Digital Briefing on COVID-19 in Africa and the U.S. Response

Special Briefing Via Telephone
April 2, 2020
Dr. Meredith McMorrow, Medical officer in the U.S. Centers for disease control and prevention’s Influenza division,
Dr. John Nkengasong, Director Africa CDC

Moderator:  Good afternoon, everyone.  My name is Marissa Scott, I am the Director of the Africa Regional Media Hub.  I just want to let all of you know that we are using Zoom for the first time for one of our press briefings, so please bear with us.  If there are any technological issues or the Internet drops, we really want to make sure that we can entertain as many of your questions as possible.

So again, good afternoon to everyone from the U.S. Department of State’s Africa Regional Media Hub.  I would like to welcome our participants from across the continent and thank all of you for joining this discussion.

Today we are very pleased to be joined by Dr. Meredith McMorrow, Medical Officer in the U.S. Centers for Disease Control and Prevention’s Influenza Division, and Dr. John Nkengasong, Director of the Africa Center for Disease Control.

Our speakers will discuss the U.S. response to the COVID-19 pandemic in Africa, and coordination efforts with national governments on the continent.  They are joining us from Pretoria, South Africa and Addis Ababa, Ethiopia.

We will begin today’s call with opening remarks from Dr. Meredith McMorrow and Dr. John Nkengasong, then we will turn to your questions.  We will try to get to as many of them as we can during the time that we have, which is approximately 45 minutes.

At any time during the briefing, if you would like to ask a question live, please indicate that by clicking on the “raise hand” button and then typing your name, media outlet, and locations in the “question-and-answers” tab.  Alternatively, you can type your full question directly into the Q&A for me to read to our speakers. Again, please include your name, your media outlet, and location in the questions-and-answers tab.

If you would like to join the conversation on Twitter, please use the hashtag #AFHubPress and follow us on Twitter @AfricaMediaHub.

As a reminder, today’s briefing is on the record.

And with that I will turn it over to Dr. Meredith McMorrow.

Dr. McMorrow?

Dr. McMorrow:  Hi.  Good afternoon to everyone.  So I just wanted to talk briefly about this novel virus that was identified in January 2020: the SARS-Coronavirus 2, which is also the name of the virus that causes Coronavirus Disease, or COVID-19.  It’s rapidly spread across the globe.

And in the first three months since we first identified this virus in Wuhan, China, we have more than 700,000 confirmed cases and 33,000 deaths worldwide.  And it has been officially deemed a global pandemic by the World Health Organization.

In Africa specifically, COVID was first identified in Egypt on February 14, and then the first case was identified in Nigeria in Sub-Saharan Africa on the 27th of February this year.  Many countries on the continent have faced challenges in establishing diagnostic capacity, and I would say that current reporting is likely significantly underestimating the number of cases that we have here in Africa.

South Africa first diagnosed their first case on March 5th of this year, and since that time we have grown to over 1,300 cases and 5 deaths.  And we are currently on day 7 of a 21-day national lockdown ordered by President Cyril Ramaphosa, and the South African Government is trying to make testing capacity broadly available and to implement door-to-door screening in dense urban areas to assist with case identification and isolation.

The U.S. Centers for Disease Control Prevention, or CDC, office here in South Africa has been a close technical partner of the National Department of Health and the National Institute for Communicable Diseases for more than a decade, and these existing relationships have aided us in integrating into the local COVID-19 incident management structure and response to aid in development of guidelines and communication messages.  And currently, CDC-South Africa continues to provide technical assistance to the national government focusing on containing the spread of this virus and mitigating the impact of the virus in South Africa.

To date, we – our assistance has included involvement of technical and communication staff, and helping devise guidelines for risk communication, case identification, isolation, testing, and contact tracing for COVID-19.  Moving forward, we’ll continue to support the National Department of Health, the National Institute for Communicable Diseases, and our provincial partners as we aim to increase public knowledge of how to prevent and test and access different strategies for mitigating the spread of COVID-19.  Thank you.

Moderator:  Thank you, Dr. McMorrow.  We will now begin the question-and-answer portion of today’s call.  Everyone, please note that we’re still waiting on Dr. John Nkengasong to join the call.  And once he does, we will make sure that he provides some opening remarks to us.

