The coronavirus has been relatively slow to take hold in Africa, but blazing hot spots are beginning to emerge on the continent. In Somalia’s capital, Mogadishu, officials say that burials have tripled. In Tanzania, after cases suddenly rose and the U.S. Embassy issued a health alert, the government abruptly stopped releasing its data two weeks ago.

The worst may be in Kano, Nigeria’s second-largest city, where government inaction allowed an unchecked outbreak. Dozens of doctors are infected. Gravediggers are overwhelmed. Officially, Kano, with an estimated population of five million, has reported 753 infections and 33 related deaths, but those numbers do not reflect what health workers and residents say they are seeing on the ground.

Kano’s state government, until recently, claimed a spate of unusual deaths was caused not by the coronavirus, but by hypertension, diabetes, meningitis or acute malaria. There is little social distancing, and few people are being tested. “The leadership is in denial,” said Usman Yusuf, a hematology-oncology professor and the former head of Nigeria’s national health insurance agency. “It’s almost like saying there is no Covid in New York.”

Kano’s location, population and connectivity to the rest of the region mean the consequences of an uncontrolled outbreak could be severe. Already there are reports of hundreds more people dying what some officials call “mysterious deaths” in Nigeria’s northern states of Jigawa, Yobe, Sokoto and Katsina.