Questions and answers about coronavirus and the UK economy
Questions and answers about coronavirus and the UK economy

Are there differences in Africa’s responses to Ebola and Covid-19?

Sub-Saharan Africa seems to have been less affected by coronavirus than many developed countries in terms of cases and deaths. Lessons from the Ebola epidemic may have helped, but economic damage from the current pandemic will still be considerable.

Fewer cases of Covid-19 have been reported in Africa compared with the United States and Europe (see Figure 1). It has been suggested that this is a result of the lessons learned from the fight against Ebola during the 2014-16 outbreak (predominantly in West Africa).

For example, the two viruses have different causes and consequences, which Africa’s responses to Covid-19 have taken into account. In addition, it seems that precautionary measures were implemented quickly following the announcement of the coronavirus pandemic, particularly when compared with the earlier Ebola outbreak.

Figure 1: Daily new confirmed Covid-19 cases per million people

Source: Roser et al (2020)

What do we know about the history and epidemiology of Ebola and Covid-19?

  • Both are viral diseases and therefore infectious.
  • Ebola emerged in 1976 in the Democratic Republic of the Congo and Sudan (now South Sudan). Covid-19 was first detected in Wuhan City, Hubei Province, China, on 31 December 2019.
  • The sources of both outbreaks are still unknown, although there are suggestions that they might have a ‘zoonotic’ origin (passed from an animal to humans).
  • The largest Ebola outbreak occurred in West Africa between March 2014 and June 2016. Its spread was somewhat limited, primarily affecting Guinea, Liberia and Sierra Leone. In contrast, by February 2020, more than 50% of the world’s countries had reported a case of Covid-19 infection. The outbreak was assigned pandemic status by the World Health Organization (WHO) on 11 March 2020.
  • Ebola is transmitted through contact with an infected person’s fluid, while coronavirus is more easily transmitted via infected aerosols.
  • Ebola virus kills faster than Covid-19. The mortality rate of Ebola, at 50%, far exceeds that of Covid-19, at 3.4% (Fox, 2020). Hence Ebola stands out as one of the deadliest infectious diseases, killing around a half of the people it infects.
  • The reproduction rate of coronavirus (2.8) is higher than that of Ebola (1.9), which implies that Covid-19 infections spread faster in a population than Ebola (Fox, 2020).
  • The prevalence of asymptomatic cases is lower with Ebola, at 25%, than with Covid-19, at 40% (Zhang and Jain, 2020). This means that Ebola victims are quickly bed-ridden, which, in turn, reduces contagion risk compared with coronavirus.
  • Covid-19 can be transmitted asymptomatically, whereas the Ebola virus doesn’t spread until the victim shows symptoms. 
  • The contagion process of the current pandemic has been perpetuated through three waves. There are suggestions that the third wave may be the deadliest given the new variants of the virus (Washington Post, 2021). The Ebola outbreak came in two waves, the second reportedly deadlier in some communities.
  • There is considerable difference in where has been most affected by the two outbreaks. Ebola is prevalent in developing countries due to their agrarian economies. In contrast, it appears from Figure 1 that Covid-19 is more pronounced in developed countries.
  • Ebola affects children more than adults, while the reverse is true for coronavirus (WHO, 2019; Avery et al, 2020). While this is confirmed by scientific studies, from an epidemiological standpoint there is no agreement on why one sub-population is more immune to one virus and less to the other.
  • As Ebola affected a smaller area – primarily Guinea, Liberia and Sierra Leone – the implementation of social restrictions were essentially limited to these three worst hit countries. Covid-19 has had a more global impact, requiring simultaneous worldwide containment policies and responses.

Are there differences in the socio-economic effects of Ebola and Covid-19 on Africa?

To compare the socio-economic impacts of the two outbreaks effectively, it makes sense to look at Guinea, Liberia and Sierra Leone, as it was here that the Ebola outbreak was most prevalent. This will help to assess whether Ebola-hit countries were better prepared for the current pandemic. These countries are also representative of the continent of Africa, as more than 90% of Ebola cases occurred in them.

Figure 2: Cumulative Ebola cases and deaths (29 August 2014 to 23 March 2016)

Source: Ebola data from WHO (2021)

Figure 3: Cumulative Covid-19 cases and deaths (22 January 2020 to 9 February 2021)

Source: Covid-19 data from The New York Times repository

Figures 2 and 3 show a clear disparity in the numbers of cases and deaths in the two outbreaks (note the different numbers on the axes). These discrepancies follow from differences in the viruses’ epidemiology, as highlighted in the previous section.

Starting from Week 1, which refers to the week in which the first cases were reported in the countries, Figure 2 shows that by Week 31, the curves (cumulative cases and deaths from Ebola) had flattened out in Sierra Leone. This occurred even earlier in the other two countries.

