Coronavirus : pourquoi la catastrophe n’a pas eu lieu en Afrique
Mi-février, alors que l’épidémie de Covid-19 se répandait à travers le monde, les instances internationales craignaient pour l’Afrique, considérée plus vulnérable. Pourtant, trois mois plus tard, le continent reste largement épargné par le virus, même si des inquiétudes subsistent.
« Notre principale préoccupation demeure le risque que le Covid-19 se propage dans des pays dont les systèmes de santé sont plus fragiles. » Le 22 février, le directeur de l’OMS, Tedros Adhanom Ghebreyesus, tirait la sonnette d’alarme lors d’une réunion exceptionnelle avec les ministres de la santé des pays de l’Union africaine (UA) à Addis-Abeba (Éthiopie). Alors que des dizaines de cas avaient été identifiés en Europe, une seule personne avait été testée positive en Afrique. Malgré cela, c’est avant tout le continent africain qui « préoccupait » le directeur de l’OMS à cause du manque d’infrastructures médicales qui pourraient vite être débordées en cas d’épidémie rapide.
Depuis, plusieurs études ont exploré la piste d’une catastrophe africaine. Catastrophe qui, près de trois mois après le début de la crise, n’a pas eu lieu. Alors que l’Europe et les États-Unis ont dépassé le million de cas, le nombre officiel de contaminations en Afrique s’élève, à la mi-mai, à 70 000, selon l’agence de santé publique de l’Union africaine (Africa CDC).
Des études trop alarmistes ?
Au début de la pandémie, alors que l’OMS et l’UA envisageaient le pire pour le continent africain, des chercheurs ont tenté d’évaluer la progression du virus. Le 25 mars, une étude de la London School of Hygiene & Tropical Medicine (LSHTM) a conclu que, fin avril, tous les pays africains auraient dépassé la barre des 10 000 cas. Un résultat 10 fois supérieur à la réalité.
Pour le professeur Antoine Flahault, épidémiologiste spécialiste de biomathématiques et directeur de l’Institut de santé globale à Genève, ce type d’erreur n’est pas surprenant : « On a tendance à généraliser ces études mathématiques pour prédire l’évolution des pandémies, or elles servent avant tout à évaluer des situations présentes, comme le taux d’immunité d’une population. En termes de prédictions, elles sont très peu fiables et souvent catastrophistes. D’autant plus qu’il s’agit de l’adaptation d’un modèle utilisé pour la grippe, or on sait aujourd’hui que le mode de diffusion du Covid-19 est différent »
Des mesures préventives fortes et efficaces ?
Dans son discours du 22 février, le directeur général de l’OMS exhortait les pays africains à « faire front commun pour être plus agressifs ». Un appel visiblement pris très au sérieux sur le continent. « Avant l’arrivée du virus, nous avons fait un état des lieux avec nos pays partenaires », explique le docteur Mary Stephen, responsable technique au bureau régional de l’OMS pour l’Afrique, qui travaille avec 47 pays sur le continent. « Nous avons pu adapter les processus déjà en place pour d’autre épidémies comme Ebola assez rapidement, d’autant plus que le personnel médical était déjà formé à la gestion de ce type de crises. »
En février, le nombre de laboratoires pouvant effectuer des tests Covid dans la région est ainsi passé de deux à 26, selon les chiffres de l’OMS. En parallèle, plusieurs pays ont étendu leurs capacités d’accueil de malades dans l’hypothèse d’une propagation rapide de la maladie. C’est le cas notamment du Ghana, du Cameroun ou bien encore du Nigeria, qui a converti le stade Balogun de Lagos en centre d’isolation des malades.
Enfin, des mesures ont été mises en place de manière préventive, comme les contrôles renforcés dans les aéroports internationaux, des campagnes de dépistage ou le port du masque obligatoire. Début avril, alors que le bilan des contaminations n’était que de 6 200 sur l’ensemble du continent, 32 pays africains sur 55 avaient déjà totalement fermé leurs frontières terrestres.
« Tout a été fait pour contrôler l’épidémie et limiter au maximum la propagation de cas graves et ces mesures ont porté leurs fruits », estime le Dr Stephen.
Le continent semble aussi avoir bénéficié de sa connexion moindre au reste du monde. Selon une étude de la revue médicale The Lancet du 14 mars, l’Afrique est dix fois moins exposée que l’Europe à l’importation de cas de Covid-19, du fait de ses échanges internationaux plus faibles. Bien que la Chine soit le premier partenaire économique de l’Afrique, ses liaisons aériennes avec les États-Unis ou l’Union européenne sont beaucoup plus développées. Un facteur clé pour expliquer la plus lente avancée du virus, selon le professeur Antoine Flahault : « C’est un phénomène que nous avons observé avec le virus du sida, l’Asie a été un temps épargné par l’épidémie. Les connections plus faibles entre l’Afrique et l’Asie à l’époque avaient fortement ralenti l’arrivée des cas. Le virus n’a qu’un seul mode de transmission, c’est les déplacements humains »
Pyramide d’âge et traitement
Selon les Nations Unies, l’âge médian de la population sur le continent africain est de 20 ans, ce qui suppose une bien meilleure résistance immunologique. En France, 70 % des cas de décès concernent les plus de 75 ans. Or le troisième âge en Afrique représente moins de 5 % de la population. Mais pour le Dr Mary Stephen, cet argument doit etre relativisé : « Beaucoup d’Africains ont des carences immunitaires, y compris les jeunes. Elles peuvent être dues à des infections respiratoires, comme des bronchites ou des pneumonies, ou d’autres maladies comme le sida ou le paludisme. Ces maladies ne sont pas toujours traitées comme elles devraient et ces personnes présentent de gros risques d’aggravation si elles contractent le Covid-19. »
Enfin, de nombreux pays africains comme l’Algérie, le Sénégal, le Burkina Faso ou bien encore le Cameroun utilisent le controversé protocole du professeur marseillais Didier Raoult pour traiter la maladie, et revendiquent son efficacité. « On sait que l’hydroxychloroquine est efficace sur des cellules infectées par le coronavirus en laboratoire. Mais rien ne dit qu’elle a le même effet chez l’homme, tant que cela n’est pas prouvé par des essais cliniques randomisés », rappelle Antoine Flahault. « Sa prescription est par ailleurs délicate, à trois fois la dose thérapeutique, elle tue le patient à coup sûr ».
Le continent parviendra-t-il a maîtriser la propagation de la pandémie ? Rien n’est moins sûr. Plusieurs aspects continuent de susciter l’inquiétude, comme la difficulté à imposer des mesures de distanciation sociale, peu adaptées au modèle africain, et le manque de moyens médicaux qui constituent toujours, malgré les efforts fournis, un enjeu crucial. Selon le FMI et la Banque mondiale, en avril, il manquait déjà 44 milliards de dollars au continent pour lutter contre le coronavirus.
Enfin, certains redoutent que la propagation du Covid-19, plus lente, s’installe dans la durée en Afrique. L’OMS a ainsi estimé le 8 mai que l’épidémie pourrait évoluer sur plusieurs années et que jusqu’à 190 000 Africains pourraient mourir du Covid-19 durant la première année de propagation du virus.
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