COVID-19 Pandemic: Is Africa Different?

Abstract

COVID-19 has now spread to all the continents of the world with the possible exception of Antarctica. However, Africa appears different when compared with all the other continents. The absence of exponential growth and the low mortality rates contrary to that experienced in other continents, and contrary to the projections for Africa by various agencies, including the World Health Organization (WHO) has been a puzzle to many. Although Africa is the second most populous continent with an estimated 17.2% of the world's population, the continent accounts for only 5% of the total cases and 3% of the mortality. Mortality for the whole of Africa remains at a reported 19,726 as at August 01, 2020. The onset of the pandemic was later, the rate of rise has been slower and the severity of illness and case fatality rates have been lower in comparison to other continents. In addition, contrary to what had been documented in other continents, the occurrence of the renal complications in these patients also appeared to be much lower. This report documents the striking differences between the continents and within the continent of Africa itself and then attempts to explain the reasons for these differences. It is hoped that information presented in this review will help policymakers in the fight to contain the pandemic, particularly within Africa with its resource-constrained health care systems.

The SARS-CoV-2 pandemic: A syndemic perspective

“…Actually, the low intensity and lethality of the national epidemics in most African countries suggest hypothetical protective interactions of the high burden of tuberculosis (and/or BCG coverage) and tropical parasitic diseases, along with the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs [ [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] ]. However, the detection of a new variant of the SARS-CoV-2 in South Africa (variant 501Y·V2) in middle December 2020 with preliminary studies suggesting that the variant is associated with a higher viral load, which may suggest potential for increased transmissibility, might challenge the low transmissibility, low lethality trend observed so far in most African Countries [ 81 ].…”

Covid-19 deaths in Africa: prospective systematic postmortem surveillance study

“… 1 A puzzling question is why covid-19 seems to have largely skipped Africa. 2 3 4 Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should be favored wherever population densities are high, but the Institute of Health Metrics and Evaluation recently listed covid-19 as the 45th most common cause of death in Africa, despite it being the 12th leading cause globally. 5 No obvious reason exists why covid-19 would not spread as efficiently in Nairobi, Accra, or Lagos as it has in New York City, London, or Mumbai.…”

COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa

“…1 A puzzling question is why CV19 appears to have largely skipped Africa? [2][3][4] transmission should be favored wherever population densities are high, yet the institute of Health Metrics and Evaluation (IHME) recently listed CV19 as the 45 th most common cause of death in Africa, despite being the 12 th leading cause globally. 5 There is no obvious reason why CV19 would not spread as efficiently in Nairobi, Accra, or Lagos as it has in New York City, London, or Mumbai.…”