COVID-19: Africa needs unprecedented attention to strengthen community health systems
July 8, 2020

As the first cases of COVID-19 were confirmed in Liberia, in March, 2020, former President Ellen Johnson Sirleaf,1 among others,2 highlighted the need to adopt lessons learned from the response to the 2014–16 outbreak of Ebola virus disease in west Africa. Ebola claimed about 11300 lives in 21 months across Liberia, Sierra Leone, and Guinea.3 Comparisons to Ebola benefit from remembering the key differences between the two viruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory virus and is infectious among asymptomatic carriers.4 SARS-CoV-2 differs from Ebola virus in terms of the reproduction number (SARS-CoV-2 5·7 vs Ebola 1·5–1·9),5,6 incubation period (2–14 days vs 8–10 days on average),7,8 and case fatality rate (this varies for SARS-CoV-2 but average is estimated at 4·7% as of July 7, 2020, vs up to 90% for Ebola).9,10 COVID-19 is easier to transmit, harder to diagnose, and can quickly spread in communities.

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