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[Paper] Racial COVID-19 against death and hunger and its impact on African populations.

[Paper] Racial COVID-19 against death and hunger and its impact on African populations. Melkamu Dugassa Kassa1 and Jeanne Martin Grace

Summary

Background

The global health and economic impact of the coronavirus epidemic that originated in Wuhan, China, has been and continues to be devastating. In Africa, the disease-causing virus, COVID-19, has caused African countries to suffer unprecedented levels of caseloads and deaths. This narrative review aims to establish the scale of the health and economic crisis caused by the pandemic in Africa, including the impact on the informal economic sector, the projected impact on domestic GDP and its political dimensions.

Method

Evidence published between January 8 and August 8, 2020, was obtained from Google Scholar, PubMed, Scopus, and Web of Science databases.
We also searched published and unpublished abstracts from appropriate websites, government documents, organizational reports, newspaper commentaries, and reports published by global, regional, and local centers for disease control and prevention.

Result

The COVID-19 pandemic is responsible for four crises in Africa. (1) Health crisis: as of August 8, 2020, 1,039,000 (12%) front-line health care workers have been confirmed dead, 22 or more than 966 (2.4%). The highest number of deaths occurred in Southern Africa with 11,024 (48%), followed by North Africa with 6,989 (29.2%). (2) Social crises such as human rights abuses, killings of civilians by security forces, and increased crime. As a result, social inequality, household breakdown, cases of social unrest, and general poverty worsen. (3.) Economic crisis, symbolized by declining GDP and massive unemployment.
(4.) Political crisis: implementation of measures not suitable for Africa, discrimination against refugees and immigrants, displacement of citizens to their home countries, distrust of political leaders, postponement of national elections, and increase in conflicts and disturbances.

Conclusion.

COVID-19 Lockdown during an outbreak is a race against death and hunger in developing regions such as Africa, whereas it is a prevention mechanism in wealthier countries. Policymakers must apply new regionally relevant prevention and control strategies to address this growing disaster.

Keywords:

Africa, coronavirus disease, economic impact, GDP, political crisis, social impact

Background

The rapid and global spread of coronavirus disease caused by COVID-19 is causing the greatest public health and economic crisis the world has faced in over a century. It affects all racial, gender, and religious groups, regardless of economic status [1, 2]. The widespread and increasing prevalence of this virus around the world is due to the movement of people from Wuhan, China, to other previously unaffected areas due to the ease of movement of people through labor, tourism, trade, and international travel [3, 4]. The dramatic increase in the prevalence of COVID-19 outbreaks and the associated morbidity and mortality has placed significant limits on freedom of social life, freedom of travel, social cohesion, and the productivity of the global community [5, 6].
On January 3, 2020, the World Health Organization (WHO) declared this situation to the world's population as the disease spread both inside and outside of China. Calling it a pandemic for the first time, it expressed great concern about the need to protect countries with limited resources, fragile health systems, and a lack of preparedness to avert the health crisis that was about to strike them [7, 8]. To support preliminary preparedness and response activities, WHO contributed US$1.8 million from the Contingency and Emergency Fund (CFE) [9], taking into account ancillary impacts, potential human health impacts, and the efficiency of current preparedness and response measures. In early February 2020, recognizing the increase in cases in developed countries and the inability of health care systems to handle the large number of sick people requiring life-saving emergency care, African countries such as Kenya, South Africa, Rwanda and Uganda implemented lockdowns, flight bans, closure of schools, universities and other educational institutions, border closures, public transportation bans, and the commandeering of carafeus, among other precautionary measures [10,11].