For those asking questions, please indicate if you would like to ask a question, and then type your name, location, and affiliation.  We ask that you limit yourself to one question related to today’s topic of briefing: COVID-19 in Africa and the U.S. response.

Okay, our first question will go to Nick Turse from The Intercept.  Mr. Turse, we’re going to answer your question live.

Our technician, please open the line.

QUESTION:  Thanks very much for doing this this morning.  In the last decade, the U.S. has spent far more on counterterrorism in Africa than public health assistance.  In your [inaudible] far more people than terrorists. Thank you.

Dr. McMorrow:  I’m sorry, Nick, you were cutting in and out.  I don’t know if Marissa heard the question better, but could you possibly repeat?

Moderator:  Mr. Turse, please repeat the question.

Operator, open the line.

Question:  Yes —

Moderator:  Okay, Mr. Turse —

Question:  I just put into —

Moderator:  There you go.

Question:  — the Q&A – I just now [inaudible] so you can see it, but I was asking [inaudible] than public health assistance over the last decade.  In your opinion, should more resources have been allocated to the latter, given the potential pandemics that kill far more people than —

Moderator:  Dr. Meredith, I think you understood the gist of the question.

Dr. McMorrow:  Yes, I think I understood.

Moderator:  Okay.

Dr. McMorrow:  Exactly.  So, obviously, I’m not a Member of Congress, and I don’t determine funding.  But I do think that there has been a substantial investment by the U.S. Government in terms of support of PEPFAR, which has been over $85 billion since its inception in 2003.  We have certainly seen lots of other organizations like USAID and other members, other portions of the U.S. Government, including the Centers for Disease Control and Prevention.

So while certain [inaudible] we are anticipating that this pandemic could cause some significant [inaudible] public health systems here, I wouldn’t say that there hasn’t been significant support in the past.

Moderator:  Thank you.  The next question, Dr. McMorrow, is: “What do you have to say about the thousands of Africans who are not taking lockdown or confinement seriously?”

Dr. McMorrow:  So I think this is the best thing that we can do to protect everyone.  We have a limited amount of time to prevent widespread circulation of this virus in communities.  And so the best thing that we can all do right now is practice good hygiene, social distancing, take care of ourselves.

I think that the challenge is, obviously, in areas where perhaps there are limited resources, and not every person can do that on this continent.  And in those areas, then that’s where government needs to step in and try and assist people that perhaps can’t self-isolate because they live in one room with several other people.

So I think someone has their mic open – maybe Thomas.  And I’m getting a little feedback. So I – to make it clear for everyone – thank you.

So yes, I think it’s important that South Africans and Africans in general, when their governments request for them to lock down, this really is our best defense against the spread of this virus, which has proven to be much more severe than your average influenza.

Moderator:  Thank you.  I understand that we have Dr. Nkengasong now on the line.  We only have him on audio.

Dr. Nkengasong, can you hear me?  Dr. Nkengasong?

Okay, so we are going to – Dr. Nkengasong?  Okay. We are going to give Dr. Nkengasong and our technical folks a chance to get everything in order.  We will go to the next question.

The next question is from Kevin Kelley of Nation Media Group in Kenya.  His question is: “Given the scant amount of testing in Africa, Kenya, for example, had carried out about 1,100 tests as of March 31st in a nation of 45 million people.  Is it not true that the actual number of COVID-19 cases is being grossly under-reported?”

Dr. McMorrow:  So, yes, it is likely that the current lay-reported laboratory confirmed case counts are a gross under-estimate of the true burden of COVID-19 disease because of the issues that you have highlighted.

Sometimes it is – as far as the actual burden, it’s difficult to estimate, because the symptoms of COVID-19 are very similar to other viruses, and they are very non-specific.

It is somewhat reassuring that we haven’t seen or heard of large increases in severe respiratory illness in that – in this time.  But certainly here in South Africa our surveillance systems for [inaudible] are focused on a relatively small number of sentinel sites, and I think that’s true of most countries in Africa.  And so that may limit their utility right now in these early days of telling us where to focus our efforts. But they will serve us really well for monitoring illness trends and risk factors for severe disease, and other important information about controlling COVID disease, once there is broader community transmission.

Moderator:  Thank you Dr. McMurrow. I believe that we do have Dr. Nkengasong on the line.

Dr. Nkengasong, you must unmute your phone.  Dr. Nkengasong, are you on now?

