DAKAR, Senegal – In the northern Nigerian city of Kano, some people claim to receive four or five death notices on their phones every day: a colleague has died. A friend’s aunt. A former classmate.
The city’s gravediggers, one of the largest in West Africa, say they work overtime. And so many doctors and nurses have been infected with the coronavirus that few hospitals are now accepting patients.
Officially, Kano has reported 753 cases and 33 deaths attributed to the virus. But in reality, the metropolis is experiencing a major and uncontrolled epidemic, according to doctors and public health experts. It could be one of the worst on the continent.
The coronavirus has been slower to implant in Africa than on other continents, according to figures released daily by the World Health Organization.
But blazing hot spots are starting to emerge. Kano is just one of many places in Africa where the relatively low number of official cases is nothing like what health workers and residents say they see in the field.
In the capital of Somalia, Mogadishu, authorities say the burials have tripled. In Tanzania, after cases suddenly increased and the US Embassy issued a health alert, the Tanzanian government abruptly stopped publishing its data.
The Kano state government, until recently, has said that a series of unusual deaths is not due to the coronavirus, but to hypertension, diabetes, meningitis or acute malaria. There is little social distancing and few people are tested.
“The management is in denial,” said Usman Yusuf, professor of hematology-oncology and former head of Nigeria’s national health insurance agency. “It’s almost like saying there is no Covid in New York.”
He said he believed that a significant part of the population was probably infected in Kano, a city with around five million inhabitants (although there has been no census since 2006).
Although they have now acknowledged that they have a problem with Covid-19, the coronavirus disease, the Kano authorities have spent precious weeks denying it, despite the sharp increase in what Abdullahi Umar Ganduje, the state’s governor, called it “a mysterious death.”
“So far, there is no evidence to suggest that they are related to Covid-19,” said Ganduje. published on Twitter on April 27, when, according to doctors at Kano hospitals, the city was already firmly in the grip of a serious epidemic of coronavirus.
There was nothing mysterious about what the doctors said they saw at Aminu Kano University Hospital, the city’s main public hospital. Beginning well before the first case of Kano was reported on April 11, the hospital saw a steady stream of elderly patients suffering from fever, cough, difficulty breathing and low levels of oxygen saturation, many of whom had underlying health problems.
Doctors at the hospital called the government response team. Sometimes it took 24 hours to be called back. The team sometimes refused to test or isolate patients, saying they were ineligible because they hadn’t traveled recently.
About 60 to 70 percent of elderly patients who went to hospital and died later had arrived with all of Covid-19’s symptoms, said a medical doctor who, with another doctor, spoke under cover anonymity because they feared retribution.
A doctor said that the department’s death registers for April showed that many more patients had died than normal. Most of the patients were discharged, he said, and hospital staff would often learn later that they had died.
Without personal protective equipment, with the exception of surgical masks, doctors said they knew the risks they faced in treating these patients. They said they begged the hospital management for N-95 masks, face shields, gloves and aprons, but none came. They asked for an isolation center at the hospital, fearing that patients with other illnesses might be infected. They wanted the facilities to be fumigated. Nothing happened.
And then it was too late. Doctors started to get sick.
“We have all been exposed,” said the other doctor. “In the end, what we feared happened. “
Twenty of the 91 doctors in the hospital’s medical service tested positive, the doctors said. Overall, in Kano, 42 doctors and 28 nurses tested positive and one doctor died, according to Dr. Sanusi Bala, president of the Kano branch of the Nigerian Medical Association. Laboratory technicians at what was then Kano’s only test laboratory also fell ill and it shut down for several days. The city’s already extremely limited healthcare system is paralyzed.
Nigeria, a country of around 200 million people, says it can theoretically do 2,500 tests a day, and Kano up to 500. But it has done far fewer tests, generally 1,000 to 1,200 per day. Test results in Kano can take two weeks. Doctors who are waiting for their test results cannot go to work. People in quarantine cannot leave.
