Africa’s COVID-19 third wave: A coupled behavior-disease system in a mutual feedback loop

Abstract

A year after COVID-19 was declared a pandemic much of the Africa continent started experiencing spikes in the number of COVID-19 cases and related deaths in what was referred to as the third wave of the pandemic. These spikes came right behind the heels of a second wave of the pandemic that barely went unnoticed in Africa. As of July 2021, Morocco, South Africa, Tunisia, Egypt, Nigeria, Libya, Kenya, Algeria, Zambia and Ethiopia accounted for approximately 86% of the reported increase in COVID-19; these countries were aptly described as being at the forefront of the continent’s third wave of the COVID-19 pandemic. Unlike those countries in Asia and Latin America that experienced what may generally being described as autochthonous COVID-19 third wave, Africa’s third wave COVID-19 cases are widely believed to have been triggered by imported cases. Africa like the rest of the world relaxed its COVID-19 restrictions almost at the same time; hence the continent’s spikes of COVID-19 cases and related deaths during the third wave of the pandemic have raised some questions.

Epidemiological Trends of Coronavirus Disease 2019 in Sierra Leone From March 2020 to October 2021

“…As of December 31, 2020, 40 (73%) countries in Africa had experienced or were experiencing their second wave of cases ( 19 ). Moreover, after April 2021, some countries in Africa experienced a surge in the number of COVID-19 cases and related deaths in what is now referred to as the continent's third wave of the pandemic ( 28 ). Furthermore, the three waves of COVID-19 in Sierra Leone occurred later on than in other African countries, and 6.4% (409/6,398) of cases arose from incoming travelers.…”

“…It is important to note that there was no increase in the numbers of confirmed COVID-19 cases alongside increased testing, except during the third waves. Moreover, the spikes in the incidence and mortality rates during the third wave of COVID-19 in Africa were not associated with an increase in diagnostic COVID-19 testing ( 28 ). This suggests that SARS-CoV-2's introduction led to local transmission events.…”

“…A previous study showed that, in Sierra Leone, the second COVID-19 wave was mainly caused by the R1 lineage, while the third COVID-19 wave was dominated by the spread of the B.1.617.2 lineage (Delta variant), and further phylogenetic analysis revealed that multiple introductions of SARS-CoV-2 into Sierra Leone subsequently led to clusters and community transmission in the country ( 29 ). Similarly, most of Africa's COVID-19 cases that were considered to constitute the third wave of the pandemic were either imported cases or were triggered by imported COVID-19 cases ( 28 ). Moreover, based on the data from “Our World in Data,” around 1,284 new cases were reported from Nov 2021 to May 2022 in Sierra Leone.…”

“…The various COVID-19 waves were exacerbated by different human behaviors, inertia governmental actions and rules, travel, daily activities, and the emergence of novel variants ( 28 ). In order to prevent SARS-CoV-2 from further spreading and expanding, there is a need, therefore, to intensify ongoing efforts, except for some of the existing measures.…”

“…Most deprived communities lack running water, toilet facilities, soap, and basic food items ( 39 ). Thus, it may be a difficult chore for Africans to follow COVID-19 precautions, such as physical distancing, hand hygiene, and the wearing of face masks ( 28 ). Therefore, we suggest that the vaccination rate should be increased by improving the vaccine supply, population awareness about infection with the new viral variants and its complications, particularly the long-term COVID-19.…”