Why we can hope that Ethiopia will be spared the worst of the pandemic? (By Dr. Alula Pankhurst )

The current official projections suggest a worst case scenario up to 39 million people being affected by COVID-19 in Ethiopia. The Multi Sectoral Preparedness and Response Plan projects that 102,000 people could be infected in the next three months. According to the Ethiopian Public Health Institute by the end of April 235,000 people could be affected with the numbers reaching 1.94 million by the end of May. Even with social distancing measures over 15 million could be infected before the pandemic runs its course.

The numbers are very alarming. Insofar as this galvanizes action at individual, societal and governmental levels, it can be a good thing, so long as it does not lead to panic. However, I am hopeful that the trajectory of the pandemic may end up being different in Ethiopia (and possibly in other parts of Africa too) for reasons to do with the environment, poverty, globalization, culture, the timing of the pandemic and learning from the rest of the world, as well as the state system and leadership.

Flus tend to spread more easily in temperate climates during cold weather and the COVID-19 pandemic occurred in winter in Asia, Europe and America, and may be subsiding with the coming of spring (see Bruce Lipton https://www.facebook.com/BruceHLiptonPhD/videos/577988852925866/). However, there are sometimes second waves as was the case during the 1918 epidemic in Ethiopia. A first wave starting in April spread during the rainy season and the second from October come to an end in November. COVID-19 spread to Ethiopia while the weather was warm. There is now what appears to be the start of the Belg small rains which may have an adverse impact, although it might also encourage people not to congregate, go out unnecessarily and abide by government recommendations and directives. We should, however, be wary of the possibility of a second wave as well.

The spread of the pandemic in the rest of the world was exacerbated by hospital contexts where patients and doctors were exposed to high loads of the virus, before it was understood how easily and fast is can be transmitted. Ethiopia has few hospitals (0.3 for 1000 people according to World Bank Figures) and those who have been identified with COVID have been sent to special centres. However, should the worst case scenarios come true, the health services would rapidly be overwhelmed as many experts point out, hence the importance of heeding these warning and doing everything possible to avoid this happening.

3. Less locked into the global economy.

Ethiopia (and the rest of Africa) are less enmeshed in the global economy. International passengers come through Bole airport, and screening was put in place early on. Ethiopian airlines reduced flights to many countries including China in mid February and suspended flights to 30 countries relatively late on March 21. There is limited train travel – the railway to Djibouti runs every four days (It is worth remembering that the 1918 epidemic came through the Djibouti railway and worryingly there are currently 241 cases in Djibouti for a population of under a million, compared to 197 in Kenya, 34 in Eritrea, and 25 in Somalia). There is limited cross border road traffic and no evidence of spread by land, with the borders closed since March 23, when there were 11 confirmed cases.

A strong focus on airport screening and follow up of foreigners and Ethiopians coming from abroad may be paying off and might mean that the pandemic will be have been sufficiently addressed to prevent the take-off of community transmission and its inexorable logic of exponential progression. In Ethiopia the categories that have been most at risk were initially those in contact with foreigners, including investors and government officials and then those with travel history. These are often among the better off and/or better aware sections of the populations, most of whom have been taking precautions, reducing contacts and even self-isolating, and it soon became clear that the risks were mainly associated with returned travelers and contact with them. The risks from those returning from Dubai (representing more than half the cases – See COVID Ethiopia Dashboard) and the forced evictions from Saudi Arabia are clear ongoing threats that the government is well aware of and seeking to address.

The timing of the arrival of the pandemic in Africa in general and in Ethiopia in particular was much later than in Asia, Europe and America. In Ethiopia the main tourist high season (December – January) had fortuitously passed before the pandemic was first identified on 13th March. Moreover, tourism was much lower this year than usual due to security fears. The holiday season when diaspora Ethiopians return had also passed, and less came and travelled within the country due to security concerns.

By the time the pandemic hit the African continent and started to spread, awareness of the means of transmission was much greater, and there had been time for debates about what measures can reduce risks and what behaviour make it worse, leading to government and societal action, including airport screening, isolating suspected cases, mandatory quarantine for travelers from abroad, following up their contacts, limiting meetings, closing schools and universities, banning large gatherings, etc.

The Ethiopian state is well known for its organizational capacity that has increased over the regimes, and its ability to organize zemecha campaigns, mobilizing people and resources rapidly and efficiently. While there may be criticisms and debates about whether measures should have been taken earlier (such as reducing Ethiopian airlines flights), there have been vigorous government actions, and media campaigns, including the messages before every telephone call, culminating in the State of Emergency. Finally, there has been impressive leadership notably from Dr Lia Tadesse, the Minister of Health (see her briefing and response to questions on facebook yesterday 12 April).

I should end by saying that these speculations are not based on any expertise or hard evidence and I may be proved wrong and foolhardy. But I also suspect that those that worst cases scenarios are also not based on accurate data on the progression of the pandemic as we only know the numbers tested, how many were positive, and how many died, but cannot have data on how many have been infected.

Ethiopia deserves a break and some good fortune as a country that has been ravaged repeatedly by famine, war, internal conflict (now hosting the largest global number of IDPs), and having faced many epidemics, and epizootics most recently the ongoing locust invasion.