Senegal, a model for managing the COVID-19 crisis

Only 16,000 confirmed cases, 332 deaths in a country of 16 million inhabitants. The numbers of the COVID-19 pandemic in Senegal do not have much to envy those of some Asian countries. Experts wonder about the keys to this surprising success in a country that has become a transit route for migrants and with human and economic development indices that are usually among the lowest in world rankings.

The authorities reacted very quickly but they themselves are surprised by this success and wonder if it is not due so much to the containment measures as to a herd immunity achieved almost effortlessly.

The authorities closed the country very quickly, as soon as the first cases were registered. Closing of borders, schools, mosques and night curfew. Patients were quickly seen and potential contacts isolated in hotels. Today they no longer need these measures and have only a handful of patients hospitalized in intensive care.

Management success or cross immunity?

The WHO has congratulated Senegal as “one of the model countries with regard to the application of the prevention measures of Covid-19” according to Nsenga Ngoy, a person in charge of the WHO for Africa: and they have reaped the benefits “, recognized recently an official of the World Health Organization (WHO) for Africa, Nsenga Ngoy.

However, those responsible for managing the crisis, perhaps everything is not explained by the speed of the government’s reaction and the sense of responsibility of the citizens.

Abdoulaye Bousso, one of the managers of the response program, believes that the quick and strict reaction of the authorities has played an important role in containment, especially in the early stages, but since then, as in many other countries, it has been installed a certain fatigue in the citizenship and fewer and fewer people respect distances or wear a mask.

Be that as it may, Senegal escapes the second wave for the moment.

Compared to western countries with a similar number of inhabitants, such as the Netherlands, Senegal falls far, far behind.

The African exception Thanks to seasonal infections?

At the end of July, Senegalese celebrated “Tabaski” and, two months later, “Magal”, another great Muslim festival that attracts large crowds.

But these encounters have not triggered waves of contagion, so “maybe the question of immunity should be raised,” says Dr. Bousso.

“We realize that in Africa in general, and in Senegal in particular, we do not have the deaths that we should have had,” confirms a field specialist, Massamba Sassoum Diop, president of the organization SOS Medicos de Senegal.

The ER doctor suggests that a “cross immunity” has emerged in Senegal. He explains this by the respiratory infections that ravage the entire population in May-June and September, the periods when air conditioning is at its peak.

Relatively benign, these air conditioning colds are caused by four types of coronaviruses. Senegal residents are believed to have been able to develop immunity to this family of viruses, something that began to be observed in March when COVID-19 appeared according to Dr. Diop.

The new coronavirus would then have spread massively, from April to August, in a population that was predominantly young and generally did not develop severe symptoms.

Without making any noise, “about 60% of the population” would have acquired this immunity, he says.

Living in Africa has played a much bigger role than ethnicity or genetics, he says.

Calls for prudence

The proof is that blacks die disproportionately in Europe or the United States, while Europeans, Lebanese or Chinese living in Senegal die far less than in their home countries.

Cross or herd immunity has “scientific support in virology and immunology.” But it’s still an unproven hypothesis, he admits.

An ongoing serological study should provide initial indications of its validity in the coming weeks, he says.

The Minister of Health, Abdoulaye Diouf Sarr, is more reserved.

If the numbers are so low, “we can safely say that it is due to the effectiveness of the response because herd immunity cannot be a strategy for a response. If herd immunity were the response strategy, the corollary it would be an extremely high number of deaths because nothing would be done, “he says.

For Senegalese specialists, as for the WHO, it is not a question of giving in to the euphoria that splashes the local media, if only because we do not know how long immunity lasts, if it exists at all.

It is dangerous to transfer the hypothesis to regions where populations are larger and more exposed. “If we apply it directly in Europe, it means 3 or 4 million more deaths, and in the United States, maybe 8 or 10 million,” warns Massamba Diop.

In 2016, the average age of the Senegalese population was 18 years compared to 42 in Spain or 45 in Italy, which could largely explain the differences in the response of its inhabitants to the infection. A hypothesis that can be transferred to almost the entire continent, with some exceptions such as South Africa.

Age does not explain everything because Germany has an average age of 46.3 years and is relatively well resistant to waves of coronavirus.

Meanwhile, Senegalese President Macky Sall urges strict observance of barrier gestures, “the only therapy at the moment against Covid-19.” “The virus continues to circulate. The battle is not completely won, he said Thursday, we do not want to have a second wave that is unbearable for our country, for our economy.”

Since September, African countries have registered a significant increase in cases, although unevenly distributed. They begin to rise mainly in North Africa, where, as in Europe, temperatures begin to drop.

The effect of the seasons, less important in the tropics, could be another factor that explains the success of much of Africa in the fight against the virus. This would be consistent with the situation in South Africa, which also has winter months with low temperatures. Although as in everything that surrounds Sars-CoV-2, there are very few certainties.