How Senegal has set the standard on COVID-19

At the onset of the COVID-19 pandemic, health experts warned of a ticking time bomb in Africa as many feared that the coronavirus would overwhelm the continent’s fragile health care systems, resulting in massive fatalities.

But nearly eight months after the first confirmed case on the continent, African countries appear to be coping. With around 1.5 million cases at the time of publication, and 37,000 deaths, researchers are now looking to uncover the lessons behind the continent’s quiet successes.

One notable case is Senegal, the West African country with roughly 7 doctors for every 100,000 people. Despite its relatively limited resources, it was ranked second out of 36 countries on Foreign Policy’s COVID-19 Global Response Index, which looks at how national leaders are responding to the pandemic. Beaten to the top spot only by New Zealand, it scored high marks for providing fact-based communication and for the public health directives introduced in the country.

Senegal’s pandemic response has not been without challenges. But in the seven months since its first infection, it has recorded just over 15,000 cases and 300 deaths, translating to 96 cases per 100,000 people — far lower than countries like the U.S., with 2,308 cases per 100,000, or the U.K., with 819 per 100,000.

Health officials working in the country attribute its success to experience, preparation, and a timely government response.

However, they warned the fight is not over yet. This week, concerns were raised about a major pilgrimage for the religious festival of Magal, which the government did not step in to prevent.

Dr. Lucile Imboua, Senegal country coordinator at the World Health Organization, said that preparation began in January, drawing on the country’s experience from dealing with the Ebola epidemic.

“Senegal, like all other countries in sub-Saharan Africa, is used to managing outbreaks and has the experience and capacity to respond. … The experience gained from the Ebola outbreak has been useful in triggering preparedness and response interventions,” she said.

The country’s Health Emergency Operations Center, which is now coordinating the COVID-19 response at an operational level, was set up after the 2014 Ebola outbreak. When COVID-19 first emerged as a concern in January, the center began by assessing the response capacities of the country, according to Imboua, and then used the results of its assessment to build the capacity of actors at all levels.

“When the first case in the country was confirmed on the second of March, it triggered the response that continues to this day,” she said.

As part of the response, the government put up 64.4 billion CFA francs ($115 million) to support the health sector, according to a KPMG report, and far more for economic stimulus measures and help for the poorest households, paying for food, water, and electricity.

According to data compiled by Devex, Senegal received around $880 million in direct support from donors, with large contributions coming from the International Development Association, the International Monetary Fund, and the Islamic Development Bank, but may have received more as part of regional support packages.

As early as March, President Macky Sall introduced a “dusk till dawn” curfew, banned all public gatherings, and suspended international commercial flights to slow the spread of the virus.

He was forced to ease some of these restrictions after widespread riots in June, however, which were sparked by the measures’ impact on the economy. In a survey conducted by the Center for Global Development in April, more than 86% of Senegalese respondents said they had seen a reduction in income. The growth rate of Senegal's gross domestic product, which was initially projected to be 6.8% for 2020, will also suffer; it is expected to drop to -0.7% because of the pandemic, according to an International Monetary Fund projection.

“Senegal, like all other countries in sub-Saharan Africa, is used to managing outbreaks and has the experience and capacity to respond.” - Dr. Lucile Imboua, Senegal country coordinator, World Health Organization.

In August, the government reintroduced restrictive measures after a spike in cases, which it says was caused by people becoming more relaxed in their adherence to COVID-19 protocols.

Nicolas Mouly, program manager for emergency response and country openings at The Alliance for International Medical Action, which has been supporting the COVID-19 treatment center at Fann Hospital in Dakar, praised Senegal’s preparation and response to the pandemic but said testing capacity must now be increased.

“The response has been good. At the beginning, there was a lot of pressure to develop a strategy to avoid the spread of the outbreak and reduce the mortality. It has been six long months, but we are now seeing a decrease in the number of new cases every day, and I think that’s good news,” he said.

However, “right now we are testing between 7,000-8,000 people a week, and this is very far from what we are seeing in other countries,” he said, noting that increasing testing capacity “will help us to isolate cases and protect the population.”

John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said that Senegal is one of a number of African countries to have successfully managed the pandemic by employing five steps.

“Firstly, you need to test. Second, you follow through by making sure that there is contact tracing and isolation of people that are infected. The third thing, [which] we all now know, is that masks work. If you mask consistently, massively, universally, it works,” he said. Senegal made it mandatory for people to wear nonmedical cloth masks in all public spaces in April.

“Fourth, you must engage the community through the media, religious groups, village leaders, and community leaders. … Lastly, you deploy a large number of community health workers to follow through with the contact tracing and support some of the case management, because most of the cases of people that are infected can be managed from home,” Nkengasong said.

In addition to this strategic response, WHO’s Imboua also pointed to the country’s ability to adapt to the progression of the pandemic.

“The country has adapted response strategies to the evolution of the epidemic, and the continuous sharing of information on the evolution of the epidemic by health authorities demonstrates transparency in the management of this crisis,” she said.

At the onset of the pandemic, Senegal pledged to provide a hospital or health center bed for every patient and test results within 24 hours. A few months down the line, in July, the country adjusted its response plan to focus testing on vulnerable and symptomatic individuals and introduce home-based care.

“This month, Senegal also conducted an intra-action review for the response to COVID-19 over the past six months. This is the first review of its kind in Francophone Africa, and it will enable us to identify good practices and areas for improvement,” Imboua said.

Nkengasong, however, warned that although there are “many good stories coming out of the region,” it is too early to declare a victory.

“We should be very careful that we do not overproject any successes. This is a very delicate virus. It spreads quickly. And we have seen and are currently seeing trends in Europe where, until a few weeks ago, the numbers were decreasing … and now we are beginning to see significant increases,” he said.

The impact of this week’s Magal festival — which typically attracts millions to the city of Touba for communal prayers and meals — is still unknown, but a study published last year already highlighted the risk of respiratory infections spreading there, as with other large pilgrimage events.

For Imboua, the key to continued success lies in adaptation.

“Everyone in the health sector has learned a lot from this pandemic. Going forward, Senegal should examine the results of the [intra-action] review, organize and effectively implement the activities and recommendations made,” she said.