Dr. Nkengasong:  Yes, I am on now.

Moderator:  Okay.  Would you like to give your opening remarks?

Dr. Nkengasong:  Yes —

Moderator:  Okay, it looks like we lost Dr. Nkengasong.  We will work on trying to get him back. As we try to do that, we will go to another question.

Dr. Nkengasong, are you there?

Okay, we’ll go to another question.  The next question goes to Anna Cara of The Associated Press in South Africa.  Her question is: “Are the number of cases reported in Africa artificially low” – we’re seeing a repeat in some of these questions – “because of the shortage of testing materials and delays in results?  And, if so, what is more likely the estimate of cases in Africa? Also, which African countries have you been unable to coordinate with so far, and why?”

Dr. McMorrow:  So we’re actually quite fortunate.  We have CDC staff in a number of African countries that are coordinating very closely with the ministries of health and local partners, including National Reference Laboratories.  And we haven’t really had many obstacles to assistance in that way, and collaboration.

So I think we feel quite strongly that everyone recognizes the severity of this, and the potential impact that it could have on their population.  They’re taking this disease quite seriously. And so a lot of those traditional barriers seem to have evaporated, because everyone is very concerned about this coming epidemic.

Again, I do think you are all 100 percent right and correct, that our current case counts are an under-estimate.  Part of it is due to some of our own challenges around trying to prioritize testing for people that we think are most likely to have the disease.  So here in South Africa, many of our case definitions have been limited to people who have had contact with a case, or who have traveled recently.

And so, as we are seeing more community spread, we may need to update those case definitions to be able to test more people that acquired their disease locally.  And I think that’s probably true for many other countries, that we have to modify case definitions, but also expand capacity for laboratory testing.

Moderator:  Thank you.  We’re going to go to a phone-in listener now, to Verah, who has her hand raised.

Verah, we want you to ask your question.

Operator, please open the line.

Verah, please identify your media outlet, as well.

Question:  Hi.  So I’ll just go on ahead and ask.  I wanted to ask about the Africa CDC, but it looks like he’s not in.  I just wanted to know whether he gets the supplies that he needs, given that it’s a young organization, just three years old, and he’s supposed to step up to the work, like  his counterpart in the U.S. So I would like to ask Dr. John whether he has something to say. Does he get the support he needs? Is there money coming in, or any other technical support so you can work with the others?

And then to Dr. Meredith, I would like to find out something about the airborne thing.  Could you clarify that? Because there’s a lot of confusion around it. People are reaching their own conclusions, and now with the mask thing, health care workers in my country don’t have enough stuff and the public is really panicked. So that’s all.

Dr. McMorrow:  Sure.  So thank you for those questions.  Is Dr. Nkengasong on, or have we lost him again?

Moderator:  So I believe we have him, but if you want to answer your portion of the question first, we’ll then move to Dr. – we’ll try to move to Dr. Nkengasong.

Dr. McMorrow:  Okay.  So I can’t speak for the Africa CDC, but I’ll tell you my experience with them has been very good and very positive lately.  They have been very helpful in assisting countries with setting up diagnostic capacity and getting diagnostic kits out to countries quite early.  So hopefully Dr. Nkengasong can give you more information about their work. But from my point of view, they’ve been doing an excellent job of coordination and providing the needed reagents to the laboratories.

In terms of the whole airborne transmission, I think that there is a lot of confusion around this.  And part of that is us, as medical scientists, not always, like, being super clear in our communications.  And I’m certainly guilty of that as anyone else.

So – but what I will say is I think this was all brought up again by the New England Journal article.  So the New England Journal article that talked about how the virus could be aerosolized and then hang in the air for up to three hours, they actually used a very sophisticated machine to actually force the virus to be aerosolized.  It wasn’t as though they just took a sick patient and let them cough for a while, and then there was all this aerosolized virus in the air. They actually used [inaudible] to make that aerosol happen.

Oh, I see Dr. Nkengasong, so I will quickly finish my aerosolization thing, and let him hop in on the Africa CDC question.

So I think, in general, what we expect is that the vast and overwhelming majority of transmission is going to happen through respiratory droplets.  And that is what people need to most protect themselves against. We don’t have evidence that your average person coughing or having regular symptoms of sneezing and coughing would produce aerosolized virus.  So if we all do a good job of protecting ourselves against respiratory droplets, then I think we will do a wonderful job of reducing 95 percent or more of transmissions.

