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The impact of the COVID-19 outbreak on the East and Horn of Africa is expected to be far reaching and more catastrophic than for high income countries given concurrent co-morbidity among the general population, the population size, and status of health systems and health workforce, which both have low resilience to external shocks and have insufficient critical care capacities. The underlying health issues in the region are represented by higher HIV and Tuberculosis prevalence, higher burden of respiratory tract infections and malnutrition, even in the young populations, compared to high income countries. These pre-existing conditions are expected to worsen any health impacts from COVID-19. It can be estimated that the number of COVID-19 cases with severe progression of the disease may be exacerbated by all of the above, creating an unmanageable and unaffordable burden on the already overstretched health systems.

Communal living and the high density of urban and peri-urban areas in Africa, including slums and informal settlements, pose another significant challenge to containing COVID-19. With the rainy season already upon the East and Horn of Africa, individuals who may already suffer from respiratory illnesses and water borne diseases are likely to be acutely vulnerable to COVID-19. Of great concern will be the potential flooding, landslides, or other disasters that could induce the displacement of communities, further complicating COVID-19 transmission patterns and prevention strategies.