“If I say that thousands of people die from Covid, I don’t think I have exaggerated the figure,” said the doctor who begged P.P.E. “So many people die without being tested, without even going to the hospital.”
While the government eased blockages on May 4 in the capital, Abuja, and the largest city, Lagos, it extended that of Kano. But few people observe it. Numerous funerals are well attended, residents said.
Many in the city think the coronavirus is a hoax, perhaps because public messages about it are mostly in English, which most people in Kano don’t speak, health experts said.
Others believe a Covid-19 diagnosis is a death sentence, experts said, and don’t want their neighbors to think they are infected. So they avoid being tested and try to behave as if everything is normal.
They go to funerals and shake hands with their mourners because it would be socially unacceptable not to do so. They shop barefoot in crowded markets. They organize soccer tournaments – a recent one was called the “Coronavirus Cup”.
Although the situation in Kano is bleak, the picture varies widely from country to country in Africa.
Of figures collected by the World Health Organization and other groups, Djibouti, in East Africa, appear to have the highest per capita infection rate on the continent, at 1 in 746. But officials public health interviewees attribute this to aggressive testing and contact tracing. Anyone who tests positive is hospitalized, even if no symptoms appear.
Tanzania reported 509 cases, but stopped publishing data two weeks ago, and the U.S. Embassy there said Wednesday the risk of contracting Covid-19 was “extremely high”. A government spokesperson told the BBC that testing had been suspended while authorities investigated the many test kits, but denied that Tanzania was doing too little to stop the spread of the virus.
In Somalia, more than 1,200 people tested positive and, officially, 53 died. But doctors, officials and aid workers think these figures are far away. Thousands of people with the virus stay at home and do not get tested, they say.
The Somali prime minister’s office, which oversees the response to the epidemic, has rejected the concept of hidden tolls, saying Mogadishu has already reached its peak.
Dr. Mohamed Abdi Hassan, who directs the medical response to Covid-19 in the Prime Minister’s Office, said that “there may be cases here and there that died suddenly and were buried”, but the number of cases in which people had died of the coronavirus without being tested had been exaggerated. “We have captured the real picture as much as possible. “
In Nigeria, some say that with the widespread Kano epidemic, the city may already be home to a giant and involuntary experience of collective immunity.
“The disease takes its natural course,” said Dr. Faruk Sarkinfada, a medical microbiologist who works in Kano.
Eighty percent of the tests in the city return positive, said a presidential task force sent to Kano at the end of April to the service in Hausa of the BBC.
But since nobody trusts official reports, the citizens of Kano have come up with their own ways of assessing the virus.
Nazir Adam Salih, writer and engineer, conducted an impromptu survey of more than 100 acquaintances. Almost all of them said they had fever, cough and loss of smell. Almost none had been tested or treated.
Doctors phone relatives of the dead to perform “verbal autopsies”.
In late April, the Kano state government finally acknowledged that there was a problem with Covid-19 and asked the federal government to help it. Dr. Sarkinfada, the medical microbiologist, said that the federal government has focused its efforts on increasing Kano’s testing capacity and that test results are now coming sooner.
“The situation in Kano went through us with deception, denial, challenge, denunciation, disagreement and finally acceptance and action to control the disaster,” said Oyewale Tomori, a virologist who heads a committee of the Nigerian government on Covid-19.
The location, population and connectivity of Kano to the rest of the region means that the consequences of an uncontrolled epidemic could be serious.
There are already reports that hundreds of additional people have died of “mysterious deaths” in the northern states of Nigeria, Jigawa, Yobe, Sokoto and Katsina, including three emirs, or traditional Muslim leaders, and a former minister of health.
“If Kano falls, all of northern Nigeria falls. The whole of Nigeria is falling, “said Dr. Yusuf. “It spreads to the whole of West Africa and to the whole of Africa.”
Abdi Latif Dahir contributed to reports from Nairobi, Kenya, and Simon Marks from Addis Ababa, Ethiopia.