Now, there could be a small amount of transmission that’s happening from asymptomatic people.  And we do see it with influenza, that occasionally small amounts of virus do get aerosolized. But usually it’s not enough to cause illness in people, or – and so we’ll get additional information about COVID as more studies are produced.

I think for right now we feel quite confident that the vast majority of transmission is happening from respiratory droplets, and not from aerosolization.

Moderator:  Thank you, Dr. McMorrow.

Dr. Nkengasong, we are happy to have you on the call.  I’m not sure if you heard the initial question regarding response and the coordination with different countries within Africa.  But if so, please address that and give us some brief opening remarks, as well.

Dr. Nkengasong:  Thank you.  Can you hear me now?  Good. I think that I have been on from the beginning, so because of technology challenges, I wasn’t able to call in.  So thank you for the opportunity.

First of all, just to give you a very quick update on the situation in Africa, we currently have about 6,000 cases on the continent, and about 15 countries have crossed the 100-case report in their countries, so – as we compare the evolution of these COVID-19 in Africa every week, we see that, of course, our numbers are increasing significantly.  We currently have about 220 deaths across the continent that Africa CDC is monitoring, and it is also important to note that about 460 of these patients have recovered. That is important.

With respect to the response from Africa, I think very early on, when Egypt just reported the first case – first important case – on February 14, I believe, we immediately called for an emergency ministers of health meeting of all 55 member states.  And at that meeting, Dr. Tedros, the director general of WHO, weighed in by video call. Dr. Morrissey [ph] attended in person. There were two major outcomes, because we realized early that we needed a continental approach for this – for the pandemic.  Two major outcomes was the need to have a continental strategy; secondly, to establish a task force that would pull on all the human capital and assets that exists on the continent.

So we have, as you probably are aware, the African Task Force for Coronavirus Preparedness and Response, which has at least five working groups.  And it is through those working groups that, as my colleague from the U.S. CDC mentioned, that we were able to scale up diagnostics very quickly from just two countries to – for three countries, and now to – about 48 countries there.

So I think the preparedness phase is over, we are in the response phase.  And some of the challenges that we discussed earlier are true: the ability to have commodities as a whole, which is in short supply, globally; we are fighting hard to continue to support member states with commodities, with diagnostics, with personal protective equipment.

I think let me stop there as part of my opening remarks, and wait for the questions.

Moderator:  Thank you, Dr. Nkengasong.

The next question comes from Anita Powell, of Voice of America News in Johannesburg.  And this question may be for the both of you: “By many objective measures, the U.S.’s reaction to this pandemic has been delayed, and some critics say disastrous.  So why should the U.S. be advising anyone on this, especially African nations that have a decent track record of battling epidemics? And is this a two-way street? Is the African CDC offering any advice or assistance for the crisis in the United States?  Finally, could this new dynamic portend a shift in U.S.-Africa diplomatic relations?”

Dr. Nkengasong:  So you want me to go first?

Moderator:  Sure, Dr. Nkengasong.

Dr. Nkengasong:  I will be happy to do that.  I mean, so I mentioned early there is – the centrality of our response strategy is underpinned by a couple of principles:  that we cannot win the battle or the war against COVID-19 in Africa if we do not work collaboratively, if we do not work cooperatively, if we do not communicate effectively across the continent, and if we do not cooperate – if we do not collaborate across the continent.  So I think those are the center – centrality of the continental strategy.

We recognize that COVID-19 will not be resolved in any member state except if it’s resolved in all member states.  That is a fact. So, assuming that South Africa locked down and cleaned up and everything, you have zero COVID cases there.  Then there is nothing that tells you that you do not have imported cases from the SADC region or even from afar. So I think that is the centrality of our strategy, which we are – now have it endorsed at the highest level of the continent, by the bureau of the head of states, which agreed them last Thursday, and will be doing so again tomorrow.

So I think, with respect to what can we learn from this, I don’t think I have any lessons to offer to the United States, but rather look at the continent of 1.2 billion people and say, “How can we join hands and use all the assets that we have?”  This is Africa’s problem, and we are at the dawn of a outbreak, and we have to find solutions that are African in nature to address our situation.

