Until there is a vaccine it is likely that coronavirus cases in Africa will continue to rise, according to the World Health Organisation (WHO).
The head of the UN agency in the region, Dr Matshidisho Moeti, said she expects to see a gradual rise in cases until well into next year, and warned that there could be spikes - as seen in Europe and elsewhere - if countries begin to open up too quickly.
Speaking at a virtual press conference on Thursday, six months after Africa declared its first coronavirus case, Dr Moeti said: "As we have seen in other regions, as people start to move around, start to have mass gatherings, schools reopen and religious gatherings start, we do expect to see an increase in cases."
She pointed to Kenya, Ethiopia, Algeria and Ghana as countries where this had already begun to happen, as well as Nigeria, Madagascar and Zambia. However, other countries - including Cameroon, the Seychelles and South Africa, by far the worst affected place in Africa - were reporting fewer cases than in previous months.
She said she hoped the rise would not be exponential as countries began to move out of lockdown, although local outbreaks were to be expected, and the WHO's role would be in supporting countries to quickly get on top of them. It is also working with a number of countries to ensure that essential services in other areas of health, like childhood immunisation or the provision of HIV drugs, re-started safely, she said.
Dr Moeti also stressed that many countries were now in much stronger places to deal with the virus than they were at the start of the pandemic, including Nigeria and Ethiopia, which had scaled up testing capacity dramatically. She also praised the quick responses of many African countries, which enforced strict, early lockdowns that she said were arguably "justified" even amid human rights criticisms.
Aside from localised spikes, Dr Moeti said she expected a "gradual" increase in case numbers to continue across Africa.
"I expect we will have to contend with these not very dramatic increases until such time as we manage to have access to a vaccine, and manage to deploy it. This will continue well into the next year," she said, urging ongoing vigilance, particularly as the virus continues to spread from capital cities to rural areas in a number of countries.
There have been more than one million confirmed coronavirus cases in Africa, and 23,000 deaths.
Recent antibody tests in countries like Kenya have suggested, however, that far more people may have been infected by the virus and gone under the radar. Data suggested that up to 1 in 20 of its population may have had the virus. However, unlike in other regions, death rates have not increased anywhere near as dramatically.
Scientists are unsure why this may be, and have pointed variously to deaths not being reported comprehensively in some countries, potential immunity in populations due to exposure to previous coronaviruses, and the relatively young average age of most populations in Africa.
Dr Moeti said: "We have a very young population in the region compared to other regions, so even if we do have significant proportions of young people infected, most of the people dying in other regions tend to be over the age of 60 and with underlying illnesses that make them vulnerable. These might be factors that come into play."
She added: "We all need to analyse the data further to see what the real situation is in Africa. It is no doubt telling us that more people have been infected through this surveillance, and this is something we expected."
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