Why lockdowns might not be Africa’s best bet.

As cases of the coronavirus increased in Wuhan this January, China took the then drastic step of imposing a lockdown.

In a country where over 23% of the population is over 55, the government introduced severe restrictions to mitigate the spread of the disease and avoid overwhelming the health system.

As the disease spread to other parts of the world, the likes of Japan, Europe and the US – all of which have even older populations than China’s – employed the same strategy.

Many governments in Africa have also imposed lockdowns to deal with the pandemic. Yet these countries have radically different age demographics to those in Asia and Europe.

Take two extremes. In Japan, 40% of people are over 55, and 28% are over 65. In Uganda, the equivalent figures are 5% and 2%.

In Japan, 13% of the population is made of up children under 14. In Uganda, this figure is 48%.

These different age demographics are very important. Mortality rates for coronavirus start to increase for people aged 55 and higher.

Meanwhile, young people are statistically highly unlikely to suffer severe symptoms. This means that in countries with a lower proportion of old people, the relative benefits of lockdown are more limited and are more likely to be outweighed by the downsides.

In many countries in Africa, these downsides are particularly significant. Poor countries are much less able to cushion the potentially devastating economic impacts produced by lockdowns. This is if they are feasible in the first place.

Effective lockdowns are near impossible in crowded low-income settlements that lack taps and sewers.

Part of the lockdown strategy is also to “protect the health system” by “flattening the curve” and reserving resources for coronavirus cases.

This approach not only has more marginal benefits when populations are young and there is a less of a system to protect, but it also diverts attention from addressing health that are dangerous to much of the population, such as malaria, measles and complications in childbirth.

It might be argued that poorer countries with less effective health systems will have a higher burden of underlying health conditions, thus increasing vulnerability to COVID-19. However, the pre-existing health problems most closely related to getting severe symptoms from coronavirus tend to be associated with age.

Current evidence from Spain, for example, suggests that people living with HIV are not at increased risk of acquiring COVID-19 or developing severe symptoms. In fact, the opposite may be the case.

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