For example, we are not going to be – we don’t manufacture diagnostics on the continent, we import the diagnostics.  So it would come to a certain point that we say, “Well, how can we use the combination of serologic assays and even symptoms, okay, to manage our situation?”  We cannot rely on the experiences that are happening in Singapore or are occurring in the United States. We have to find our own solutions locally.

We have to find our solutions locally to address social distancing, which my colleague earlier touched on, which is critical.  It’s a known and proven strategy in public health that we are challenged on the continent. It’s a must-do. This is not a situation of we are trying and working hard.  It’s a question of we have to win the battle against COVID in Africa in order to survive. It is an existential threat for our continent.

Moderator:  Dr. Meredith, do you want to answer the U.S. portion of that question?

Dr. McMorrow:  Sure.  So I do think that the United States is certainly suffering right now under this pandemic.  We have increasing case counts daily, and certain areas of the country are quite overwhelmed in their response to the pandemic.

And so I think it has probably limited our ability to respond promptly in some areas.  But we do – we are fortunate that we have staff physicians throughout the world and throughout the continent that are able to respond rapidly and help with planning and coordination, in collaboration with partners like WHO and Africa CDC.

So I think it – Dr. Nkengasong is very right, that this is a joint strategy and a joint effort, not a U.S.-led strategy, and that we are just amongst the many people who are supporting local governments in their response to the COVID pandemic.

Dr. Nkengasong:  And just to link Africa to the United States, I mean, it is very clear from the onset that the battles will have to be fought locally, but the war has to be won globally.  So it will be global solidarity and global action to succeed. It cannot be an American victory, it will just be a short-term victory. It has to be a global victory before we consider ourselves safe again.

Moderator:  Thank you, Dr. Nkengasong.  We are going to go to someone who has his hand raised.  We have Nick Turse again.

Mr. Turse, you can ask your question again from The Intercept in Burkina Faso.

Operator, open the line.

Mr. Turse, you may ask your question.

Question:  Since January – yes.  Since January, has the United States sent any critically-needed ventilators and/or PPE to African nations?  And, if so, how many and to which countries? If not, why not?

Dr. McMorrow:  So I don’t have the full scope of what’s happening in every country, but I can say that, for right now, many of the medical supplies and PPE supplies that are available within the United States are being used within the United States, and that we are assisting in the procurement and purchasing of PPE for countries through our USAID and CDC and other Department of State resources.  And what those specifics are depends on what the countries have requested, and the availability of funds.

So we are trying to respond, and respond as quickly as possible.  There are global international shortages of some of these PPEs, and so we are trying to make those procurements as rapidly as possible to support national responses here on the continent.

Moderator:  Just to continue on the line of PPE, we do have a question from – let’s see, who is it from?  Kanthan Pillay of CliffCentral.com in South Africa. His question is: “What is the position of the CDC in the U.S. and the African CDC regarding the use of face masks when people go out in public?  Should they be using them or not?”

Dr. Nkengasong:  Let me go first.  The answer is no, we don’t have any evidence that using the face mask in public will reduce the transmission.  We have many lessons to learn from China. We also know that the virus, as my colleague explained earlier, is not airborne and moving in the air, so there is absolutely no reason to recommend that for now, for wide-scale use on the continent, and we are not, as Africa CDC, going to recommend that.

Dr. McMorrow:  Yes, I’d agree with Dr. Nkengasong.  I think the important thing to focus on right now is things like N95 respirators.  Those masks are desperately needed by health care workers right now, and the public should not be wearing N95 respirators around, A, because they are very rarely fit-tested or taught how to wear them properly, and so – and B, because there is such an incredible shortage that they are really desperately needed in health facilities.

So, first and foremost, I would strongly recommend that the public, if they do have access to N95 respirators, that they make those available to health care providers, who are at much higher risk of infection due to some of the procedures that they are required to do that do generate aerosols, like intubating patients, ventilating patients, performing CPR on patients.

So the other thing is surgical masks are also in short supply on the continent, and those also should be reserved for healthcare providers whenever possible.

