What Could Explain the Lower COVID-19 Burden in Africa Despite Considerable Circulation of the SARS-CoV-2 Virus?

Abstract

COVID-19 differential spread and impacts across regions is a major focus for researchers and policy makers. Africa has attracted tremendous attention due to predictions of catastrophic impacts that have not yet materialized. Early in the pandemic, the seemingly low African case count was largely attributed to low testing and case reporting. However, there is also reason to consider that many African countries got out ahead of the virus early on. Factors explaining low spread include early government mandated lockdowns, community-wide actions, population distribution, social contacts, and ecology of human habitation. While recent data from seroprevalence studies posit more extensive circulation of the virus, continuing low COVID-19 burden may be explained by the demographic pyramid, prevalence of pre-existing conditions, trained immunity, genetics, and broader sociocultural dynamics. Though all these prongs contribute to the observed profile of COVID-19 in Africa, some provide stronger evidence than others. This review is important to expand what is known about the differential impacts of pandemics enhancing scientific understanding and gearing appropriate public health responses. Also, highlighting potential lessons the world may draw from Africa for global health on assumptions regarding deadly viral pandemics given its long experience with infectious diseases.

The immunological nature of the pathological effects of SARS-CoV-2 and other pathogens

“…The consequence of this conclusion is that those who have survived despite high previous Plasmodium falciparum exposure are more likely to be exposed to conditions that permit immune mechanisms to reduce the severity of the diseases in that spectrum by blocking the pathway through which they are produced by the gravity-like unobservable in response to their different causes and therefore more likely to be those in whom the frequency of severe or critical manifestations of such diseases will be lowest. This consequence finds representation in the fact that the African region, which is at the most risk of malaria, has a comparatively lower COVID-19 disease burden than other regions of the world instead of the mass COVID-19 catastrophe which was predicted to be its fate on the basis of what was known about how the disease is transmitted and evidence of extensive SARS-CoV-2 spread in the region 17,18 and in the fact that the exception in the region is South Africa, 17 a nation which had low malaria levels by the time the pandemic began. 19 And malaria is not the only disease which observations demonstrate to be part of the immunological spectrum to which COVID-19 belongs.…”

Community-Level Health Interventions are Crucial in the Post-COVID-19 Era: Lessons from Africa’s Proactive Public Health Policy Interventions

“…The world is still not out of the woods. Countless uncertainties remain with the governance of the COVID-19 pandemic (Ahen 2021;Wamai et al 2021;Beaton et al 2021). The challenge of susbtantive health inequalities keeps increasing in complexity (Mehtar et al 2020;Ottersen et al 2014).…”

“…By contrast, if they are credited for their efforts, it will serve as further impetus for doing more even with less resources as in this case of COVID-19 outbreak. Despite surging infections around the world, Africa is still the continent least affected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing the disease COVID-19, albeit disputed in some quarters (Wamai et al 2021;WHO 2021;El-Sadr and Justman 2020). As at 12 th of April 2022, the total global cumulative cases stood at 497,960,492 (Africa 8,614,444) and total cumulative deaths at 6,181,850 (Africa 171,230) (https:// covid 19. who.…”

“…The answer is found in the neglected but rediscovered rituals of self-determination in public health through community-focused bottom up, preventive measures, frugal innovations (Harris et al 2015;2017a), and traditional and lately, modern therapeutics and prophylactics (Ahen and Salo-Ahen 2018). Epidemiological questions in the global South are extremely complex, and no single factor stands out as a hypothetical/empirical explanation (Wamai et al 2021;WHO 2015). More prominently, it is not for journalists, IT gurus and people with little knowledge of the multifaceted African pharmacognosy regime to attempt to predict anything.…”

“…More prominently, it is not for journalists, IT gurus and people with little knowledge of the multifaceted African pharmacognosy regime to attempt to predict anything. It is worth noting that while their roles are scientifically inconclusive (but cannot be discounted), the environment (hot and humid temperatures) and youthful demographic structure, national health profiles (without predominance of obesity and other chronic diseases and a small percentage of over 65-year-olds) help account for the limited spread and severity of the virus (Diop et al 2020;Wamai et al 2021). In the beginning of the unfolding pandemic, the predictions for Africa were nothing short of apocalyptic.…”