The outbreak of COVID-19 disrupted networks of African residents, particularly affecting meetings, tourism, travel, trade, and physical contact. This was due to the country's restricted territory and borders in order to limit and ideally prevent the spread of this disease. In addition, African communities were obliged to stay in touch through advanced technologies such as the Internet, webinars, smart phones, and other electronic systems. Despite the lockdown in many countries, the prevalence and spread of COVID-19 is increasing exponentially, with over 1.8 million cases and 729,891 deaths reported as of this writing on August 8, 2020 [12]. Other countries have quickly surpassed the numbers first recorded in China, including the United States, Brazil, India, Russia, South Africa, and Mexico [13]. Although the COVID-19 outbreak in China was in its maturation stage, it initially peaked in many developed countries, including Italy, France, Germany, Spain, the United States, and the United Kingdom, where it spread domestically via contagious immigration [14]. The global impact of the disease has been very large and overwhelming, causing widespread morbidity, death, social disruption, and economic losses [15]. In Africa, the spread of the epidemic is in a growth phase, and there is great concern about future high infection rates due to poverty and socioeconomic factors in Egypt, Algeria, South Africa, Morocco, Ghana, and Nigeria [16, 17]. Unlike Europe and other rich countries, the culture of African peoples is unique in that they value collectivity and cohesive living. This is inconsistent with lockdown, kerfing, social distance, and enforced isolation, which undoubtedly increases infection, morbidity, and mortality [18]. Large gatherings at religious services, large social events, traditional funerals, and weddings are standard cultural practices in Africa [19]. These, coupled with the lack of adequate knowledge and information about the disease and poor implementation of practical information, contribute to the spread of coronaviruses [20]. In contrast, evidence from countries such as China, Korea, Japan, and Turkey confirms that self-care and social isolation may significantly reduce the spread of infection [21]. If temporary cultural reforms were not implemented in Africa, the number of cases and deaths from outbreaks would exceed the total number of deaths worldwide [19, 22].

In contrast to the situation in rich western countries, the lives of many Africans are based on a daily intake of food sufficient for survival [23, 24]. It is not possible to fix African communities at home for long periods of time. This is because people need to access fields and find ways to obtain food. For example, many people in Ethiopia, Kenya, Nigeria, and South Africa violate lockdown measures [25-27] and move in large numbers through public places such as towns and limited market places to find and gather daily food, even though such movements are prohibited [ 28]. Although the lockdown is intended as a measure to control the outbreak of COVID-19 and prevent its spread in the rich world, it is a race against death for survival among many people in Africa, where life has become a state of "avoidance-avoidance" conflict, where people are confined to their homes, die of starvation, or are forced to work and food recovery, and violate lockdown regulations to die from disease. Whatever citizens choose to do, the race defies death, starvation, and the virus. In Africa, the public view of the morbidity and mortality caused by the disease remains inconsequential [20], and it is particularly difficult to implement prevention mechanisms to halt its spread in most countries [29]. This major obstacle is the influence of social practices, traditional greetings, poor hygiene (injunctions to wash hands with soap when clean water is scarce) [30], sharing of materials such as door handles, toilets, TV remotes, cell phones, and computer keyboards, and the transmission of coronavirus in Africa further exacerbated by a general lack of vigilance and egocentrism[31] that is predicted to double the risk. Evidence from China indicates that transmission has decreased significantly since material sharing was banned, lockdowns were implemented, and social distance was established [32]. This is because the majority of Africans live below the poverty line and millions are engaged in informal work. Even if they stay in their homes, these workers and their families continue to be exposed to the virus in Africa because of overcrowded and unsanitary living conditions that make physical distance and hygiene almost impossible. In addition, most Africans lack access to running water that not only limits the possibility of hand washing but also puts women in line for water, thereby endangering those who come in contact with the women themselves [32].

Community-based self-care management approaches to combat coronavirus pandemics are encouraged because of their broad impact on global morbidity and mortality, the resulting financial consequences, and the significance to the public of their prevention [33 ]. Effective control of COVID-19 requires cooperation between governmental and nongovernmental organizations, private institutions, and social institutions such as medical facilities, schools, universities, and religious centers to mitigate the spread of the virus [34]. If properly implemented, such collaboration will enable health care systems to successfully address the impact on high-risk individuals and groups as part of a global prevention strategy [35].

