Africas confirmed coronavirus cases have surpassed one million, but global health experts say the true toll is likely several times higher, reflecting the gaping lack of testing for the continents 1.3 billion people.

While experts say infection tolls in richer nations can be significant undercounts, large numbers of undetected cases are a greater danger for Africa, with many of the worlds weakest health systems.

The World Health Organization calls the milestone a pivotal point for Africa as infections in several countries are surging.

The virus has spread beyond major cities into distant hinterlands where few health resources exist and reaching care could take days.

African nations banded together early in the pandemic to pursue badly needed testing and medical supplies and advocate for equitable access to any successful vaccine. Swift border closures delayed the virus spread.

But Africas most developed country, South Africa, has strained to cope as hospital beds fill up and confirmed cases are over a half-million, ranking fifth in the world.

The country has Africas most extensive testing and data collection, and yet a South African Medical Research Council report last week showed many Covid-19 deaths were going uncounted.

Other deaths were attributed to other diseases as people avoid health centres and resources are diverted to the pandemic.

The WHOs Africa chief, Matshidiso Moeti, said:

Its all a warning for Africas other 53 countries of what might lie ahead.

While dire early predictions for the pandemic have not played out, we think its going to be here at a slow burn.

Just two African countries at the start of the pandemic were equipped to test for the virus.

Now virtually all have basic capacity, but supplies are often scarce. Some countries have a single testing machine.

Some conduct fewer than 500 tests per million people, while richer countries overseas conduct hundreds of thousands. Samples can take days to reach labs.

Even in South Africa, turnaround times for many test results have been a week or longer.

We are fighting this disease in the dark, International Rescue Committee expert Stacey Mearns said.

In addition, Africa has just 1,500 epidemiologists, a deficit of about 4,500.

African nations overall have conducted just 8.8 million tests since the pandemic began, well below the Africa Centers for Disease Control and Preventions goal of 13 million per month.

Africa CDC director John Nkengasong said estimating the true number of cases on the continent is very tricky. Some 70% of infections are asymptomatic, he said.

But some experts are making their best guesses.

Africa likely has at least 5 million infections, said Ridhwaan Suliman, a senior researcher at South Africas Council for Scientific and Industrial Research.

He believes the true number in South Africa alone is at least 3 million.

The country has conducted far more tests than any other in Africa, more than 3 million, but in recent days about 25% have come back positive.

Because of shortages, South Africa largely limits testing to health workers and those showing symptoms.Experts see South Africa as an indication of whats to come elsewhere.

Sema Sgaier, an assistant professor of global health at Harvard and director of the Surgo Foundation, thinks the number of infections across Africa could be more than 9 million.

The US-based Institute for Health Metrics and Evaluation puts the number at more than 8 million. And Resolve to Save Lives, led by Tom Frieden, former director of the US Centers for Disease Control and Prevention, estimates it could be 14 million.

Excerpt from:

Spain denies it is facing second wave; Africa cases hit 1 million as it happened - The Guardian