The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

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Abstract

The demographic age structure of sub-Saharan Africa contributes significantly to the low morbidity and mortality of COVID-19 compared to other regions in the world.

Key Messages

Evidence suggests the demographic age structure of sub-Saharan Africa is the leading factor of the low morbidity and mortality of COVID-19 compared to other regions of the world.
Widespread social mitigation strategies, such as lockdowns, have resulted in severe economic and societal consequences in terms of food security, adolescent pregnancy, gender-based violence, and disruptions in treating other diseases.
It is imperative to weigh the risks and benefits of social mitigation strategies for future waves.

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Most cited references 36

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Is Open Access

OpenSAFELY: factors associated with COVID-19 death in 17 million patients

Elizabeth J Williamson, Alex J Walker, Krishnan Bhaskaran … (2020)

COVID-19 has rapidly impacted on mortality worldwide. 1 There is unprecedented urgency to understand who is most at risk of severe outcomes, requiring new approaches for timely analysis of large datasets. Working on behalf of NHS England we created OpenSAFELY: a secure health analytics platform covering 40% of all patients in England, holding patient data within the existing data centre of a major primary care electronic health records vendor. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19 related deaths. COVID-19 related death was associated with: being male (hazard ratio 1.59, 95%CI 1.53-1.65); older age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared to people with white ethnicity, black and South Asian people were at higher risk even after adjustment for other factors (HR 1.48, 1.29-1.69 and 1.45, 1.32-1.58 respectively). We have quantified a range of clinical risk factors for COVID-19 related death in the largest cohort study conducted by any country to date. OpenSAFELY is rapidly adding further patients’ records; we will update and extend results regularly.

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The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro

Leon Caly, Julian Druce, Mike Catton … (2020)

Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 hours post infection with SARS-CoV-2 able to effect ∼5000-fold reduction in viral RNA at 48 h. Ivermectin therefore warrants further investigation for possible benefits in humans.

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A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19

David Boulware, Matthew Pullen, Ananta Bangdiwala … (2020)

Abstract Background Coronavirus disease 2019 (Covid-19) occurs after exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For persons who are exposed, the standard of care is observation and quarantine. Whether hydroxychloroquine can prevent symptomatic infection after SARS-CoV-2 exposure is unknown. Methods We conducted a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis. We enrolled adults who had household or occupational exposure to someone with confirmed Covid-19 at a distance of less than 6 ft for more than 10 minutes while wearing neither a face mask nor an eye shield (high-risk exposure) or while wearing a face mask but no eye shield (moderate-risk exposure). Within 4 days after exposure, we randomly assigned participants to receive either placebo or hydroxychloroquine (800 mg once, followed by 600 mg in 6 to 8 hours, then 600 mg daily for 4 additional days). The primary outcome was the incidence of either laboratory-confirmed Covid-19 or illness compatible with Covid-19 within 14 days. Results We enrolled 821 asymptomatic participants. Overall, 87.6% of the participants (719 of 821) reported a high-risk exposure to a confirmed Covid-19 contact. The incidence of new illness compatible with Covid-19 did not differ significantly between participants receiving hydroxychloroquine (49 of 414 [11.8%]) and those receiving placebo (58 of 407 [14.3%]); the absolute difference was −2.4 percentage points (95% confidence interval, −7.0 to 2.2; P=0.35). Side effects were more common with hydroxychloroquine than with placebo (40.1% vs. 16.8%), but no serious adverse reactions were reported. Conclusions After high-risk or moderate-risk exposure to Covid-19, hydroxychloroquine did not prevent illness compatible with Covid-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure. (Funded by David Baszucki and Jan Ellison Baszucki and others; ClinicalTrials.gov number, NCT04308668.)

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Author and article information

Journal

Journal ID (nlm-ta): Glob Health Sci Pract

Journal ID (iso-abbrev): Glob Health Sci Pract

Journal ID (hwp): ghsp

Journal ID (publisher-id): ghsp

Title: Global Health: Science and Practice

Publisher: Global Health: Science and Practice

ISSN (Electronic): 2169-575X

Publication date Collection: 30 September 2021

Publication date (Electronic): 30 September 2021

Volume: 9

Issue: 3

Pages: 433-443

Affiliations

[a ]Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University , London, Ontario, Canada.

[b ]Department of Medicine, Schulich School of Medicine and Dentistry, Western University , London, Ontario, Canada.

[c ]Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast , Cape Coast, Ghana.

[d ]Dornsife School of Public Health, Drexel University , Philadelphia, PA, USA.

[e ]School of Public Health, University of the Witwatersrand , Johannesburg, South Africa.

[f ]Bayero University , Kano, Kano State, Nigeria.

[g ]Aminu Kano Teaching Hospital , Kano, Kano State, Nigeria.

[h ]University of Ibadan , Ibadan, Nigeria.

[i ]College of Medicine, University of Ibadan , Ibadan, Nigeria.

[j ]Pan African University Life & Earth Sciences Institute (PAULESI) , Ibadan, Nigeria.

[k ]School of Nursing and Midwifery, Aga Khan University , Kampala, Uganda.

[l ]Family and Youth Health Initiative (FAYOHI), Jigawa State , Nigeria.

[m ]Karanda Hospital , Mount Darwin, Zimbabwe.

[n ]The University of Zimbabwe , Harare, Zimbabwe.

[o ]University of Toronto , Toronto, Canada.

[p ]African Population and Health Research Center , Nairobi, Kenya.

[q ]Department of Family Medicine, Western University , London, Ontario, Canada.

[r ]The Africa Institute, Western University , London, Ontario, Canada.

[s ]Department of Population Health, Luxembourg Institute of Health , Strassen, Luxembourg.

[t ]Division of Infectious Diseases, Western University , London, Ontario, Canada.

Author notes

Correspondence to Michael Silverman ( michael.silverman@ 123456sjhc.london.on.ca ).

Article

Publisher ID: GHSP-D-21-00172

DOI: 10.9745/GHSP-D-21-00172

PMC ID: 8514030

PubMed ID: 34593571

SO-VID: 10eee2d3-a0c1-4b49-b0b6-d81c27346066

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-21-00172

The Conundrum of Low COVID-19 Mortality Burden in sub-Saharan Africa: Myth or Reality?

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COVID-19 Research in and about Africa

Most cited references 36

OpenSAFELY: factors associated with COVID-19 death in 17 million patients

The FDA-approved Drug Ivermectin inhibits the replication of SARS-CoV-2 in vitro

A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19

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