Evidence from Africa also indicates that the prevalence of the disease is higher among international travelers, large gatherings, hand washing, physical contact with others, and those who share hand materials, all of which increase exposure to infected people and the virus [36]. Coronavirus transmission continues to increase and its prevalence is spreading across Africa, regardless of health system and economic level [37, 38]. This has increased the need for further analytical studies of the health, social, economic, and political impact to assist decision makers on service delivery by indicating public health requirements that require attention and estimating the funding and measures needed for appropriate preventive measures. Therefore, it is essential to conduct a broader analysis than has been previously reported when assessing the impact of COVID-19 outbreaks on health and economic growth in resource-poor countries such as Africa. Current evidence focuses primarily on the number of confirmed cases, recoveries, and deaths, leaving the social, economic, and political impact largely unknown. In this narrative review, we sought to establish the number of COVID-19 cases, recoveries, and deaths; the impact of the health crisis on the formal and informal economic sectors; projected changes in gross domestic product (GDP) in Africa before, during, and after the pandemic; and the political and other consequences of preventive measures such as lockdown The aim of the project was to.

Method

Sources.

We conducted an electronic search of relevant reports published between January 8 and August 8, 2020, extracted from Google Scholar, PubMed Central, Scopus, and Web of Science databases. We also searched published and unpublished abstracts, as well as reference lists and tables of contents of relevant journals such as The Lancet, New England Journal of Medicine, and Nature, for Africa-related global and regional government documents, WHO global and regional reports, regional and updates from the regional Centers for Disease Control and Prevention (RLCDC), as well as from The Guardian (UK) and The Washington Post (USA).

Search Terms in the Survey

The following search terms were used. "infectious disease," "coronavirus," "COVID-19 pandemic," "COVID-19 pandemic," "COVID-19 pandemic," "severe acute respiratory syndrome (SARS)," "impact of COVID-19," "economic impact of COVID-19," "economic impact of COVID-19," Economic Impact," "GDP," "Health Impact of COVID-19," "Social Impact of COVID-19," "COVID-19 Case Reports," or "COVID-19 Death Reports," or "COVID-19 Death Reports," "Social Distance" and "Lockdown"

Selection Criteria

Two reviewers independently evaluated all titles and abstracts of the identified studies and applied the following four selection criteria to determine whether (1) the report required further investigation:(1) did it include African countries? (2) is the study published in English? (3) is the content appropriate for the purpose of the study? 4. was it published between January and July 2020? For studies that met the selection criteria, we obtained full-text versions of journal articles or other source documents; for studies that were unclear, we reached consensus after discussion. From the final selection of source documents, we (J.G. and M.K.) extracted the data independently on standard data forms. Authors of studies with missing data were contacted by e-mail and, where possible, data were obtained.

Estimation of Gross Domestic Product

Africa's pre-pandemic, current, and post-COVID-19 GDP projections were calculated based on data from the continent's World Economic Outlook database [39, 40]. Raw material search results. First, duplicates and data management were identified using Mendeley Desktop reference management, and then 136 studies were identified using the search criteria (Figure 1). Duplicates were excluded, full-text articles were checked for eligibility, exclusion criteria were applied, and screening was conducted, resulting in 32 articles meeting the selection criteria.

Figure 1 The process of selecting data from the literature and conducting a narrative review

文献からデータを選別し、物語的レビューを行う過程

Africa's Health Crisis

Since the first case of COVID-19 in Africa was confirmed in northern Egypt on February 15, 2020, there has been a dramatic increase in pandemics and associated morbidity and mortality in five regions of Africa (North, Central, East, West and Southern Africa). During the period when the virus reached the continent only three months after it was first reported by WHO in China and then one month after it arrived in northern Italy, considered the center of the disease, fewer cases were expected in Africa. As shown in Table 1, as of August 8, 2020, a total of 9.2 million COVID-19 tests have been performed in Africa, more than 1 million cases have been confirmed, more than 707,877 people have recovered, and 22,966 deaths have been registered.

