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

Abstract

The differential spread and impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing Coronavirus Disease 2019 (COVID-19), 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 reason to consider that many African countries attenuated the spread and impacts early on. Factors explaining low spread include early government 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. Furthermore, it highlights potential lessons to draw from Africa for global health on assumptions regarding deadly viral pandemics, given its long experience with infectious diseases.

Increased airborne transmission of COVID-19 with new variants, Implications for health policies

“…made the prediction [74] that sub–Saharan Africa will not be stricken so much by the pandemic in the future due to airborne considerations. This low spreading of the disease has been observed up to now and a variety of explanations have been proposed [75,76]. Rowe et al .…”

“…More than a year ago Rowe et al made the prediction [74] that sub-Saharan Africa will not be stricken so much by the pandemic in the future due to airborne considerations. This low spreading of the disease has been observed up to now and a variety of explanations have been proposed [75,76]. Rowe et al [6] have rationalized this observation considering an "outdoor" way of life in these countries, which includes housing without air conditioning (AC), with large natural ventilation to ensure refreshment and open outdoor markets instead of supermarkets.…”

High infectious disease burden as a basis for the observed high frequency of asymptomatic SARS-CoV-2 infections in sub-Saharan Africa

“…However, this has not been the case and there are several theories that have been postulated to explain the low prevalence of symptomatic SARS-CoV-2 infection in the sub-region. Factors such as the significantly younger population, warm weather conditions, poor healthcare surveillance systems and pre-existing immunity from exposure to other coronaviruses may all make some contribution to this observation [60][61][62][63] . However, the available literature suggests that the high infectious disease burden on the African continent could be a very significant factor that can explain the high proportion of asymptomatic SARS-CoV-2 infections in sub-Saharan Africa.…”

Antibiotic dispensing practices during COVID-19 and implications for Antimicrobial Resistance (AMR): Parallel mystery client studies in Uganda and Tanzania

“…The direct impacts of COVID-19, in terms of morbidity and mortality, have been less severe in Africa compared with other world regions, in uenced by a number of demographic and health systems factors, such as younger age structures, African governments' responses, and health system preparedness for infectious disease [1,2]. However, COVID-19 will likely have many serious indirect impacts on health and society in Africa.…”