COVID-19 in Africa: an ovarian victory?

Abstract

Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mainly attacks the respiratory system and is characterized by pneumonia, cytokine storm, coagulation disorders and severe immune downregulation. Although public health experts predicted worst outcomes in Africa, the incidence, hospitalization and mortality rates have been lower in Africa compared to other continents. Interestingly, lower incidence and mortality rates have been observed in women from Africa compared to their cohorts from other continents. Also, in the US non-Hispanic Black females have lower COVID-19 and death rates compared to their white counterparts. It’s unclear why this significant difference exists; however, the ovarian function, genetics and immunological statuses could play a major role. Women of African descent have elevated levels of estrogen compared with Caucasians hence we anticipate that estrogen might offer some protection against the SARS-CoV-2 infections. The racial differences in lifestyle, age and inaccessibility to contraceptive usage might also play a role. Here, we provide insight on how the high levels of estrogen in African women might contribute to the lower cases and fatalities in Africa. Specifically, estrogen might offer protection against COVID-19 by suppressing hyper-production of cytokines, promoting anti-inflammatory cytokines, stimulating antibody production and suppressing endoplasmic reticulum (ER) stress. This will as well provide useful information on how future pandemics could be managed using Africa as a case study.

Gender and genetic factors impacting COVID-19 severity

“…This in turn decreases SARS-CoV-2 multiplication in the cells leading to lesser severity of infection. [ 35 ]…”

Characteristics and Outcomes of Individuals With Covid-19: Evidence From a Hospital Based Study

“…On the 14 th of February, 2020 and 16 th of March, 2020 the first case of Sars-cov-2 infection was reported in Egypt and Zambia respectively [7,8]. As opposed to the prediction by public health experts on COVID-19 in Africa, worst outcomes, the incidences, hospitalization and mortality rates recorded have been to a minimal as compared to other continents [6].…”

“…By the second week of June the number of COVID-19 cases surpassed 200,000 and had escalated to 400,000 by the 6 th of July,2020 [6]. On the 14 th of February, 2020 and 16 th of March, 2020 the first case of Sars-cov-2 infection was reported in Egypt and Zambia respectively [7,8].…”

“…WHO indicated the COVID-19 pandemic to be of public health emergency and of international concern that needed extensive resources directed at containing and controlling the spread of the virus as a surge in the number of cases was observed [1,2]. The severity of some of the cases of Covid-19 infection mimicked that of SARS-CoV, however, it was observed that the SARS-CoV-2 virus is not similar to other coronaviruses that usually spread in human beings responsible for causing common cold to severe respiratory distress syndrome [4,5]. The SARS-CoV-2 has shown to overwhemingly surpass SARS and MERS in terms of the number of people infected and the spatial range of epidemic areas [4].…”

Multiple introduced lineages and the single native lineage co-driving the four waves of the COVID-19 pandemic in West Africa

“…Moreover, 11,756,052 cases of COVID-19 have been recorded, with 252,811 cases of death and 10,975,288 recoveries, in Africa, of which the confirmed cases and deaths accounted for 2.4 and 4.1%, respectively. Most of the initial COVID-19 cases in African countries were imported cases from Europe ( 2 ). Around January 28, 2020, Nigeria (NGA) announced sub-Saharan Africa's first confirmed case of COVID-19 ( 3 ), and the remaining 15 West African countries detected their first cases all in March 2020.…”