Southern Africa had the highest number of trials with 4 million cases (43% of all COVID-19 trials conducted), while Central Africa had the lowest number with 327,007 cases (4%). The highest number of cases, over 565,003 (56%), was in North Africa and West Africa, followed by North Africa and West Africa with 171,251 (17%) and 136,952 (13.6%) cases, respectively. Southern Africa had the highest number of fatalities with 11,424 (48%), followed by North Africa with 7030 (29.3%). Countries with the highest number of recognized cases were South Africa (553,188), Egypt (95,314), Nigeria (46,140), Ghana (45,533), and Algeria (34,693). The six countries with the highest number of virus-related deaths are South Africa (10,210), Egypt (4992), Algeria (1293), Nigeria (942), Sudan (773), and Morocco (480).

The resilience of African countries and societies in the face of the COVID-19 pandemic

According to current data, COVID-19 has a greater impact on countries with more "developed" countries than on poorer countries on the continent. On the other hand, urban areas had a higher disease burden than rural areas. A review of data from the Coronavirus Resource Centre at Johns Hopkins University shown in Table 2 indicates that mortality rates in African countries ranged from 0.5% in Ghana to 8.1% in Chad, compared to 15.0% in the UK and 14.1% in Italy, 3.3% in Brazil. The relatively low mortality rate of COVID-19 cases in Africa is most likely due to the youth of the African population, but may also be due to inefficiencies in the social and medical data collection systems [41].

Impact of COVID-19 on the Informal Economy and GDP Crisis in Africa

80~90% of Sub-Saharan Africa's economic activity comes from the informal sector, which accounts for 40% of GDP [42, 43]. The outbreak of the COVID-19 pandemic severely affected this economic sector. Informal workers and businesses [42] are involved in activities such as the provision of accommodation and food services, manufacturing, wholesale and retail trade, and include over 500 million farmers who were producing for urban markets. Logistical challenges within the supply chain, especially restrictions on internal movement across borders, can disrupt food supplies and undermine the food security of informal workers. Informal produce markets also play a vital role in ensuring food security in many countries, both as a source of food and as a place for small farmers to sell their products. Their closure would lead to increased food insecurity and poverty [44].

Table 1: COVID-19 Tests, Confirmed Cases, Deaths, and Active Cases in the African Region

アフリカ地域における COVID-19 検査、確定症例、死亡、活動性症例

Table 2: COVID-19 Mortality Rates, Comparison among Several Countries

COVID-19 の死亡率、数カ国間の比較

The overwhelming majority of workers in the informal economy experience increased exposure to occupational health and safety risks due to lack of adequate protection and increased likelihood of suffering illness, accident or death. COVID-19 increases these risks. If they fall ill, most workers, including migrants, have no guaranteed access to medical care and no income security through benefits due to illness or occupational injury [45]. If they do not have access to medical care, the virus will spread more widely, with fatal consequences. If they could access medical care, many would be forced to incur out-of-pocket costs, incur debt, or sell their productive assets, leading to more severe poverty [45,46].
Table 3 compares the projected changes in gross domestic product (GDP) of various African countries before, now, and after the pandemic has passed. Table 3 shows that Africa's overall GDP is projected to decline from 2.4% to 5.1% during its high from 2.4% before the outbreak and then increase to 4.1%. COVID-19 reports that GDP in sub-Saharan Africa and low- and middle-income countries will change by -1.6%, -3%, and 1.6%, respectively, and is projected to increase by 4.2%, 4.9%, and 4.9%, respectively, after the pandemic passes [35, 47].