In contrast, Covid-19 was still on the rise even 45 weeks after the first case. The descriptives in Figures 2 and 3 show that the impacts of the two outbreaks differ for these three countries and, by extension, Africa, as also seen in Table 1.

Coronavirus may have more devastating and more enduring effects on Africa’s economies compared with those of Ebola virus. Table 1 shows the human costs of both Ebola and Covid-19. In nominal terms, the costs of the Ebola virus outbreak to the economies of Guinea, Liberia and Sierra Leone in lost output and revenues are significant.

Some studies suggest that the effects of Ebola on these worst-hit countries, estimated to be between $82 and $89 million, are both temporary and negligible when compared with the likely impact of coronavirus on the aggregate economies of Africa, which is projected to be about $70 billion in lost output (Population Council, 2015; Rasul et al, 2020). The cost of containing Covid-19 is much higher than Ebola due to the former’s pervasive nature – leading to more infections and more deaths as shown in Table 1.

Table 1: Human costs of Ebola and Covid-19 in Africa

OutbreakNumber of casesNumber of deaths
Ebola Virus Disease28,639*11,316*
Covid-193,223,749**77,750**
Sources: *Amadeo (2020), ** Coronavirus Worldometers (2021) at 05:25 GMT on 16/01/2021

What was the timeline of Africa’s response to the Ebola outbreak of 2014-16?

The response timeline of critical control and containment measures during the Ebola crisis of 2014-16 in Guinea, Liberia and Sierra Leone is presented in Table 2.

Table 2: Initial control/response actions to Ebola Virus Disease in the worst hit West African countries of Guinea, Liberia and Sierra Leone in 2014-16

Ebola Virus Disease Control/response actionGuinea Date/specificsLiberia Date/specificsSierra Leone Date/specifics
1First confirmed case22 March 201426 March 201429 March 2014
2Land border closure9 August 201427 July 201411 June 2012
3School closureMarch 2014 to January 2015September 2014 to February 2015July 2014 to April 2015
4State of emergency declaration13 August 20146 August 201430 July 2014
5Internal travel ban/lockdownN.A.1 September 2014 (for three days)19 September 2014
Sources: Bullard (2018); World Education Service (2015)
Note: N.A. – Not available

There are suggestions that the actual first incidence of Ebola in Guinea might have occurred in late December 2013 (Lo et al, 2017). Still, it took around 11 weeks before the first official alerts were issued by the Guinea Ministry of Health about an ‘unidentified’ disease on 13 February 2014 (WHO, 2015). Four additional weeks passed before the WHO formally declared an Ebola outbreak, on 23 March 2014.

The timeline of the discovery of first cases in Liberia and Sierra Leone – on 26 and 29 March 2014, respectively – suggests that the ‘unidentified’ disease could have been in these countries much earlier than these dates.

Table 2 also shows the long time lag between the formal declaration of an Ebola outbreak and the subsequent critical response actions. This response lacked the urgency required in dealing with a deadly epidemic. For example, while Guinea was relatively quicker in closing its schools (within a few weeks of the formal declaration of the Ebola outbreak in March 2014), its land borders were not closed to its neighbours, Sierra Leone and Liberia, until after approximately 20 weeks on 9 August 2014.

Worst still, the outbreak was not declared a national emergency in Guinea until 13 August 2014 – also 20 weeks after the confirmation of the country’s first case. Sierra Leone and Liberia were also slow to react. Consequently, the flattening of the epidemic curve, signifying that transmission was slowing, did not commence until after the Week 20, as displayed in Figure 2.

What have been the responses of African countries to the coronavirus pandemic?

Africa’s responses to the current pandemic have been similar to those of other countries worldwide. A critical look at the details and timings of responses in Ebola-hit countries suggests that their experiences in the earlier outbreak informed their actions this time around. Compared to other countries, particularly those outside the continent of Africa, it appears that lessons were learned from the Ebola experience, which influenced the timing and specifics of Covid-19 responses in those (Ebola-hit) countries.

