A steady increase in the number of cases has been observed in the WHO African Region since the first case of coronavirus disease 2019 (COVID-19) was reported on 25 February 2020 in Algeria. All Member States have since been affected, with the exemption of Comoros and Lesotho where there have been no official reports of confirmed COVID-19 cases to date. Since our last situation report on 22 April 2020 (External Situation Report 8), there has been a 52% increase in the number of confirmed COVID-19 cases (7 982 additional cases) and a 26% increase in the number of COVID-19 related deaths (183 additional deaths) reported in the WHO African Region. As of 28 April 2020, a cumulative total of 22 376 confirmed COVID-19 cases with 899 deaths (case fatality ratio 4.0%) have been reported across the 45 affected countries in the region. With the rising number of COVID-19 cases, the overall case fatality ratio fell from 4.7% to 4.0% during the reporting period.

The number of reported new cases has increased by 42% in week 17 (n= 6 254 cases) compared to week 16 (n= 4 419 cases). Although the outbreak has been ongoing for over 9 weeks, the majority (88%) of cases were reported over the past five weeks. Out of the 45 affected countries, 10 (22%) reported over 500 cases, 14 (31%) reported between 100 and 499 cases and 21 (47) reported fewer than 100 cases. Seven countries have registered more than 1 000 confirmed COVID-19 cases, including, South Africa (4 996), Algeria (3 649), Cameroon (1 705), Ghana (1 671), Nigeria (1 337), Guinea (1 240) and Côte d’Ivoire (1 164). Côte d’Ivoire, Guinea and Nigeria are the latest countries to cross the 1 000 cases mark this week. Together, these seven most affected countries account for 71% of the cases reported in the region. Among countries with widespread transmission, the highest case fatality ratios were observed in Algeria (12.0%), Liberia (11.3%), Burkina Faso (6.6%), Democratic Republic of the Congo (6.1%) and Mali (5.7%). Algeria alone accounted for 49% of COVID-19 deaths reported in the region.

In week 17 (week ending 26 April 2020), five countries observed an exponential increase in their weekly case incidence; these include Equatorial Guinea 299% (from 79 to 315 cases), Central African Republic 257% (from 14 to 50 cases), Eswatini 196% (from 24 to 71 cases), Nigeria 147% (from 541 to 1 337 cases) and Sierra Leone 108% (50 to 104 cases). Since our last report on 22 April 2020, five countries including Eritrea, Gambia, Mauritania, Namibia and Seychelles have not reported any new confirmed COVID-19 cases.

Notably, a critical group of people, health workers, have been greatly affected by the COVID-19 outbreak, with 423 infections registered from 23 counties in the region since the beginning of the outbreak. Niger has been the most affected, with 126 health workers infected, followed by Côte d’Ivoire (72), Cameroon (40), Mauritius (30), Ghana (25) and Senegal (22). Other countries that recorded health worker infections include Democratic Republic of the Congo (20), Sierra Leone (17), Zambia (15), Equatorial Guinea (13), South Africa (13), Togo (6), Madagascar (5), Congo (4), Eswatini (3), Uganda (3), Kenya (2), Namibia (2), Benin (1), Burundi (1), Central African Republic (1), Guinea-Bissau (1) and Zimbabwe (1).

Information on sex and age is currently available for 4 361 (20%) of cases. The male to female ratio among confirmed cases is 1.8, and the median age is 42 years old (range: 0 - 105). The distribution of cases according to age and sex is presented in figure 4; older males continue to be disproportionately affected by this disease.