The health, social, economic, and political impacts of the COVID-19 pandemic in Africa are shown in Table 4. The health impact has been overwhelming, resulting in over 3 million early deaths in 2016 [47, 48], in addition to early deaths from resource-poor health systems on the continent and underlying diseases such as lower respiratory tract infections, HIV/AIDS, diarrheal diseases, malaria, and TB. In many wealthy countries, comorbidities complicate the health outcomes of COVID-19 patients, and in large populations that are malnourished and experience underlying diseases, these patients may be at increased risk of death from the virus, although this impact is unknown. It is also unlikely that the inadequate health service infrastructure on the African continent will prevent many infected patients from receiving the care they need in adequately equipped facilities [24].

Table 3: GDP projections for different African regions and individual countries before, now, and post COVID-19 outbreak [35, 47].

COVID-19 アウトブレイク前、現在、およびポスト COVID-19 アウトブレイク前の、さまざまなアフリカ地域および個々の国の GDP 予測[35, 47]

The outbreak of the pandemic has had a profound impact on the social life of Africans, limiting material sharing, disrupting family life, and disrupting social cohesion through social distance and enforced isolation. Most African educational institutions have been closed. Traditional African life is cohesive and based on interdependence, making social distance and isolation very difficult. Constraints imposed by national governments have not only exacerbated existing inequalities, but have also victimized women, leading to an increase in rape cases [49]. It is the disabled and elderly who are the most economically deprived and vulnerable [50]. In addition, agricultural markets are closed, limiting people's access to food sources causing hunger among vulnerable communities already below the poverty line (Table 4). Some African countries, such as Ethiopia, Kenya, South Africa, and Uganda, are experiencing human rights violations, killings of citizens by security forces, and an increase in traditional crimes [28]. This has resulted in social unrest and further impoverishment of communities [51].

Table 4 :Health, Social, Economic, and Political Implications of COVID-19 in Africa

TypeAffect
Health EffectsMore than 1,039,678 confirmed cases and 22,966 deaths Increased risk of comorbidities, disabilities, and morbidity and mortality in the elderly Increased burden on health care systems of sacrificed and under-resourced front-line health care workers Lack of adequate health care infrastructure Increased burden of existing diseases such as HIV/AIDS, TB, malaria, diarrhea, lower respiratory tract infection
Social ImpactBreakdown of social cohesion following social distance and interpersonal isolationMost academic institutions were closed. Travel bans at the international, national, and local levelsFood markets closed and hunger increased among vulnerable communities with limited access to food sourcesRestrictions on religious gatheringsOccurrence of fear-based isolation and discriminationHumans rights violations, increase in crimes and other illegal activitiesFalse news about social media, Bring unauthorized viral precautions to communities. Increased inequality, harming women and the elderly
Economic ImpactCargo and people air and maritime transportation shutdownsVarious lockdown conditions affectedPrimary, secondary, and tertiary industriesDomestic production limitedTourism industry temporarily shut down and may have long-term effects Decreased value of supply chainsDecreased imports and exports, affecting foreign revenuesTrade and industry shutdownsIncreased debt to cope with the pandemicReduction in supply and demand for some productsIncreased unemployment with reduced per capita incomeFinancial recession and depressionIncreased pressure on monetary and fiscal policies
Political ImplicationsClosure of governmental, nongovernmental, and private organizations Countries are closing borders and preventing the movement of goods and services Discrimination against refugees and immigrants increasesEmigration of citizens to their home countries discredits leadersPostponement of national elections exacerbates conflict and chaosHandwashing may not be appropriate in Africa