Now, there are some interesting data that are coming out, and I think CDC might slowly be changing some of its ideas about the potential benefit of other masks, like homemade masks and other masks; not necessarily protecting the individual wearing that mask, but for preventing that individual from potentially coughing or sneezing, and spreading the virus in an area.  So stay tuned. I think over time we may be changing some of our recommendations, or being more open to that. But I think, for many people, because they’re not accustomed to it, there is this risk of, in adjusting the mask, they may actually touch their face more than they would otherwise have done. And so we are trying to be cautious about what we do recommend. But I think stay tuned.  We are starting to think more about what role that might play in reducing transmission.

Moderator:  Okay.  The next question goes to Brooks Spector of the Daily Maverick: “Please evaluate the impact of the multiplicity of and conflicting messages from Washington on global responses to dealing with COVID-19.  How is this messaging being refocused and refined?”

Dr. McMorrow:  So it would be helpful if I knew specifically what messages that you were referring to.  But I think we are all in the process of learning about this virus, and so some of the messages we may have been sharing earlier in the pandemic may not be what we would choose to share now.

Moderator:  Thank you.  Next question goes to the both of you.  There is considerable – but I would like Dr. Nkengasong to start: “There is considerable disinformation and misinformation on the continent about COVID-19.  Can you tell us how this is impacting your efforts to curb the spread of the virus on the continent?”

Dr. Nkengasong:  That’s a very good question.  We – the experience with COVID-19 continues to highlight the importance of building the trust and having a relationship with the community before we have to deal with such outbreaks.  The community misinformation stems from the distrust that I mentioned, and we saw that in DRC during this – the current Ebola outbreak, where until — when we started repairing the relationship with the community, it was difficult to gain their trust, and actually make inroads into controlling Ebola.  It’s the same we are seeing in – for COVID, especially early on.

There will be, of course, as suspected, different theories, as you can expect from a human behavior standpoint, different assumptions, and that is not unique for Africa; it’s global.  So it only points to the fact that the traditional approach to public health has to be reconsidered, and begin to bring in the community that I mentioned.

So that we create champions in the communities, we create leaders in the communities, and we use – or influence us, so that our message can be appropriately targeted to the right audience and seek their cooperation.  Without that, you continue to get all kinds of misinformation, and all kinds of fear factors that weight in, and it becomes harder to control the outbreak, or the pandemic.

Moderator:  Thank you.  The next – oh, please, Dr. McMorrow.

Dr. McMorrow:  No, I think that was an excellent answer.  And I think the other thing to recognize is that Africa is so diverse.  There are so many diverse communities, and each country has a plethora – I mean, South Africa here has 11 or 14 different national languages.  And so it’s really important that we focus on the appropriate type of communication messages, and fit the communication messages to the individual country and the individual community, as needed.

So we have been working closely with WHO and our national counterparts to try and combat incorrect myths and messaging when they arise.

Moderator:  Thank you.  Next question goes to Sarah Nanjala from the Daily Nation in Kenya: “When do you project will be the peak infection cases and deaths in African countries, and what are the highest risk factors for African countries in combatting COVID-19?”  Dr. Nkengasong?

Dr. Nkengasong:  Yes.  I think we project that in the next three to four weeks we will begin to see a clearer picture of where this is taking us to.  And why is that so? Because we expect that, by the third to fourth week from now, the virus will begin to seed into different communities or sub-communities.  For example, the most vulnerable populations in slums around capital cities, or even expand to remote areas. I think we’ll begin to understand how severe this pandemic will be.  We still don’t know for Africa.

I mean, there are three things that we have to project for Africa.  One is that this becomes a mild pandemic, and second is that it’s a moderate pandemic, and lastly, it’s a severe pandemic.  And several factors will determine this: where the virus is seeded, as I said, if we seed this extensively in the remote areas and/or slums, it becomes very challenging.

Second is we don’t just know for now what the comorbidity will play.  We have so many people in several parts of Africa, depending on which country infected with Malaria, with Tuberculosis, and HIV.  We have a large number of our population that is malnourished, so we just don’t know how these factors will play into the dynamics and the projection of COVID-19.

We also know that our population is fairly young.  I mean, at least 70 percent of our population is less than 30 years old, and that may also be a factor, but we don’t know which direction that will play.  If we look at it strictly from mortality, you could argue on the basis of the – of what we saw in China, that this may be something that will play in our favor, but we just don’t know all the underlying factors.

