Africa’s confirmed cases of COVID-19 have surpassed 1 million, a Reuters tally showed on Thursday, as the disease began to spread rapidly through a continent whose relative isolation has so far spared it the worst of the pandemic.

The continent recorded 1 003 056 cases, of which 21 983 have died and 676 395 recovered.

South Africa – which is the world’s fifth worst-hit nation and makes up more than half of sub-Saharan Africa’s case load – has recorded 538 184 cases since its first case on March 5, the Health ministry said on Thursday.

Low levels of testing in many countries mean Africa’s infection rates are likely to be higher than reported, experts said.

In South Africa, a study showed some 17 000 deaths above the normal rate, or a 60% excess, between early May and mid-July, suggesting more people are dying of COVID-19 than official figures reflect.

South African mortuaries that are running out of space and coffins have resorted to storing bodies in refrigerated shipping containers.

Already creaking public health services are overwhelmed and there are shortages of beds, protective gear and nurses.

COVID-19 patients have sometimes had to be treated alongside others.

A nurse at a hospital in South Africa’s biggest township of Soweto, who declined to be named because she was not authorised to speak to the media, said patients were sometimes left lying next to a corpse for hours because there weren’t enough staff to remove it. More than a third of staff caught the virus on duty.

Virus spreading further 

South Africa’s experiences are a precursor for what is likely to happen across the continent, the World Health Organisation’s top emergencies expert Mike Ryan warned last month. But few African nations have health services as advanced as South Africa’s.

“The fact that South Africa is more connected than other African countries may have influenced the timing, but in the end it will reach – has reached – all African countries,” said Cheryl Cohen, epidemiologist at the National Institute for Communicable Diseases.

Rolling out sufficient testing, vital to tracking outbreaks, has been a major problem. In the Democratic Republic of Congo, it can take more than a week to get results, by which time patients may have already died, government officials said.

Steve Ahuka, a senior member of Congo’s response committee, said the country had chosen to focus on treating the sick rather than trying to track the disease.

Younger population 

Africa’s younger population when compared to other continents may help curb death rates, as the virus is most deadly for older people.

“The profile of the population is different. Less 85-year-olds with diabetes and more 35-year-olds who are fit and healthy,” said Charl Van Loggerenberg, head of emergency medicine at South African private provider, Life Healthcare.

Many African countries imposed quick lockdowns and shut their borders early, buying precious time to prepare hospitals, set up testing machines and learn from evolving treatments.

But governments, mindful of the damage to their economies and the risk of widespread hunger, have mostly lifted lockdowns.

Other measures remain in place: Nigeria has banned travel between its 36 states, Rwandan police are arresting anyone in public without a face mask and Ethiopia, an air travel hub, is quarantining passengers who can’t produce a negative COVID-19 test certificate. But it’s almost impossible to keep a distance between people in Africa’s poor, tightly packed urban areas, and hospitals outside African capitals are often poorly equipped with protective gear and necessities like oxygen, experts say.

Kenya, considered to have relatively good healthcare, has lost eight health workers to COVID-19, the Health Ministry said. The most recent was a 32-year-old nurse who died days after giving birth to her first child, local media reported.