing. A team of exper ts have been deployed in Sa o Tome and Principe and have operationalized the PCR laboratory for COVID – 19 testing. 4 . Actions to date

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 9 Laboratories are w ork ing closely with the surveillance team to enhance laboratory information management including: tests per capita; p ositivity rate of specimens tested; and a nalysis of laboratory information based on sampling strategy to provide a better understanding of the regional status. Case management WHO has donated 50 beds and mattresses to help with establishment of an isolation cent re at Ndolo Prison in the De mocratic Republic of the Congo . The team p resented on AFRO guidance on Case Management and Anti – biotherapy: Lessons learnt, best practices, challenges and way forward at the Webinar A ntimicrobial R esistance threat during COVID – 19 response taking action on antimicrobial stewardship. A total of 370 participants attended across the continent. A WCO case management officer is supporting the M inistry o f H ealth in the Ghana team in mapping available treatment cent re s across the country to address increasing number of cases. A curriculum was developed for community health workers along with Guidelines on healthcare worker s performing CPR in a COVID – 19 patient . G eneral and specific technical advice was provided on p rone position ventilation and h ome management of COVID – 19 patients. Risk Communication The communication team at AFRO supported Nigeria, South Sudan, Lesotho, Eswatini, Sierra Leone to address Stigma and resistance. In Nigeria, 1 808 Town announcers from 226 wards in Adamawa State were trained on COV ID 19 and their role in the con tainment of the disease and11 000 people reached using mobile vans; 108 CSOs were sensitized in Kano state on prevention strategies; Yobe state sensitized bike riders on correct use of face masks; 100 media correspondents and news reporters were trained in Kana state The team briefed the elderly people and equipped them to protect themselves, peers and other members of community against COVID – 19 Burkina Faso . The communicatio n team c onducted capacity building on risk communica tion and community engagement, Mauritania. The team also trained field team leads in Nigeria and Senegal, trained local journalists in three region of Cote D prison administrators and transport union delegates in Cameroon. In Ghana, training of 100 District health staff, engagement of traditional leaders, sensitization of fishermen and dissemination of key messages in the central Region. A 2 – day sta keholder engagement and material development workshop was organized by USAID Breakthrough Action and focused on communication needs assessment for stakeholders to generate knowledge and information for print and audio materials for COVID – 19. 50 blind stude nts were sensitized on prevention and control measures. Engagement of the public using mass media was intensified throughout the country. Logistic s A total of 37 countries placed request s in the UN supply portal for an amount of 34 million laboratory te st kits with sample collection kits, 22 million units of personal protective equipment and five million units of biomed equipment. Delivery of lab test kits is starting this week and is expe cted to continue during the following weeks . Delivery of PPE was e xpected to start next week but partner s are facing challenges in organizing shipment s from China. An a lternative solution being explor ed in order to retain the same estimated time of arrival . The AFRO logistics team doubled the number of laboratory shipmen ts and new ad – hoc routes have been opened with a progressive increase in the number of commercial flights. Emergency Medical Team Preparation of a scoping mission in Addis Ababa with WHO/AFRO EMT, HQ, M inistry of H ealth and WFP for the technical discussi ons of the implementation of the Regional EMT Simulation Center. Monitoring the submission of operational partner projects at the co untry office level (NGOs and academic institutions) and activities of technical thematic group with academic institutions.

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 10 D eployment of Malteser EMT in Cameroon is underway with the arrival of the team leader in the field. Ongoing discussion with IMC and UK – MED for the implementation of their deployment in South Sudan. There is o ngoing discussion with Zambia for implementation of National EMT with the support of UK Med and DFID , with c ontinued m onitoring of EMT activities for experts deployed in Zambia and Ghana. The AFRO IMT team has continued to organize a weekly meeting with operational partners. Human Resources Since the outbreak started, a total of 232 experts have been deployed to 39 c ountries , including the Regional Office in Congo , to support : Coordination (33), Surveillance (19), Laboratory (14), IPC (24), Case Management (19), Point of Entry (5), Epidemiology (11), R isk Com (22), Media Com (10), Logistics (19), Partnership coordination (2), Data Management (15), Information Management Officer (1), SHOC Sup port (1), Training & Capacity Building (2), Planning & Monitoring (1), technical support to Countries (focal point s) (25), Resources Mobilization (2), Planning & Information Management (1), Translator (2), staff wellbeing (1), EOC (1) Technical advisor (1) and Writing and Reporting (1). The team is conducting a dvocacy at higher level for more flexible funding within the region . The l ockdowns and international flights restricti on s in most African countries remain the main challenge s affecting the deployment of experts to support national response s . WHO recommendations for international traffic in relation to COVID – 19 outbreak are available at https://www.who.int/news – room/articles – detail/updated – who – recommendations – for – i nternational – traffic – in – relati on – to – covid – 19 – outbreak WHO continues to monitor IHR measures being implemented by countries in the region: All countries in the region are conducting entry screening at the Points of Entries (PoEs), mainly at the airports, with some doing so at seaports and ground crossings. Due to movement of goods through the ground crossing, countries have intensified screening at ground crossing s, which has led to detection of COVID – 19 cases among truck drivers . A total of 24 countries a re implementing lockdown; natio nwide lockdown in 13 countries and lockdown in affected areas in 11 countries. Eight countries have started a phased easing of the lockdown measures. The COVID – 19 outbreak continues to evolve in the WHO African Region , w ith the numbers of new cases and deaths rapidly increasing. The pandemic in the region is mainly driven by Sout h Africa, al though four other countries ( Nigeria, Algeria, Ghana and Cameroon ) are also reporting larger number of cases . These five countries ac count for 72% of all cases and 74% of all deaths. Many governments are gradually easing their lockdown restrictions, including the reopening of businesses and the gradual reopening of schools; however, restrictions on border cros sings and flight operatio ns largely remain in effect. With a few reports from countries on r e – introduction of lock down in some countries leading to civil unrest, including attacks on ministry of health vehicles and healthcare workers, there is need for co untries to start focusing on protection of responders. Countries must continue with strong implementation of comprehensive public health measures in order to slow down this rapid growth in cases. The cornerstone of the response in every country is to find, isolate, test and care 6. Conclusion 5. IHR travel measures and cross border health

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Health Emergency Information and Risk Assessment WHO Health Emergencies Programme Pa ge 11 for every case, and to trace and quarantine every contact. Additionally, c ommuni ties need to adhere to physical distancing , with good personal hygiene practices and cough e tiquette . Annex 1. Global and Regional time line for COVID – 19 as of 20 June 2020

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