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COVID-19 Situation update for the WHO African Region, External Situation Report 33 (14 October 2020)

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1. Situation update

Cases 1 232 030

Deaths 27 684

The number of coronavirus disease 2019 (COVID-19) cases in the WHO African Region is now at 1 232 030 with 27 684 deaths. Since our last External Situation Report 32 issued on 7 October 2020, a total of 30 919 new confirmed COVID-19 cases and 1 209 new deaths were reported from 44 countries between 7 and 13 October 2020. This is a 20% increase in incidence cases and an 86% increase in deaths compared to 25 840 cases and 659 deaths registered during the prior reporting period (30 September - 7 October 2020). The region observed a considerable increase in case incidence and deaths in the past seven days, mainly due to increases in reported cases in some of the top 10 countries including Cameroon, Kenya, Côte d'Ivoire and Nigeria.

In a similar trend to the previous reporting period, 22 countries recorded a decrease in new cases, with 15 registering a decrease of more than 20%; Central African Republic (92%), Seychelles (80%), Niger (75%),
Democratic Republic of the Congo (48%), Sierra Leone (42%), Equatorial Guinea (42%), Guinea-Bissau (40%),
Namibia (39%), Mauritius (36%), Gambia (32%), Eritrea (30%), Eswatini (28%), Senegal (25%) and Ghana (23%).
At the same time, 21 countries reported an increase in case-counts with 14 showing an increase of 20% or more;
Cameroon (501%), Sao Tome and Principe (400%), Lesotho (124%), Burundi (100%), Kenya (95%), Chad (84%), Angola (84%), Mozambique (66%), Liberia (64%), Benin (57%), Zimbabwe (55%), Côte d'Ivoire (38%),
Malawi (29%) and Mauritania (30%). Only Comoros did not record any significant change in case incidence.
United Republic of Tanzania did not officially submit any reports indicating any new confirmed cases.
A total of 288 new health worker infections were reported from five countries: Ethiopia (205), Uganda (51),
Namibia (18), Eswatini (13) and Zambia (1).

During this period, 1 209 new COVID-19 related deaths occurred in 29 countries, with 925 (67%) of the deaths recorded in South Africa. This was followed by Ethiopia, with 67 (7%) deaths, Algeria with 45 (7%) and Kenya with 44 (6%). South Africa, Ethiopia and Kenya recorded a 112%, 43%, and 22% increase in deaths, respectively; while the number of deaths in Algeria decreased by 4%. The other countries that reported new deaths during the reporting period include; Angola (30), Uganda (11), Zambia (9), Cabo Verde (8), Mozambique (7), Ghana (5),
South Sudan (5), Botswana (4), Burkina Faso (4), Chad (4), Lesotho (4), Madagascar (4), Namibia (4), Cameroon (3), Congo (3), Nigeria (3), Rwanda (3), Senegal (3), Democratic Republic of the Congo (2), Eswatini (2), Guinea (2), Mauritania (2), Gambia (1), Guinea-Bissau (1), Malawi (1), Mali (1) Togo (1) and Zimbabwe (1).

As of 13 October 2020, a cumulative total of 1 232 030 COVID-19 cases was reported in the region, including 1 232 029 confirmed, with one probable case reported in Democratic Republic of the Congo. South Africa has consistently registered more than half, 56% (694 537), of all reported confirmed cases in the region. The other countries that have reported large numbers of cases are Ethiopia (85 718), Nigeria (60 655), Algeria (53 399), hana (47 097), Kenya (41 939), Cameroon (21 441), Côte d’Ivoire (20 183), Madagascar (16 754) and Zambia (15 549). These 10 countries collectively account for 86% (1 057 272) of all reported cases.
Six countries are still reporting fewer than 1 000 cases: Sao Tome and Principe (929), Burundi (529), Comoros (496), Eritrea (414), Mauritius (404) and Seychelles (147). To date, a total of 1 043 969 (85%) case-patients reported from all the 47 countries have recovered.

The total number of deaths reported in the region is 27 684, reported in 45 countries, giving an overall case fatality ratio (CFR) of 2.3%. Two countries, including Eritrea and Seychelles, have not registered any COVID19 related deaths since the beginning of the pandemic.

Since the beginning of the outbreak in the region, the majority of the deaths have been reported from: South Africa 65% (18 028), Algeria with 6.6% (1 818), Ethiopia 4.7% (1 305), Nigeria 4.0% (1 116), Kenya 2.8% (787), Cameroon 1.5% (423), Zambia 1.2% (344), Senegal 1.1% (315), Ghana 1.1% (308), Democratic Republic of the Congo 1.0% (276), and Madagascar 0.9% (237). The top five countries: South Africa, Algeria, Ethiopia,
Nigeria, and Kenya account for 83% (23 054) of the total deaths reported in the region. Chad (7.0%), Liberia (6.0%), Niger (5.7%), Mali (4.0%), Algeria (3.4%), Angola (3.3%), and Gambia (3.2%) have the highest country specific case fatality ratios.

The current figures in the region represent 3.3% of confirmed COVID-19 cases and 2.6% of deaths reported worldwide. South Africa remains the hardest hit country on the African continent and is ranked tenth globally, although with relatively low numbers of deaths. Table 1 shows the affected countries and their corresponding number of cases and deaths. The daily and weekly distribution of cases by date and week of reporting are presented in Figures 1 and 2, respectively. Figures 3 and 4 show the distribution of cases and deaths with case fatality ratio by reporting date in South Africa and in the other top six countries.

The number of health worker infections continue to increase gradually with 43 984 (3.6%) infections reported in 43 countries since the beginning of the outbreak. South Africa remains the most affected, with 27 360 (62%) health workers infected, followed by Algeria (2 300), Nigeria (2 175), Ghana (2 065), Ethiopia (1 711), Kenya (1 029), Cameroon (808), Uganda (659), Guinea (513), Mozambique (484), Namibia (478), Equatorial Guinea (363), Senegal (349), Eswatini (299), Guinea-Bissau (282) and Malawi (280). The other 28 countries that have recorded health worker infections are shown in Table 1. Liberia 15.7% (215/1 372), Niger 15.3% (184/1 201),
Guinea Bissau 12.0% (282/2 385), Sierra Leone 10.2% (236/2 309), Sao Tome and Principe 9.6% (89/929),
Mauritius 7.4% (30/404) and Equatorial Guinea 7.2% (363/5 066) have the highest country specific proportion of health worker infections among confirmed cases.

Considering the available data 1.0% (11 877) on age and gender distribution, males (61%) 7 241 in the 31-39 and 40-49 age groups are more affected than females (39%) 4 636 across the same age groups in the African region. The male to female ratio among confirmed cases is 1.6, and the median age is 37 years (range: 0 - 105).
The distribution of cases by age and sex is presented in Figure 5.

Diverse transmission patterns continue to be observed across the region, with established community transmission seen in 39 (83%) countries, five (11%) countries have clusters of cases and three (6%) with sporadic cases.
As of 13 October 2020, the seven African countries in the WHO EMRO Region reported a total of 362 257 confirmed COVID-19 cases: Morocco (104 787), Egypt (104 787), Libya (44 985), Tunisia (32 556), Sudan (13 691), Djibouti (5 428), and Somalia (3 864). Additionally, a total of 10 886 deaths has been recorded from Egypt (6 071), Morocco (2 685), Sudan (836), Libya (656), Tunisia (478), Somalia (99) and Djibouti (61).

A cumulative total of 1 594 287 confirmed COVID-19 cases, 38 570 deaths (case fatality ratio 2.4%) with 1 316 035 cases that have recovered have been reported in the African continent.