key: cord-0953169-ton2b5q6 authors: Musa, Hassan H.; Musa, Taha H.; Musa, Idriss H.; Musa, Ibrahim H.; Ranciaro, Alessia; Campbell, Michael C. title: Addressing Africa’s pandemic puzzle: perspectives on COVID-19 infection and mortality in sub-Saharan Africa date: 2020-09-30 journal: Int J Infect Dis DOI: 10.1016/j.ijid.2020.09.1456 sha: 9861d1e6aa4f3aa164ed99853fcb88db0816c9d5 doc_id: 953169 cord_uid: ton2b5q6 To date, SARS-CoV-2 (the virus that causes COVID-19) has spread to almost every region of the world, infecting millions and resulting in the deaths of hundreds of thousands of people. Although it was predicted that Africa would suffer a massive loss of life, the number of COVID-19 cases has been relatively low across the continent. Researchers have speculated that a number of factors could be responsible for this pattern in Africa, including the extensive experience that countries have with infectious diseases and the young median age of their populations. However, it is still important for African countries to adopt aggressive and bold approaches against COVID-19, in case the nature of the pandemic changes. This short review will summarize the status of the outbreak in Africa and possible reasons for current trends, as well as discuss interventions aimed at preventing a rapid increase in the number of COVID-19 cases in the future. Intriguingly, it also has been suggested that previous exposure to other less-lethal coronaviruses could provide individuals with some protection from COVID-19 (Nordling, 2020 (Ebuenyi, 2020) . This social investment will help to minimize the adverse effects of lower income on health (Ebuenyi, 2020) . By enhancing public health interventions, African countries can still effectively fight against COVID-19, and other infectious diseases (e.g. malaria), even in the absence of effective vaccinations (Torti et al., 2020) . Ethical approval was not required for this research. The authors declare no conflicts of interests. 310 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 FI G U RE LE G Chloroquine and Hydroxychloroquine for the Prevention or Treatment of COVID-19 in Africa: Caution for Inappropriate Off-label Use in Healthcare Settings Asymptomatic coronavirus infection: MERS-CoV and SARS-CoV-2 (COVID-19) Access to improved water and sanitation in sub-Saharan Africa in a quarter century Access to improved water and sanitation in sub-Saharan Africa in a quarter century Will Africa be Devastated by Covid-19 as Many Predicted? Perspective and Prospective The peopling of the African continent and the diaspora into the new world A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster COVID-19 and malaria: A symptom screening challenge for malaria endemic countries Emerging coronaviruses: Genome structure, replication, and pathogenesis High SARS-CoV-2 seroprevalence in Health Care Workers but relatively low numbers of deaths in urban Malawi Coronaviridae Study Group of the International Committee on Taxonomy of V. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2 COVID-19 Pandemic and Africa: From the Situation in Zimbabwe to a Case for Precision Herbal Medicine Mapped: The Median Age of the Population on Every Continent The relatively young and rural population may limit the spread and severity of COVID-19 in Africa: a modelling study The relatively young and rural population may limit the spread and severity of COVID-19 in Africa: a modelling study Antibody testing for coronavirus disease 2019: not ready for prime time Could the D614G substitution in the SARS-CoV-2 spike (S) protein be associated with higher COVID-19 mortality? COVID-19: an opportunity for African governments to rethink social welfare benefits and protection Short report on implications of Covid-19 and emerging zoonotic infectious diseases for pastoralists and Africa Africa in the Path of Covid-19 Genomewide Association Study of Severe Covid-19 with Respiratory Failure A dissymmetry in the figures related to the covid-19 pandemic in the world: what factors explain the difference between africa and the rest of the world Isolation and characterization of a bat SARS-like coronavirus that uses the ACE2 receptor First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA Genetic variation and adaptation in Africa: implications for human evolution and disease COVID-19 faecal-oral transmission: Are we asking the right questions? Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy CSSE Coronavirus COVID-19 Global Cases (dashboard) Covid-19: risk factors for severe disease and death Access to lifesaving medical resources for African countries: COVID-19 testing and response, ethics, and politics Effects of natural selection and gene conversion on the evolution of human glycophorins coding for MNS blood polymorphisms in malaria-endemic African populations Identifying Darwinian selection acting on different human APOL1 variants among diverse African populations Health Inequalities in Japan: An Empirical Study of Older People Coronavirus-19 and malaria: The great mimics Mounting hunger in the Sahel: the unintended impact of COVID-19 prevention. Refugees International Resistance to malaria through structural variation of red blood cell invasion receptors Coronavirus disease 2019 (COVID-19): current status and future perspectives Developing Covid-19 Vaccines at Pandemic Speed Resistance to HIV infection COVID-19 in Africa: the spread and response COVID-19 in Africa: the spread and response Rethinking the role of hydroxychloroquine in the treatment of COVID-19 The implications of silent transmission for the control of COVID-19 outbreaks It is Time to Address Airborne Transmission of COVID-19 Health seeking behaviour and challenges in utilising health facilities in Wakiso district Global health initiatives in Africa -governance, priorities, harmonisation and alignment Mobile Health Technology for Enhancing the COVID-19 Response in Africa: A Potential Game Changer? Let Africa into the market for COVID-19 diagnostics Africa's pandemic puzzle: why so few cases and deaths? Emerging SARS-CoV-2 mutation hot spots include a novel RNAdependent-RNA polymerase variant Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2): An Update Obesity a risk factor for increased COVID19 prevalence, severity and lethality (Review) Efficacy of waterless hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania COVID-19 in Africa IOM steps up risk communication and community engagement in response to COVID-19 in West and Central Africa The Need for the Right Socio-Economic and Cultural Fit in the COVID-19 Response in Sub-Saharan Africa: Examining Demographic, Economic Political, Health, and Socio-Cultural Differentials in COVID-19 Morbidity and Mortality COVID-19 and citizen science: lessons learned from southern Africa COVID-19: Shining the Light on Africa Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany Leveraging Africa's preparedness towards the next phase of the COVID-19 pandemic Genome sequencing and the diagnosis of novel coronavirus (SARS-COV-2) in Africa: how far are we? Promote hand hygiene to save lives and combat COVID-19. World Health Organzation Microarray analysis of HIV resistant female sex workers reveal a gene expression signature pattern reminiscent of a lowered immune activation state Global Trends in Epidemiology of Coronavirus Disease 2019 (COVID-19) Genomics meets HIV-1 The COVID-19 vaccine development landscape The Lancet Editorial. COVID-19 in Africa: no room for complacency Evidence for the innate immune response as a correlate of protection in human immunodeficiency virus (HIV)-1 highly exposed seronegative subjects (HESN) Potential implications of SARS-CoV-2 epidemic in Africa: where are we going from now? Diagnosing COVID-19: The Disease and Tools for Detection Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 Chloroquine is a potent inhibitor of SARS coronavirus infection and spread Detecting natural selection in genomic data Simple and sensitive molecular diagnostic test for SARS-CoV-2 surveillance African countries scramble to ramp up testing for COVID-19 OpenSAFELY: factors associated with COVID-19 death in 17 million patients World Health Organization. COVID-19 situation report 29 COVID-19 Coronovirus pandemic Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2 Insight into 2019 novel coronavirus -An updated interim review and lessons from SARS-CoV and MERS-CoV Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission A systematic review of lopinavir therapy for SARS coronavirus and MERS coronavirus-A possible reference for coronavirus disease-19 treatment option Acting locally: innate mucosal immunity in resistance to HIV-1 infection in Kenyan commercial sex workers Senegal to trial $1 speedy test for covid-19 The major genetic risk factor for severe COVID-19 is inherited from Neandertals A pneumonia outbreak associated with a new coronavirus of probable bat origin This work was supported by Darfur College (Nyala, Sudan), and by funds provided by the National J o u r n a l P r e -p r o o f