When a passenger arriving from Brussels at Cameroon’s Yaounde Nsimalen airport was found to have a temperature, health officials whisked him to hospital and diagnosed inside four hours as the country’s fourth case of coronavirus.
The central African country was doing more generalised screening for disease before China revealed the new virus that killed more than 7 500 people globally. Along with other countries on the continent, it hopes its experience guarding against Ebola and other epidemics will help its health system cope with a pandemic that could quickly overwhelm it.
“We have cases not caught by measures in France and Italy we caught here,” Georges Alain Etoundi Mballa, who runs the health ministry’s epidemic response, told Reuters, describing the screening as a “spying network”.
“Epidemics come and go, but we maintain surveillance.”
The virus now ravaging Europe has appeared in 27 out of 49 countries in sub-Saharan Africa. In most recorded cases are still in single figures and have come from abroad – notably Europe – rather than emerging at home.
The stakes are high – if the disease reaches Africa’s poorest areas, squalid, cramped conditions could see it spread at lightning speed.
By Tuesday, Cameroon decided to close its land, air and sea borders indefinitely – an unusual step on a continent where the World Health Organisation (WHO) fears porous frontiers mean movements could continue unchecked.
Countries with no registered cases were taking action. Mali’s government suspended commercial flights from countries with the virus, while Niger is halting international flights and closing land borders for two weeks from Thursday, President Mahamadou Issoufou said in a statement.
Hospitals across Africa are overburdened with measles, malaria and other deadly infectious diseases and conflicts displaced hundreds of thousands of people and destroyed infrastructure.
Asking patients to self-quarantine at home is not practical in many areas, where families cram into a single room, share a communal tap or latrine and survive on daily earnings.
“Africa should brace for a serious challenge,” John Nkengasong, head of the Africa Centres for Disease Control and Prevention (CDC), said. “I believe containment is possible, but only with extensive testing and surveillance.”
In some places that seems all but impossible.
In South Sudan, devastated by a five-year civil war, the government has 24 isolation beds, said Dr Angok Gordon Kuol, incident manager for the outbreak at the Ministry of Health.
He said public officials were encouraging hand-washing, but many in the impoverished East African nation of 12 million people cannot afford soap and do not have running water.
The health ministry in Burkina Faso, under siege from jihadist groups linked to Islamic State and al Qaeda, said the country lacked resources to deal with the outbreak.
Its border crossings have no isolation sites for suspected cases and the West African country does not have enough skilled health workers, the report said. “This can result in high mortality rates and an increased risk of spreading the disease.”
Ebola killed more than 11 000 people in West Africa between 2013 and 2016, mainly in Guinea, Liberia and Sierra Leone. It devastated communities but provided valuable lessons.
The Africa CDC, set up by the African Union in 2017, works with the WHO to strengthen emergency co-ordination, improve testing and surveillance and equip treatment centres.
The number of countries with labs able to diagnose COVID-19 in WHO’s Africa region increased from two to 39 in a month. That leaves eight countries without.
With three confirmed cases, Nigeria, Africa’s most populous nation is scrambling to increase the number of isolation beds and provide specialised medical training and equipment at state hospitals.
“Our health system is not as strong as we’d like it to be,” said Chikwe Ihekweazu, head of the Nigeria Centre for Disease Control. “It is because we are a bit worried about our capacity to deal with a large outbreak that we are focused so intensively on prevention and early detection.”
Promoting good hygiene is a key part of the effort. That is easier said than done. Less than half the population in 34 African countries have basic hand-washing facilities in their homes, according to a 2017 United Nations survey.
In Senegal’s capital Dakar, announcements ring out through loudspeakers on cars urging people to wash their hands. A group of school children in soccer shirts reel off highlights from a recent lesson – a crash course in preventing COVID-19.
In their suburb, Pikine, where more than a million people live, water is frequently cut off.
“Cleanliness is important, but here it’s not easy,” said Marcelle Diatta, a 41-year-old mother of four who lives in a two-bedroom apartment with four extended family members.
Khary Faye Sougou, head nurse at a local health centre, encouraged residents to stockpile bottles of water; but not everyone can afford to do so.
In Senegal, a West African country that has recorded 31 cases, medical staff said they received limited protective equipment beyond extra gloves and masks.
“If we have a case, maybe I’ll go with a mask and my white coat,and after the visit I’ll throw them away,” Sougou said.
Ousmane Gueye, head of the crisis unit at Senegal’s health ministry, said government was deploying protective gear to facilities that need it.
There are ample stocks of masks and gloves and enough beds to accommodate more patients, according to health officials. There are no reserves of ventilators, in short supply across Africa.
In South Africa, which recorded over a 100 cases of the virus, medical services could be “swamped” if it spreads in the country’s shanty towns, Susan Cleary, a health economist at the University of Cape Town, said.
“Transmission in an informal settlement is a disaster, an absolute disaster,” she said.