You’re beginning to see also in the United States that young people – a good number of young people – are in hospitals, and require oxygen support and other services there.  So we are still early. As I said, this is the morning of a pandemic. There is a lot to be learned from it, and we are doing that actively. As we used to say in HIV/AIDS, you have to know your epidemic.  In this situation, we have to know our pandemic in order to better respond and develop systems to – that are adapted for our own response.

Moderator:  Thank you.  Now, we’ll go to July Nafuka of the Namibia Broadcasting Corporation.  Her question is: “Are there – is there any progress in getting a vaccine or antibiotics for COVID-19?”

Dr. Nkengasong:  There is definitely, as we speak, more than 30 candidate vaccines that are being looked into – that is at least that I’m aware of.  I also serve as a board member of the Coalition for Epidemic Preparedness and Innovation. They are accelerating several candidate vaccines across the board.  I mean, it has to also be very, very, very clear that we would not be having a vaccine in the next couple of months. This will take several months, if we are lucky.  Maybe one year or one-and-a-half year before we have an effective vaccine that will be safe and efficacious in people.

I also know that there are multiple clinical trials going out there, and we are hopeful that some of those who are – lead to promising results that will be widely available.  Now, for the continent of Africa, we are beginning to make our position very clear, that there are issues of access to these vaccines and treatment. We don’t want to wait until the vaccines are available, then we start a discussion on access and equity.  And the same thing will be true for medication or any drugs that are under trial. So we want to have – begin the discussion now and address issues of access and equity for the continent.

Dr. McMorrow:  Marissa, I think you’re on mute.

Moderator: [Laughter.]  Thank you. We’re going to go to Kenya, to East Africa.  Question from Elizabeth Merab from Nation Media Group. “What can African countries do to flatten the curve?”

Dr. Nkengasong:  My – really – recommendation is to implement known public health measures, and follow the guidelines from WHO and Africa CDC.  We have issued several guidance documents, including the one relating to social distancing. We have also issued recommendations and guidance with respect to what you do when you have few cases and when you have – begin to see community transmission and widespread transmission.  WHO has done similarly.

The key is for us not to use panicking measures, but to use proven interventions that have been known to work in public health settings, and flatten the curve.  Countries have locked down. Most countries have exercising lockdown, but the opportunity is now — for example, we know Nigeria – Lagos City is under lockdown. We know South Africa is under lockdown.

Now, the opportunity is now to intensify public health measures in a way – and scale up quickly, so that you take advantage of the two weeks of the lockdown to do a couple of things:  one, identify people that are infected, isolate them; second, identify their contacts, follow them for a period of time, and understand what is going on. If we do those things with these lockdown measures, then we have a good chance of – that we’ll reopen and relax these lockdown measures in a progressive manner, we can contain the virus.  I think that is very important. But as I keep repeating, it requires the cooperation and collaboration of the community. Without the community cooperating fully in this, it would not be effective.

Moderator:  Thank you.  We have a question from the Comoros from Houmi Ahamed-Mikidache.  “Do you think Africa should take Hydroxychloroquine? And do you think that this chloroquine is the potential miracle cure against COVID-19?”

Dr. McMorrow?

Dr. McMorrow:  So we actually are not currently recommending that people take chloroquine broadly.  Chloroquine is being reserved for people who have signs of very severe disease, who are on ventilators, and who are not progressing as one would like to see them do.  So we are really using it in limited amounts. We are still waiting on conclusive data as to whether it actually provides significant benefit. It does show some suggestion of benefits, but there – the jury is still out on this.  Studies still need to be done in a much greater magnitude for us to understand.

We’re also looking at other potential therapeutics, like Remdesivir and other drugs, like Lopinavir and Ritonavir that have been used for HIV.  So I think we are all searching for that miracle cure, we’re all searching for that drug that’s going to help patients not develop severe disease.  But right now we don’t have a known medication that can prevent that severe disease at this time.

Moderator:  A question from Ethiopia, from Coletta Wanjohi, the Food and Security Network: “Any idea why we are not seeing as many cases in African countries?  Is the African CDC talking to governments? And have any – for any reason, are they offering the help that they need for surveillance and screening?”

Dr. Nkengasong?

Dr. Nkengasong:  Yes.  I think the answer to both questions is yes, yes.  And we have been doing that from day zero. Excuse me.  And we have often heard in the areas of diagnostics, enhanced surveillance, and airport screening in the areas of infection prevention and control, in the areas of risk communication.  So all of that, we have engaged the governments very, very early, since January, and continue to do so now.