Many African countries were already economically compromised by corruption, rogue regimes, and weak political leadership [39, 47]. Nevertheless, some countries, such as Djibouti, Ethiopia, Guinea, Cote d'Ivoire, Senegal, and Tanzania, have shown impressive economic growth over the past six months [39, 52]. In many countries, formal unemployment is high and people rely on small-scale agriculture and informal trade for their livelihoods. In countries with stagnant economies, thousands of jobs have been lost and the population without reliable sources of income is growing [40, 52]. At the country level, some of the economic impacts of the COVID-19 precautionary measures are characterized by the shutdown of informal economic sectors such as street vendors and small informal stores in towns, called spaza stores [43]. As a result, per capita income and trade in domestic products decline, the value of supply chains decreases, and pressure on fiscal policy and debt increases, all of which can lead to a financial recession or depression [39, 40, 52].
The salient political consequences of COVID-19, shown in Table 4, include increased discrimination against refugees and migrants, border closures, blocked movement of goods and services, disruption of formerly close relations between African countries, and displacement of citizens to their home countries, leading to distrust of their leaders [53]. In addition, due to the lack of running water, measures such as hand washing may not be suitable for Africa [53]. In addition, the postponement of national elections has caused deadly conflicts, distrust, and confrontations between political parties and the ruling party in some African countries, such as Ethiopia [54].

Consideration

This narrative review aimed to establish the number of COVID-19 cases, recoveries, deaths, impact on the informal economic sector, and projected changes in gross domestic product (GDP) in Africa before, during, and after the epidemic. It also aimed to determine the health, social, economic, and political crises of the COVID-19 outbreak in Africa and the impact of the lockdown imposed to prevent its spread to the African population.

Situation in Africa before COVID-19

Prior to COVID-19, the health situation on the African continent focused on infectious diseases such as HIV/AIDS, malaria, tuberculosis, and cholera, as well as health-related issues such as maternal and under-five mortality, with a typically lower emphasis on non-communicable diseases (NCDs) [55]. Pre-COVID-19 social factors in Africa are diverse and uniform. For example, African communities continuously move from one part of the continent to the other, either legally for visits, tours, trade, education, meetings, and training, or through illegal migration at the initiative of trafficked workers. There are also regular mass devotions in churches, mosques, beaches, and socialization around campfires, with some people visiting nightclubs, music and movie concerts, mass marketing, social works, weddings, and funeral ceremonies [19]. However, with the COVID-19 pandemic, all of the above activities have changed as African governments have implemented strategies to protect the lives, health, economies, and rights of their citizens.

COVID-19 The informal sector and formal economies in pre-COVID-19 economies, especially in the African context, are unique. For example, the informal sector consists of economic activities that avoid costs and are excluded from the benefits and rights embedded in laws and administrative regulations covering property relations, commercial licenses, labor contracts, tort, financial credit, and social systems vis-à-vis the formal economy. While labor law protects the formal economy, COVID-19 exposed the informal sector (the precarious nature of informal work), as evidenced by the absence of contract and income protection [45].

Finally, the political situation in Africa prior to COVID-19 (22 countries were preparing for national elections [56]) is problematic. Elections allow citizens to support their legitimacy or hold leaders accountable by replacing them if they seriously conduct elections in Africa characterized by fear and panic, which are considered "dead" events [57]. With the COVID-19 pandemic underway, there is uncertainty as to whether countries will proceed with elections under their respective electoral calendars. More specifically, there are concerns about how some autocratic leaders will be able to take advantage of the situation. The pandemic would extend its stay by postponing elections to a later date or indefinitely [57].

Incidence, mortality, recovery rates

Although a pandemic occurred in China, the COVID-19 epidemic in Africa is already threatening infectious and chronic diseases with very high morbidity and mortality rates among the African population [58]. At the time of writing this narrative review, cases and mortality associated with this virus were high in the North African region, followed by the Western and Southern African regions [59]. Modeling studies in Africa support our findings that by June 30, 2020, approximately 16.3 million people in Africa will be infected with COVID-19, with the East Africa region being the least affected North Africa region. The June 30 population caseload is projected to be approximately 2.9 million in Southern Africa, 2.8 million in West Africa, and 1.2 million in Central Africa [60, 61]. This variation in caseloads and mortality rates may be due to lower levels of socioeconomic development, and transmission in the early stages of a pandemic is likely to be less and slower than in stages with higher levels of socioeconomic development [62-65].

