By Dr. Alex Ezeh, Drexel University; Dr. Michael Silverman and Dr. Saverio Stranges, Western University — The Conversation — 17 August 2021
The impact of the COVID-19 pandemic in sub-Saharan Africa remains markedly lower compared to the Americas, Europe and Asia, though an increase in deaths has been recorded since mid-July 2021. The reasons for this are not yet clear, but several factors have been suggested: age demographics, lack of long-term care facilities, potential cross-protection from previous exposure to circulating coronaviruses, limitations of SARS-CoV-2 testing which may have resulted in an undercounting of deaths, and effective government public health responses.
On age demographics: the median age in sub-Saharan Africa is 18, compared to a range of 32 to 42.5 years in North and South America, Europe and Asia. COVID-19 has a significant impact on older people — most deaths occur in those aged 65 or older. On long-term care facilities: most elderly people in sub-Saharan Africa live with families rather than in institutional care, limiting the risk of transmission; 81% of COVID-19 deaths in Canada during the first wave occurred in long-term care facilities. On cross-protection: prior exposure to endemic coronaviruses may have resulted in antibodies that reduce the severity of COVID-19. On government response: the rapid response of several African governments — including screening, establishment of the Africa Task Force for Novel Coronavirus, suspension of flights from China and closure of borders in 40 nations — may have played a significant role. On testing limitations: low testing levels across sub-Saharan Africa may mean COVID-19 incidence and deaths are undercounted. South Africa stands as an outlier — with a higher median age, an established long-term care sector, higher rates of HIV and TB, and better diagnostic capabilities, it experienced significantly higher COVID-19 hospitalisation and death rates. The authors warn that the emergence of variants with increased potential for severe disease in younger populations could make Africa more susceptible, and call for enhanced molecular epidemiologic surveillance and equitable access to vaccines.