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A lockdown delivery, in Uganda. Photo: Sumy Sadurni/AFP via Getty

Africa is reeling from the economic ravages of the coronavirus. Now the disease itself is accelerating across the continent.

Why it matters: “The question we’ve been asking is, ‘Is it that we will not see widespread outbreaks or that we haven’t seen them yet?’” says Tom Frieden, former CDC director.

  • The outbreaks are now growing, the WHO warns, and COVID-19 is spreading from cities into rural areas where they will be even harder to track and treat.

By the numbers: Home to 17% of the global population, Africa accounts for just 3.5% of the global case count and 1.8% of deaths.

  • But while Africa (pop. 1.3 billion) has roughly as many confirmed cases as the U.K. (pop. 67 million), limited testing means the numbers tell only part of the story.
  • An American is 150x as likely to have been tested as a Nigerian. While South Africa is conducting several times as many tests as any other African country, its testing rate is still only one-fourth that of the U.S.

That’s not to say we have no idea what’s happening on the continent. Frieden says enough strategic testing is being done to ensure massive outbreaks aren’t going undetected.

  • But based on the data we do have, he says, “it is likely that Africa is on the brink of a large outbreak.”
  • Frieden points to high test positivity rates in countries like Sudan as a sign many cases are going undetected. However, he expects mortality rates to remain relatively low given Africa’s young population.

The big picture: Many people who are never infected by COVID-19 will nonetheless die as a result of the pandemic.

  • Issa Makumbi of Uganda’s Health Ministry noted on a media call last week that more people died of untreated malaria than from Ebola during the 2014 outbreak in West Africa.
  • Not only are health care visits for non-COVID conditions down, he says, Uganda has had to delay vaccinations for yellow fever.
  • “If health care doesn’t continue to provide the essential gains that have been provided over the last decade, you could see as many as 10 times as many deaths from malaria, tuberculosis and other infectious disease causes as from COVID even in a large COVID outbreak," Frieden warns.
Fumigation duty, in Nairobi. Photo: Luis Tato/AFP via Getty Images

The outlook darkens further when you add in the frightening increases in food insecurity, says Gayle Smith, CEO of the ONE Campaign and a former USAID administrator. “The virus is the one thing we’re all tracking, but it’s these aftershocks."

Where things stand: Commodity prices (notably oil) were crushed as the world went into lockdown. Remittance flows dried up and tourism ceased — all before lockdowns froze African economies.

  • Governments now need to do more, in terms of stimulus and health spending, with lower revenues. Their room to maneuver is severely limited by existing debts.
  • Cash and debt relief are the most valuable contributions the international community can make right now, Smith says.

Help has been slow to arrive. “I'm sure it's in part because every country is dealing with it at home, but I've never seen a crisis like this to which there's been so little international response,” says Smith.

  • “I mean, you look at Ebola, the Haiti earthquake, I worked on all the chronic humanitarian crises for years. And this is just not triggering the kind of response that these things usually do.”
  • “We just watched this move around the entire planet. I fear that we’ve got this perception that if we can just manage it here, then we’re fine. And that’s not true for any country anywhere.”

The flipside: Africa stands out in terms of international cooperation during the pandemic — from health bodies like the African CDC to coordination between finance ministers to the creation of a new Africa Medical Supply Platform to distribute supplies around the continent.

  • Lessons from AIDS and Ebola were put to good use. South Africa established testing centers in townships to catch outbreaks early.
  • Contact tracing — often conducted door-to-door — ramped up more quickly in some African cities than American ones.
  • Africa has experience to draw on, favorable demographics and it's had time to prepare.

The bottom line: As the pandemic shifts from the rich world to the developing one, countries will hope the advantages they do have will outweigh the resources they don't.

Go deeper:

Go deeper

Why the real estate boom could keep going for years

Illustration: Aïda Amer/Axios

Even after reaching all-time high average prices and sales numbers not seen since the height of the 2000s boom, the housing market still has lots of room to run, experts say.

What's happening: There were fears in late 2019 and early this year that price levels had outpaced income growth and become unsustainable — but record-low mortgage rates and promises by the Fed to keep U.S. interest rates at zero through at least 2023 have lit a new fire under the market.

Updated 40 mins ago - World

State Department orders evacuation of U.S. diplomats' families from Ukraine

From left, Under Secretary for Political Affairs Victoria Nuland, Secretary of State Antony Blinken and U.S. Chargés d'Affaires in Ukraine Kristina Kvien during a meeting with Prime Minister of Ukraine Denys Shmyhal in Kyiv. Photo: Yevhen Liubimov/ Ukrinform/Barcroft Media via Getty Images

The State Department will begin evacuating families and non-essential staff from the U.S. Embassy in Kyiv this week, according to a travel advisory published Sunday evening.

Why it matters: The move underscores U.S. fears that a Russian invasion could destabilize Ukraine and threaten embassy's ability to assist Americans.

Perfect storm brewing for extreme politicians

Data: Axios research; Table: Jacque Schrag/Axios

Redistricting and a flood of departing incumbents are paving the way for more extreme candidates in this year's midterm elections.

Driving the news: At least 19 House districts in 12 states are primed to attract such candidates — hard partisans running in strongly partisan districts — according to an Axios analysis of districts as measured by the Cook Political Report's Partisan Voter Index (PVI).