COVID-19 Pandemic: Potential Impact of Lockdown in Sub-Saharan Africa

The COVID-19 lockdown approach in sub-Saharan Africa countries may not be as beneficial as intended due to the current employment, housing and health infrastructure challenges. Hence other infection prevention and control might need to be considered.


Introduction
The COVID-19 virus (also known as coronavirus) was declared a pandemic viral outbreak by the World Health Organisation (WHO) following its rapid spread globally [1]. This resulted in many countries rolling out public health and economic response initiatives to curtail its spread and death toils [2]. Many of the public health initiatives in individual countries were based on guidance from the WHO on infection prevention and control [3]. Further exploration of the use of varied strategies by individual countries can be attributed to their economic status. Of particular attention to public health, practitioners were the strategies used in countries affected by unemployment, urbanisation, poor housing, and weak health systems [3].
Sub-Saharan African countries are mostly classed as low and lower-middle-income countries [4]. They are affected by a myriad of public health issues which are social, economic, and political [5]. The public health issues come against a backdrop of several social and economic factors such as employment status, literacy levels, housing, health infrastructure, food and water sanitisation and many more. The advent of COVID-19 and the already fragile health and economic systems in sub-Saharan African countries placed its population in a very vulnerable position and there is a chance that these countries might continue to suffer its impact long after the pandemic is over when compared to countries within other continents.
The continued increase of new cases and a number of deaths and with no cure or vaccine currently available made public health professionals advise countries to apply a total lockdown to slow the spread of the pandemic [6]. A lockdown is when all business in a country is halted to curb a pandemic except for essential services like hospitals and food shops [7]. The lockdown was introduced to reduce the spread of the virus and curb the consequence of the pandemic.
Many developed countries rolled out alleviation programmes to businesses and the most vulnerable populations before and during the lockdown [8]. For instance, business bail out strategies was rolled out in countries like the United States by injecting two trillion into the economy [9]. Likewise, in the United Kingdom, the government helped some business to pay 80% of the salaries of workers while on COVID-19 lockdown [10].
Some Sub-Saharan Africa countries also instituted lockdown [11]. The impact was greatly felt on its populace. Hence, this paper aims to discuss the potential impact of COVID- 19  on employment, food security, housing conditions and health Infrastructure in Sub-Saharan Africa. It is believed that this paper provides some indication of the potential scale of COVID-19 pandemic and the lockdown approach in sub-Saharan Countries.

Implication on Employment, Housing and Health Infrastructure
High levels of unemployment in many Sub-Saharan countries have subsequently resulted in high self-employment with many individuals reliant on daily income [12,13]. For instance, self-employment accounts for at least 60% of all Zimbabwe's economic activity [13]. This implies that the lockdown order by the government in Sub-Saharan countries will certainly impair on the economic wellbeing of individuals.
Normally, many of the countries within sub-Saharan Africa have individuals who survive on less than one United States dollar per day [14]. Besides, the high unemployment and abject poverty means that individuals may struggle to have one decent meal a day following a reduction or loss of income [15]. It was estimated that COVID-19 pushed 40-60 million people to poverty in sub-Saharan Africa countries and this figure will increase as the lockdown continues [16]. This unprecedented fall into poverty may in turn affect people ability to comply with the lockdown rules imposed by the government.
Also, unlike many developed countries who had put in place economic strategies before and during the lockdown, many Sub-Saharan countries had not put in place economic strategies before declaring a lockdown. However, countries like Nigeria soon put in place strategies such as daily supplies of food to help households and prevent individuals from breaching lockdown rules. Nevertheless, this did not substitute daily income lost during the lockdown. Overall, this implies that the level of unemployment will continue to rise, and the economic impact of COVID-19 will linger much longer even after the world economy returns to the similitude of its previous state.
About 40% of Africa's population continent's population lives in urban areas [17]. This rapid urbanisation is worrisome and could be attributed to the substantial housing deficit in urban areas and expanding urban slum and many urban dwellers having no decent place to live or sleep [17]. For instance, it is estimated that about 71.8% of the urban population of sub-Saharan Africans live in the slums and this is the highest rate in the world [17,18].
The lockdown now means that people were staying more at home and this could gravely impact on individuals who have no house or decent apartments where they can be comfortably accommodated. This may consequently impact on the health and wellbeing of individuals, families, and communities. Having individuals occupying limited space for an unpredictable duration of time can lead to anger, frustrations, anxieties, depression, and general deterioration on the mental health of society [18]. The contention for limited space and resources at home and the community could lead to social disharmony, quarrels, domestic violence, and injuries [18]. This may also impact on the ability of individuals to comply with lockdown rules in the search of a comfortable abode.
Initially, the number of reported cases and death in Sub-Saharan Africa did not rise as those reported in the developed world [19]. However, it soon became clear that if the cases rise like those reported in other developed countries, the current health system in many sub-Saharan countries will not be able to cope with the seriousness of COVID-19 infections. At the moment, many sub-Saharan countries health system is underfunded and poorly equipped [20]. For instance, there are only 55 intensive care units which serve 40 million people in Uganda [19]. Thus, having a spike in the number of cases may result in Sub-Saharan Africa recording the highest number of fatalities and this call for more public health measures.

Implications for Practice
Lockdown has helped reduce the spread and fatalities of COVID-19 in many countries. However, this measure might not be successful in sub-Saharan countries due to its current high unemployment, housing deficit, urbanisation and poor health infrastructures problems. This, therefore-calls for other infection prevention and control measures that prevents a national lockdown. For instance, a testing and contact tracing approach might be better suited for sub-Saharan Africa countries. This will mean individuals rather than the whole nation are isolated and quarantined if required. Although, fear, anxiety and stigma might prevent individuals from coming forward to be tested and provide details of those they have been in contact. This is the reason a bottom-up approach will be suggested, and key stakeholders are involved in the design and implementation of a testing and contact tracing strategy.

Limitations
The paper was written at the beginning of the COVID-19 pandemic lockdown in some sub-Saharan countries thus it is situation-specific. There is a chance that if it was written after the pandemic more social and economic factors might be impacted by the lockdown. Also, the paper is conceptual and a primary study might provide more details about the potential impact of the lockdown than what is currently being reported. However, the social and economic factors reported in this paper provide some indication of the potential scale of COVID-19 pandemic.

Conclusion
COVID-19 like other emergencies requires a measure of preparedness by sub-Saharan Africa countries to curtail its spread