Less Severe Cases of COVID-19 in Sub-Saharan Africa: Could Co-infection or a Recent History of Plasmodium falciparum Infection Be Protective?

Abstract

Sub-Saharan Africa has generally experienced few cases and deaths of coronavirus disease 2019 (COVID-19). In addition to other potential explanations for the few cases and deaths of COVID-19 such as the population socio-demographics, early lockdown measures and the possibility of under reporting, we hypothesize in this mini review that individuals with a recent history of malaria infection may be protected against infection or severe form of COVID-19. Given that both the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and Plasmodium falciparum (P. falciparum) merozoites bind to the cluster of differentiation 147 (CD147) immunoglobulin, we hypothesize that the immunological memory against P. falciparum merozoites primes SARS-CoV-2 infected cells for early phagocytosis, hence protecting individuals with a recent P. falciparum infection against COVID-19 infection or severity. This mini review therefore discusses the potential biological link between P. falciparum infection and COVID-19 infection or severity and further highlights the importance of CD147 immunoglobulin as an entry point for both SARS-CoV-2 and P. falciparum into host cells.

COVID-19 Antibody Detecting Rapid Diagnostic Tests Show High Cross-Reactivity When Challenged with Pre-Pandemic Malaria, Schistosomiasis and Dengue Samples

“…Non-specific signals in LFA such as COVID-19 Ab RDTs can be reduced by engineering the components, e.g., adding blocking proteins to the buffer or adapting the capillary flow rate by changes in the nitrocellulose strip [ 13 ]. Of note, for both dengue and P. falciparum malaria, in silico evidence of similarity with SARS-CoV-2 epitopes has also been put forward to explain the cross-reactivity [ 50 ].…”

High Seroprevalence of anti-SARS-CoV-2 antibodies among Ethiopian healthcare workers

“…The low number of reported cases and deaths in Africa have been attributed to low testing capacity, younger population, warmer environments, and the successful implementation of control measures 2 . Also, pre-existing crossprotective immunity due to the four other less pathogenic human coronaviruses (HCoVs) 3 , Bacillus Calmette-Guérin (BCG)-vaccination 4 , or recent history of malaria infection may offer some protection against infection or severe forms of COVID-19 5 . To date, Ethiopia has performed over 2,682,758 real-time reverse transcription-polymerase chain reactions (RT-PCR) tests for SARS-CoV-2 and reported 268,901 cases and 4,068 deaths since the first case was detected in the country on March 13, 2020.…”

High Seroprevalence of Anti-SARS-CoV-2 Antibodies Among Ethiopian Healthcare Workers

“…The low number of reported cases and deaths in Africa have been attributed to low testing capacity, younger population, warmer environments, and the successful implementation of control measures [2]. Also, pre-existing cross-protective immunity due to the four other less pathogenic human coronaviruses (HCoVs) [3], Bacillus Calmette-Guérin (BCG)-vaccination [4], or recent history of malaria infection may offer some protection against infection or severe forms of COVID-19 [5].…”