Health Crisis

The results of our narrative review paint a picture of the larger health crisis of the COVID-19 outbreak in Africa. This is due to already existing under-resourced health systems and premature deaths, HIV/AIDS, lower respiratory infections, diarrheal diseases, malaria, and tuberculosis, which already killed over 3 million people in Africa in 2016 [66-68]. In many developed countries, comorbidities complicate the health outcomes of COVID-19 patients, but the impact on larger populations with malnutrition and conditions that may increase the risk of death from the virus is unknown [69]. In addition, due to limited health service infrastructure, it is unlikely that many infected individuals will have access to health care in adequately equipped facilities [25, 70].

Social Crisis

The social crisis brought to the African population has caused tremendous harm, including false news [71], racism and discrimination [71, 72] as one of the constraints preventing the initial control and management of the COVID-19 pandemic. This can be attributed to life in Africa, which is based on togetherness and dependence, making social distance and isolation very difficult. The results of this study showed that the impact of COVID19 is very high in vulnerable populations such as women, the elderly, and people with disabilities, and that mortality is higher in individuals with comorbidities [5, 73]. The commentary by [74] on ethnic minority groups in Israel substantiated the findings of our review that the elderly and disabled and comorbidities were marginalized in all settings during the COVID-19 outbreak in Africa. It may also be due to the lower resistance of patients with comorbidities and the elderly than younger and non-comorbid patients, as the literature supports the findings of this review indicating that hypertension, diabetes, cardiovascular disease, renal disease, and respiratory disease are the most prevalent comorbidities [75].

The results of this review showed that food markets were closed and access to food sources was limited, resulting in many households being unable to obtain food and affordability, leading to hunger. There is evidence that the COVID-19 outbreak can significantly increase poverty among vulnerable households, including through reduced access to food [26]. This could also be attributed to the loss of income during the lockdown period. The researchers corroborate the findings of this review, revealing different understandings and perceptions of African societies regarding the COVID-19 pandemic, and the better level of knowledge West African countries exhibit about this virus may be due to lessons learned from the Ebola epidemic [76].

Economic Crisis

Many African countries have high rates of formal unemployment, low per capita incomes, and people who rely on small-scale agriculture and informal trade for their livelihoods do not have reliable sources of income. In this regard, researchers have shown that many African countries are already economically compromised by corruption, maladministration, and lack of political leadership. At the same time, some countries have shown considerable economic growth over the past 50 years, such as Ethiopia, Cote d'Ivoire, Djibouti, Senegal, Guinea, and Tanzania [52, 77].
The COVID-19 epidemic is having a significant impact on already strained African economies, even though several countries are showing economic growth. Researchers corroborated our results by showing that some of the economic impacts of COVID-19 precautions are characterized by reduced GDP and supply chain value and increased pressure on fiscal policy and debt [52, 78]. The results of this review show that Africa's economic growth in the COVID-19 pandemic era (2020) [41, 52] declined from 2.4% before COVID-19 in 2019 to -2.4~-5.1% [39 ]. Pandemics may contribute to this projection, as lockdowns reduce production and increase costs. A situation study by the United Nations Economic Commission for Africa projects economic growth in the African region to be less than -3.3% in 2020 [79]. This may be due to the fact that the African region's extensive export areas have decreased as a percentage of the global total, compared to within the African region. Corroborating our findings, a study in Kenya predicts that five sectors that contribute to GDP, namely agriculture, tourism, construction, infrastructure development, and manufacturing, will decline after COVID-19 [80]. In addition, the results of the current review show variation in GDP changes across African regions before and after the COVID-19 pandemic, as well as an increase in the GDP decrease (-3%) in middle-income countries, followed by an overall sub-Saharan Africa during the COVID-19 pandemic [39, 40, 52]. Reflecting the observed GDP decline (-1.6%), this disparity may be the result of increased lockdown across countries, with regions in Africa having differential levels of socioeconomic and trade partnerships with Europe, China, and the United States [60, 61]. A World Bank Group study showed that the majority of countries in the African region experienced a decline in GDP from 2.4% before COVID-19 to 2.4%- during the COVID-19 epidemic [52, 81]. The decline in GDP is likely the result of reduced imports and exports, loss of jobs due to the lockdown of production of export products, and increased debt to cope with the pandemic [82].