It’s very important to note that every week we coordinate with all member states through our emergency operations center to continue to work with the leadership of the continent to address this.

So yes, we have been engaged from the beginning with member states.  And it’s fair to say that the cooperation with members states has been extremely high.

Moderator:  Thank you.  We have a question from Kenya again, from James Mbugua from the Government Business Review: “What immediate assistance is the U.S. able and willing to offer Kenya, specifically, for the fight of COVID-19?”

We have similar questions about Zimbabwe and other countries.  So Dr. McMorrow, you may want to sort of answer this one broadly about what the U.S. is doing.

Dr. McMorrow:  Sure.  So the – there was an initial $274 million that were made available by USAID, and we are definitely working on the global response to prioritize programs in-country where the assistance is most needed, and will have the greatest impact.

On March 26, Secretary of State Mike Pompeo announced that the United States made available additional funding through the Coronavirus Aid Relief and Economic Security Act from the President.  And that bill includes an additional $258 million for USAID’s humanitarian programming, and additional resources that bring the joint USAID and State Department global response to more than $2 billion.  And in addition to those funds, Congress included in that bill $300 million for international assistance to the U.S. Centers for Disease Control.

So I think our commitments to date have been rather substantial, and we can hope that they will continue.

Moderator:  Thank you.  We have a question from Marlene from Le Point, and her question is: “How can we use digital resources in digital health to help alleviate some of the suffering in African countries?”

Dr. Nkengasong?

Dr. Nkengasong:  Yes, I think that is extremely – a timely question.  We – especially in the areas of case management. And we are looking for partnerships to enhance – through telemedicine, to enhance the ability to manage these patients.  That – our patients that would have – which, of course, our numbers are beginning to increase.

So I think digital devices or technology will play a very important role in this, especially now that it’s very challenging to travel across the continent.  We have to deliver some of that technical support through digital support platforms. So that’s a very – an area that we are exploring very carefully, as Africa CDC.

Dr. McMorrow:  Yeah, I’ll just add this is an area in which Africa really excels.  Africa’s mobile phone technology is really quite advanced. And I think, here in South Africa, we’re looking at all sorts of different ways that digital technology can be used to provide community education messaging, to provide reminders to people who have been positive to stay isolated, to help us with surveillance, and monitoring of symptoms from patients all across the country, and looking for kind of local hot spots or potential hot spots of disease transmission.

So I think there are lots of ways in which digital technology will play a very significant role in fighting the virus in Africa, all across the continent.

Moderator:  Thank you.  We are at the end of our digital session today.  I’d like to ask our panelists if they want to give some closing remarks before we close this out.  Before we do that, we want to remind a lot of our participants that, if they still have questions, please feel free to submit those before we end the call, and we will do our best to get those questions to our panelists and provide you with a response.

We’ll start with Dr. McMorrow.  Final remarks?

Dr. McMorrow:  Thank you, Marissa.  This has been a nice opportunity to speak and hear what your questions are, and I think we can all agree that we are in this together to try and fight to keep Africans healthy and to help African nation states and member states of the Africa CDC to manage this epidemic as well as possible, and to save as many lives as possible.  So we hope that some of these answers have been helpful to you in terms of communicating with your local communities, and we welcome additional questions.

Moderator:  Dr. Nkengasong?

Dr. Nkengasong:  Thank you for the opportunity.  I just want to end by saying that this is a global crisis.  Africa is part of this crisis, and we require global actions and global solidarity.  It has to be clear that the battle – the victory will need to be global. We cannot eliminate COVID in any country in the world if we still have it lingering in any part of the world.  So I think that requires that we exercise global solidarity, and urgently so for Africa. We still have an opportunity in Africa to do something, but we need support and we need partnership quickly.  Otherwise, our situation will be devastating.

Moderator:  Thank you.  That concludes today’s briefing.  I want to thank Dr. Meredith McMorrow, Medical Officer at the U.S. Centers for Disease Control and Prevention’s Influenza Division, and Dr. John Nkengasong, Director of the Africa Center for Disease Control, for speaking to us today.  And thank you to all of our journalists for participating in our first-ever Zoom briefing.

If you have any questions about today’s briefing, you may contact the Africa Regional Media Hub at AFMediaHUB@state.gov.  Thank you.