A man wearing a protective mask rides a bicycle, in Antananarivo, Madagascar. Photo / AP
The virus was slow to start in many African countries, but epidemiologists say the number of confirmed cases on the continent is now rising fast.
When Daniel Khan Mbuh died in a hospital in northern Cameroon, the hospital declared the cause of death to be Covid-19 — then released thebody to the family instead of arranging for a safe burial, his daughter Stella said.
Mbuh said she was told the house where she had been caring for her father in the city of Bamenda would be disinfected. Nobody came. When she tried to get tested, the hospital refused, saying there were not enough test kits. And she was never advised to self-isolate, so she simply imposed her own two-week quarantine on herself and her siblings.
"They said they are following contacts," Mbuh said of health officials, "but I am one of the contacts. And I am not being followed."
The spread of the new coronavirus is now accelerating in many countries in Africa, where medical resources are stretched, rumours are rife and efforts to stop the pandemic are sometimes haphazard.
Public health experts have warned that Africa could become the next epicentre of the Covid-19 pandemic.
The World Health Organization said last week that confirmed cases in Africa had doubled in 18 days to reach 200,000; the first 100,000 took 98 days.
"Even though these cases in Africa account for less than 3 per cent of the global total, it's clear that this pandemic is accelerating," Dr. Matshidiso Moeti, the WHO's regional director for Africa, said in a video briefing last week.
She said that until there was a vaccine available, the continent would have to live with a steady increase of cases.
Most African nations staved off the initial spread of the virus for several months, partly by closing borders early, banning public gatherings and, in some countries, effectively tracing contacts using past experience of infectious diseases.
But the time this bought was not enough to bolster weak health care systems and to prepare for the predicted explosion of cases.
And now that many African countries, like others across the globe, are lifting their restrictions in order to restart their economies, the virus has new opportunity to spread and potentially, to overwhelm health care systems.
Nigerian doctors announced a nationwide strike starting on Monday over the lack of personal protective equipment in government hospitals and hazard pay for treating Covid-19 patients. Dozens of Nigerian health care workers have been infected, partly because they had no protective gear.
Epidemiologists at the Africa Centers for Disease Control and Prevention warned of a "catastrophic shortage" of health care professionals, and a drastic reduction of medical supplies because of border closures, price increases and restrictions on exports imposed during the pandemic.
"Africa needs to intensify its efforts to slow the spread of the pandemic," they said in an article published last week in the journal Nature. They said that the continent needed financial support to stop the pandemic and tackle its economic and humanitarian effects.
The early spread of the pandemic in many African countries was driven by foreigners and the economic elite: people from Europe, and those with the means to travel there.
It has continued to spread among elites. Ghana's health minister caught the virus "in the line of duty," the country's president, Nana Akufo-Addo, said on Sunday. Four people in the Kenyan president's office tested positive and have been taken to the hospital, according to a statement from the office.
However, what has often been perceived in Africa as a foreigners' disease is increasingly reaching all sections of society. Testing is still extremely limited in most countries, so it is impossible to know how widely the pandemic has taken hold. But a month ago, the WHO predicted that between 29 and 44 million Africans could become infected in the first year.
Truckers are carrying the coronavirus across borders, just as truckers had also spread HIV, the virus that causes AIDS. Countries now have set up border controls, which can intensify the points of contact and possible spread of infection.
In the border town of Garoua-Boulaï in the Central African Republic, dozens of truck drivers jostled outside a tarpaulin tent waiting to get tested for the coronavirus. Some wore masks, but many did not, or had pulled them down below their chins.
They had to wait for many days for results until their samples could be driven 595km across the country to the capital, Bangui. But as they waited, other citizens crossed back and forth at the border without being checked. No truck, no problem.
Rumours and lack of information have also contributed to the spread. In Tanzania, President John Magufuli said that the country had eradicated coronavirus "by the grace of God." His government stopped releasing any data on cases after April 29.
In Nigeria, most of the public health messages have been released in English, which many Hausa speakers in the north do not understand.