Political Crisis

The political impact of COVID-19, in addition to the previously mentioned health, social, and economic impacts, is overwhelmingly large due to weak and fragile government structures [77]. As a result, ties between African countries have broken down, borders have closed, citizens have fled to their home countries, distrust has developed between predecessors, and it has become clear that they behave in ways that are not suitable for Africa [51, 83]. In this regard, the political decisions taken by African leaders during the first outbreak of the COVID-19 pandemic were probably encouraged by fears of weakly strained health systems, poor quality health facilities, and economic stagnation [84]. Moreover, the actions taken by African leaders to boost the spread of the COVID-19 outbreak were not only more rapid but also highly appreciated, despite the constraints on the public health emergency systems of African countries. They declared a public health emergency, banned unrelated public campaigns, and then locked down to minimize the likelihood of an outbreak of the disease in their countries [ in both developed and developing countries, consistent with the differences in economies, health systems, and lifestyles of Western and African populations, health outcomes, social impacts, and economic losses remain different [85]. This may be a result of the lack of social support, the fact that far more people live below the poverty line, and the fact that more people in the African region are self-employed or not employed in the formal sector.

Meaning

Health facilities and resources in most African countries are under stress. If the pandemic persists for as long as it is projected to spread, the secondary effects of the COVID-19 pandemic will quickly become an economic emergency, leading the world into recession and severely affecting the poorest African countries with limited resources. Furthermore, although many African countries have implemented the WHO-developed COVID-19 control strategies and approaches to dealing with pandemics, such as "isolation, social isolation, self-isolation, water use, sanitation, and hand-washing practices," these COVID-19 pandemic containment and management approaches are considered appropriate and successful in Asian countries such as China and South Korea, but in African countries, this strategy remains difficult and impossible due to inequality, significant job losses, disparities, and informal economic practices. In addition, insecurity indicating illegal activities such as crime, corruption, and maladministration obstacles to peace, security, and safety in African countries plagued by existing and prolonged poverty, hunger, and inequality.

Conclusion.

The COVID-19 pandemic has affected and will continue to have long-term effects on the organization of our health system, our production, processing, and exchange of goods and services, and on our consumption practices, culture, and our relationship to life and death. The tests evaluated in this study will contribute to our understanding of these changes and their impacts. It is the choice of policy makers and other stakeholders to consider these findings in the prevention of and response to a new epidemic. Successfully addressing the health, social, economic, and political impacts of a COVID-19 pandemic will require a unified, proactive, and organized public health emergency response among leaders, governments, and nongovernmental organizations. Successful public health emergency preparedness and response is based, in effect, on the preponderance and quantity of information accessible during a pandemic outbreak. Rapid communication and distribution of information in anger is necessary to prevent and manage the health, social, economic, and political impact of a COVID19 pandemic and to ensure that it is not a race against death or a race against starvation for the African people. Therefore, African countries need a culturally relevant indigenous pandemic management strategy in the coming years to respond to a pandemic that could affect their economies and the health and livelihoods of their citizens.

Abbreviation

BREC: Biomedical Ethics Review Committee; CFE: Contingency Fund; COVID-19: Growth Domestic Product; GDP: Growth Domestic Product; LIAC: Low Income African Countries; MIAC: Middle Income African Countries; OE: Oil Exporting Countries; RLCDC: Regional and Local Centers for Disease Control and Prevention; SSA: Sub-Saharan Africa, United Kingdom, UKZN: University of KwaZulu-Natal, United States, WHO: World Health Organization

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