Understanding varying COVID-19 mortality rates reported in Africa compared to Europe, Americas and Asia

Emeka Francis Okonji, Osaretin Christabel Okonji, Ferdinand C Mukumbang, Brian Van Wyk, Emeka Francis Okonji, Osaretin Christabel Okonji, Ferdinand C Mukumbang, Brian Van Wyk

Abstract

The SARS-CoV-2 infection, which causes the COVID-19 disease, has impacted every nation on the globe, albeit disproportionately. African countries have seen lower infection and mortality rates than most countries in the Americas Europe and Asia. In this commentary, we explore some of the factors purported to be responsible for the low COVID-19 infection and case fatality rates in Africa: low testing rate, poor documentation of cause of death, younger age population, good vitamin D status as a result of exposure to sunlight, cross-immunity from other viruses including coronaviruses, and lessons learnt from other infectious diseases such as HIV and Ebola. With the advent of a new variant of COVID-19 and inadequate roll-out of vaccines, an innovative and efficient response is needed to ramp up testing, contact tracing and accurate reporting of infection rates and cause of death in order to mitigate the spread of the infection.

Keywords: Africa; COVID-19; SARS-CoV-2 virus; pandemic; testing capacity.

© 2021 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

References

    1. African Center for Disease Control: Coronavirus Disease 2019 (COVID‐19). (Available from: ) [20 Jan 2021].
    1. World Health Organization (WHO) . Coronavirus Disease 2019 (COVID‐19). Weekly Epidemiological and Operational update, 5 January 2021. (Available from: ) [5 Jan 2021] (). Accessed January 20, 2021.3.
    1. Zheng Z, Peng F, Zu B, Zhao J, Liu H, Peng G. Risk factors of critical & mortal COVID‐19 cases: a systematic literature review and meta‐analysis. J Infect 2020: 81: e16–e25.
    1. Garg S, Kim L, Whitaker M et al. Hospitalization rates and characteristics of patients hospitalized with laboratory‐confirmed coronavirus disease 2019 — COVID‐NET, 14 states, March 1–30, 2020. MMWR Morb Mortal Wkly Rep 2020: 69: 458–464.
    1. National Institute for Communicable Diseases (NICD) . COVID‐19 Weekly Sentinel Hospital Surveillance Update, Week 38 2020. (Available from: ) [20 Jan 2021].
    1. Coronavirus: unpacking the theories behind Africa's low infection rate. [Internet, 21 May 2020]. The Africa Report. (Available from: ) [20 Jan 2021].
    1. Harding A. Coronavirus in South Africa: scientists explore surprise theory for low death rate [Internet, 2 Sept 2020]. BBC News. (Available from: ) [5 Jan 2021].
    1. Winning A. 2020. Puzzled scientists seek reasons behind Africa's low fatality rates from pandemic [Online 29 September]. (Available from: ) [20 Jan 2021].
    1. Coronavirus: Africa infections rising sharply in worst‐affected countries (Available from: ). [18 Jan 2021].
    1. Hasell J, Mathieu E, Beltekian D et al. A cross‐country database of COVID‐19 testing. Sci Data 2020: 7: 345.
    1. Cameroon . COVID‐19 Emergency Situation Report No. 13 December 2020. [Available from: ] [20 Jan 2021].
    1. Economic Commission for Africa . Report on the status of civil registration and vital statistics in Africa. ECA, Addis Ababa2017 (Available from: ).
    1. Sankoh O, Dickson KE, Faniran S et al. Births and deaths must be registered in Africa. Lancet 2020: 8: E33–E34.
    1. Statistic South Africa: Focus on Improving Civil Registration and Vital Statistics. 2019. (Available from: ).
    1. South Africa Medical Research Centre . Report on weekly deaths in South Africa 1 Jannuary‐29 December 2020 (Week 52) Burden of Disease Research Unit South African Medical Research Council. 2021. (Available from: ) [Accessed 28 Jan 2021].
    1. Makinde OA, Odimegwu CO, Udoh MO, Adedini SA, Akinyemi JO, Atobatele A. Death registration in Nigeria: a systematic literature review of its performance and challenges. Global Health Action 2020: 13: 1.
    1. At least half of mystery deaths in Nigeria’s Kano due to COVID‐19 – minister. 2020. Available online 20 June] (Available from: of‐mystery‐deaths‐in‐nigerias‐kano‐due‐to‐covid‐19‐minister/)
    1. Mwananyanda L, Gill CJ, Macleod W, Kwenda G, Pieciak R, Mupila Z. 2020. COVID‐19 deaths detected in a systematic post‐ mortem surveillance study in Africa. 10.1101/2020.12.22.20248327.
    1. National Institute for Communicable Diseases (NICD) . COVID‐19 Weekly Epidemiology. (Available from: ) [20 Jan 2021].
    1. Nigeria Centre for Disease Control . Coronavirus disease (COVID‐19) pandemic. (Available from: ) [16 Jan 2021].
    1. Nigeria Centre for Disease Control . Coronavirus disease (COVID‐19) pandemic. (Available from: ) [16 Jan 2021].
    1. Ogbolosingha AJ, Singh A. COVID‐19 pandemic: review of impediments to public health measures in Sub‐Saharan Africa. Am J Prev Med 2020: 6: 68–75.
    1. Centers for Disease Control and Prevention (CDC) . COVIDView Summary ending on September 19, 2020 CDC. 2021;1–13. (Available from:
    1. National Institute for Communicable Diseases (NICD) . COVID‐19 Weekly Epidemiology. (Available from: ) [20 Jan 2021].
    1. Nigeria Centre for Disease Control . Coronavirus disease (COVID‐19) pandemic. (Available from: ) [16 Jan 2021].
    1. Life expectancy at birth by sex‐ Our World in Data. (Available from: ).
    1. Daneshkhah A, Agrawal V, Eshein A et al. 2020. The possible role of vitamin D in suppressing cytokine storm and associtaied mortality in COVID‐19 patients, medRxiv preprint. 10.1101/2020.04.08.200585.78
    1. Jothimani D, Kailasam E, Danielraj S, Nallathambi B, Ramachandran H, Sekar P. COVID‐19: Poor outcomes in patients with zinc deficiency. Int J Infect Dis 2020: 100: 343–349.
    1. Asyary A, Veruswati M. Sunlight exposure increased Covid‐19 recovery rates: a study in the central pandemic area of Indonesia. Sci Total Environ 2020: 729: 139016.
    1. Li Y, Li Q, Zhang N, Liu Z. Sunlight and vitamin D in the prevention of coronavirus disease (COVID‐19) infection and mortality in the United States. Res Square 2020.
    1. Whittemore PB. COVID‐19 fatalities, latitude, sunlight, and vitamin D. Am J Infect Control 2020: 48: 1042–1044.
    1. Che XY, Qiu LW, Liao ZY et al. Antigenic cross‐reactivity between severe acute respiratory syndrome‐associated coronavirus and human coronaviruses 229E and OC43. J Infect Dis 2005: 191: 2033–2037.
    1. Hoffmann M, Kleine‐Weber H, Schroeder S et al. SARS‐CoV‐2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell 2020: 181: 271–280.e8.
    1. Rutayisire E, Nkundimana G, Mitonga HK, Boye A, Nikwigize S. What works and what does not work in response to COVID‐19 prevention and control in Africa. Int J Inf Dis 2020: 97: 267–269.
    1. Patel P, Adebisi YA, Steven M, Lucero‐Prisno DE. Addressing COVID‐19 in Malawi. Pan Afr Med J 2020: 35. 10.11604/pamj.supp.2020.35.2.23960

Source: PubMed

3
Subscribe