Africa’s fragile health care systems are coming under increased pressure, the World Health Organisation (WHO) said as the number of confirmed Covid-19 cases on the continent passed 893,000 cases on Thursday and the death toll edged towards 19,000.

In the two weeks through Thursday, the number of new cases increased by 50 per cent and the death toll by 22 per cent – to 4,376 – from the previous fortnight, and both figures are set to rise as countries relax travel restrictions and reopen their borders, it said.

“Coming up to the first million confirmed Covid-19 cases in the African continent, countries have averted what could have been a much worse decision by taking some very courageous decisions,” WHO regional director for Africa Dr Matshidiso Moeti said.

“As Africa approaches one million cases, the continent is at a pivotal point,” she said.

“We are seeing in Africa and other parts of the world that when measures to suppress Covid-19 transmission are eased, cases creep up, so it is important that authorities and all communities have the capacities in place to react quickly with strong surveillance, testing, isolation and contact tracing.”

South Africa, Algeria, Egypt, Ghana and Nigeria have emerged as the main infection hotspots, accounting for three-quarters of all cases on the continent.

South Africa alone has reported more than 482,000 cases and over 7,800 deaths, and local authorities say they expect the situation to get worse in the next two months.

Seven countries in Sub-Saharan Africa saw a 20 per cent jump in cases in the two weeks after easing lockdown measures, and four of them – Republic of the Congo, Morocco, Kenya and South Africa – subsequently re-implemented partial restrictions.

Of the people to have died from Covid-19 in Africa, almost 14,000 were health workers.

Dr Ahmed Al-Mandhari, WHO regional director for the eastern Mediterranean, said that as borders started to reopen and with the Islamic holiday, Eid al-Adha, set to start on Friday there were concerns the spread of the coronavirus might widen, including to areas as yet unaffected.

The WHO said that as Africa was behind the global average in terms of testing for Covid-19 – about 8.3 million tests have been performed since February – the continent was probably suffering from under-reporting of cases.

John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said if the continent wanted to keep pace with the rest of the world, “we should be testing about 13 million people, because we are a continent of 1.3 billion people”.

“There is a lot of work to be done,” he said.

Nkengasong said he was also concerned about the growing pressure on hospitals.

“I have always said that you don’t build your health systems when you need them, we build health systems before we need them,” he said.

“I don’t think we have the resources as a continent to build a 1,000-bed hospital in two weeks, as China did.”