As COVID-19 spreads around the globe, governments everywhere face a trade-off between economic well-being and containment. Ethiopia faces a greater and more dangerous challenge than many other places, given that interrupting daily economic life would threaten fragile livelihoods for tens of millions of people already living in precarious conditions. On the other hand, allowing the status quo to continue, meaning that working, traveling and worshiping practices would go on as usual, would be to proceed amid the reality that Ethiopia is unusually fertile ground for this highly contagious and potentially deadly coronavirus.
The Ethiopia Public Health Institute (EPHI) confirmed the first case of COVID-19 on 13 March. Three days later, as the fifth one was announced, the government suspended schools, sports events, and large gatherings for 15 days. But, as the case numbers edge upward by the day, many assume the virus has already spread to a significantly greater extent in Ethiopia than confirmed so far.
The authorities have provided public information about confirmed COVID-19 cases and how people can prevent infection. By 1 April, it had announced 29 cases in Addis Ababa, Dire Dawa, Oromia, and Amhara, often stating that those infected had recently traveled abroad.
Since the virus arrived, it has been the primary discussion topic among Ethiopians. Some talk about prevention techniques; others about the nature of COVID-19 itself. Yet there is a dearth of reliable data about how many people are infected, or whether any Ethiopians have died from the virus. While unreliable statistics are undoubtedly being disseminated in many other countries, including some of the world’s wealthiest, the uncertainty is arguably more pronounced in under-developed nations like Ethiopia. For example, by 31 March, the EHPI had tested just over 1,000 samples, which is a similar number to Kenya.
Moreover, the fact is, Ethiopia is not in a good position to respond. Little preparation was made before the first COVID-19 case. The government initially made do mainly with passing on prevention advice from the WHO. According to World Bank data, there are just 0.3 hospital beds for every 1,000 people in Ethiopia, compared to 3.4 in Italy, 6.5 in France, and 2.9 in the U.S.. Only a few hundred intensive care units are believed to be available along with 435 ventilators. There may soon be a need for tens of thousands.
So far, very little testing has been done; flights to and from countries hit early by the pandemic such as China and Italy are still flying; checks at Bole airport were not ramped up quickly after the virus was first reported by China on 31 December, and the environment across Ethiopia, especially in urban areas, is rife for rapid transmission. With around 40 percent of households without water access, sanitary conditions are basic for many people, who often live in crowded, multi-generational households. Despite some orders to reduce occupancy levels, public transport is jam-packed with commuters, and large numbers still flock to religious gatherings in this highly devout country.
Harmful traditional practices
Although hand-washing stations and COVID-19 posters are now common in Addis Ababa, some cultural traits are challenging the country’s ability to respond. Ethiopians tend to ignore advice that goes against their culture of communal living and offering physical greetings, such as sharing food or embracing. Religious institutions and markets also represent a challenge, because people are more concerned about the implication of not practicing their religious beliefs and millions are not financially capable of storing food.
Along with the failure to adopt widespread social distancing measures, many Ethiopians are still not taking the outbreak of the novel virus seriously. Some joke that “corona is the disease of the rich people so there is no way I can be infected”. People might get offended if there is no hand shake, as they perceive they are being suspected of infection. Others think that those wearing masks have the virus and so steer clear while remaining close to people without protective gear. In light of this context, which also includes a considerable degree of misinformation, the Health and Technology and Innovation ministries caused dismay on 27 March when they announced progress with a COVID-19 remedy that has been developed with traditional medicine experts.
Fear of being identified as a carrier of the virus is also a problem in Ethiopia. It is therefore unlikely that all people with symptoms will seek medical attention, even if services are available to them. For example, a person who came back to Ethiopia from Saudi Arabia with symptoms escaped from the ambulance taking him from the airport to the health center. He was found after spending a night with his sister in Addis Ababa and a night in Dessie, then catching a bus to his home area.
After the majority of the first confirmed cases were foreigners, there was a spate of minor attacks, such as stone-throwing and verbal abuse, on non-Ethiopians, mainly in Addis Ababa. Although that trend seems to have abated, deteriorating economic conditions combined with existing political tensions could induce panic and lead to wider social and political disorder, especially if supplies of basic commodities or essential services are threatened.
The public’s slowness to change its behavior reflects a lack of urgency and also a concern that enforcing lockdown measures seen in other countries will make life more difficult for Ethiopians because few people can work from home and many are living on narrow margins and so cannot afford to take time off work. The public’s hesitancy to embrace necessary changes in habits also corresponds with a tendency by officials to downplay the potential impact, as we have seen in the government health sector’s inability or inaction in not aggressively testing for COVID-19, in the view of one former government emergency worker. Especially in rural areas, cases of the coronavirus would be unlikely to be suspected and reported, while routinely in Ethiopia autopsies are not conducted when elderly people die, he said.