Table 3: Initial control/response actions to coronavirus pandemic (Covid-19) in selected countries (January to March 2020)

Covid-19 control/
response action
Liberia
Date/
specifics
Guinea
Date/
specifics
Sierra Leone
Date/
specifics
South Africa
Date/
specifics
Egypt
Date/
specifics
UK
Date/
specifics
United States
Date/
specifics
Hong Kong
Date/
specifics
Public information campaigns29 January 202027 January 2020N.A.5 March 2020N.A.20 January 2020N.A.3 January 2020
Testing policy16 March 2020: only those who both have Covid-19 symptoms and meet specific criteria, for example, key workers
29 January 2020: anyone showing Covid-19 symptoms31 March 2020: anyone showing Covid-19 symptoms7 March 2020: only those who both have Covid-19 symptoms and meet specific criteria, for example, key workers14 February 2020: only those who both have Covid-19 symptoms and meet specific criteria, for example, key workers20 January 2020: only those who both have Covid-19 symptoms and meet specific criteria, for example, key workers28 February 2020: only those who both have Covid-19 symptoms and meet specific criteria, for example, key workers;
14 March 2020: open testing of asymptomatic people
13 January 2020: 'enhanced laboratory surveillance' on all pneumonia patients who meet specific criteria, for example, key workers, admitted to hospital, returned from overseas, etc.
International Travel restrictions/border closure10 March 2020: quarantine for arrivals from some or all regions;
16 March 2020: ban arrivals from some regions
7 March 2020: screening all arrivals;
21 March 2020: ban arrivals from some regions
21 March 2020: ban arrivals from some regions;
28 March 2020: ban arrivals from all regions/total border closure
23 March 2020: screening arrivals;
18 March 2020: ban arrivals from some regions
19 March 2020: ban on all regions/total border closureNo restrictions on international travel throughout March 2020;
self quarantine was recommended for international arrivals
2 February 2020: quarantine arrivals from some or all regions;
4 march 2020: ban arrivals from some regions
3 January 2020: screening of arrivals using thermal imaging system
Detection of first case16 March 202013 March 202031 March 20207 March 202014 February 202031 January 202021 January 202022 January 2020
Contact tracing16 March 2020: limited contact tracing13 March 2020: limited contact tracing31 March 2020: comprehensive; done for all7 March 2020: comprehensive; done for all14 February 2020: comprehensive; done for all31 January 2020: comprehensive21 January 2020: limited, not done for all cases22 January 2020: comprehensive for all identified cases
Source: Oxford University Covid-19 Government Response Tracker

Table 3 reveals that the selected countries embarked on public information campaigns about coronavirus within the first few weeks of January 2020, after the outbreak in Wuhan City became global knowledge on 31 December 2019. In the weeks that followed, each put in place some forms of testing policies to confirm if anyone showing the known symptoms of Covid-19 had the disease. It should be noted that while other countries tested selectively, both Guinea and Sierra Leone embarked on universal testing of any individual showing the symptoms.

Table 3 also shows that Guinea, Liberia and Sierra Leone were pro-active in putting in place some control on international travellers before confirming the first cases. Countries like South Africa (with the highest number of cases in Africa as of 1 March 2021), Egypt (which had the first documented case in Africa) and the United States all began their control measures on international travellers after recording their first cases. In the UK, no (strict) containment measure was imposed on international travellers within this early period of the pandemic (January to March 2020). Instead, international arrivals were advised to self-quarantine as soon as they landed in the country.

The case of Hong Kong is unique. It is a Special Administrative Region under China with a high volume of travel between the two territories. Still, on 3 January 2020, it pro-actively put in place a thermal imaging screening system to detect anyone arriving with any symptom of coronavirus, especially from mainland China. It did this almost as soon as the outbreak became global knowledge on 31 December 2020.

In Guinea, Liberia and Sierra Leone, critical containment measures (including school closures and restrictions on internal movement – lockdowns) were announced almost immediately after recording their respective first cases of the disease.

In other countries, similar control and containment measures were slower to be implemented. Many were not put in place until a few weeks after their first cases were documented (March 2020). The containment measures in Hong Kong began immediately after the first case was discovered. But there was no total regional lockdown within the period under review as the disease was effectively under control.

Conclusions

Overall, African countries that had previously experienced the Ebola outbreak were swifter and more comprehensive in their responses when Covid-19 emerged.

Partly, this could be attributed to the difference in knowledge about the two diseases at the time they struck. Lessons leaned from the Ebola outbreak may have informed the response to the current pandemic.

The differences in the responses of African countries to both Ebola and coronavirus have contributed to the varied effects of these diseases on their populations. More research is still necessary to explain these differences fully.

Apart from the African countries that were most affected by Ebola, the other place that took quick and decisive action in early 2020, as shown in Table 3, was Hong Kong. The success of the region’s pro-active measures is likely to be connected to the well-established national surveillance system developed during the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003. Hong Kong was the second most affected country by SARS after China (Hung, 2003).

This indicates that countries with previous experience of epidemics were more cautious and responded faster to the coronavirus pandemic.

Where can I find out more?

Who are experts on this issue?

Authors: Lotanna Emediegwu and Emmanuel Oluwole Oni
Photo: EU Humanitarian Aid & Civil Protection on Flikr
Recent Questions
View all articles
Do you have a question surrounding any of these topics? Or are you an economist and have an answer?
Ask a Question
OR
Submit Evidence