The Mystery of African COVID


“New York Post” sets up the mystery:

The novel coronavirus has infected more than 26.35 million people, with just four countries accounting for over 15 million cases. They are America, Brazil, India, and Russia — the same four that have been at the top for months. The US surprised the world when it rose to the top spot in multiple COVID-19 statistics, both for the total number of confirmed cases and the number of deaths. Since then, no other country has surpassed America.

But scientists who are studying the pandemic have also identified another surprise of the pandemic. Some expected the African continent to be affected most heavily by the virus, but that wasn’t the case. South Africa stands out when it comes to the number of total cases, with nearly 631,000 infections. But fewer than 15,000 people have died of COVID-19. These figures are puzzling scientists looking to understand how the virus behaves and how it can be beaten.

Putting aside the fact that we simply don’t know the true number of cases in countries with secretive governments like China and Iran, the general point stands: considering the state of health systems throughout the continent and the prevalent conditions  of everyday life – and the consequent fact that the continent is a magnet for pandemics – the widely expected African COVID disaster has simply not happened. Not only has the number of infections and deaths (with the above-mentioned exception of South Africa) been much lower in absolute and relative terms than on any other continent bar Australia, but this continues to be the case now, while many countries are experiencing their second wave. This is the state of the world for the past fortnight:


Why the tiny dots only in Africa? The article goes to raise a number of possibilities:

One hypothesis that can explain the disparity between Africa and other continents concerns the overall age of the population. In general, the population of Africa is younger than in regions hardest-hit by COVID-19.

Another hypothesis will sound familiar to those who have been following coronavirus developments closely. Some researchers have shown that other human coronaviruses that cause common colds can elicit an immune response that could provide protection against COVID-19. South African researchers went to work on that idea, attempting to analyze five-year-old blood samples that were conserved from a flu vaccine trial in Soweto. The plan was to look for any evidence that would explain why the African continent is faring much better against the illness than others. Those samples were compromised by technical issues that put a stop to the research.

But the idea stands. The same crowded neighborhoods that would lead to the quick spread of other coronaviruses may have protected the population from SARS-CoV-2.

“It’s a hypothesis. Some level of pre-existing cross-protective immunity… might explain why the epidemic didn’t unfold [the way it did in other parts of the world],” [South Africa’s top immunologist, Professor Shabir] Mahdi said. “The protection might be much more intense in highly populated areas, in African settings. It might explain why the majority [on the continent] have asymptomatic or mild infections.”

But India and Brazil also have relatively young populations. And some sort a previously acquired viral immunity is not something that would only be present in Africa and not in other parts of the world. So the mystery remains.

For the record, we can probably rule another hypothesis – vitamin D deficiency. An American team has recently used a supercomputer to analyze the genome of the virus, finding this among other potentially important tidbits:

Interestingly, Jacobson’s team also suggests vitamin D as a potentially useful Covid-19 drug. The vitamin is involved in the RAS system and could prove helpful by reducing levels of another compound, known as REN. Again, this could stop potentially deadly bradykinin storms from forming. The researchers note that vitamin D has already been shown to help those with Covid-19. The vitamin is readily available over the counter, and around 20% of the population is deficient. If indeed the vitamin proves effective at reducing the severity of bradykinin storms, it could be an easy, relatively safe way to reduce the severity of the virus.

But for all the sunny side of life in Africa, the level of deficiency is almost exactly the same there as in the United States – just under 20 per cent.

Not being a physician or a medical researcher, I’m loath to delve into public health enigmas, but let me suggest – and let the experts debate – another factor, which to me seems an obvious contender but somehow did not rate a mention in the “NYP” article.

I’m talking about the prevalence of malaria on the African continent – and therefore of anti-malarial drugs.

In 2018, there have been 228 million cases of malaria worldwide and 405,000 deaths, of which 93 and 94 per cent respectively occurred in Africa. This translates to 1 case per 6 people per year across the continent. As a result, not only are large numbers of people talking anti-malarial drugs at any one time, but such drugs are therefore also very familiar to practitioner and health authorities and widely available throughout Africa.

Take the perhaps atypical but nevertheless interesting case of Djibouti, a small country of just over 1 million people in the Horn of Africa. With the GDP per capita of only some US$2,000 you would expect a challenged health system not coping very well with the pandemic. You would also be wrong:

Djibouti has more than 1,800 COVID-19 cases, making it the African country with the highest number of cases per 100,000 people. But more than 1,000 of those cases have already recovered and only nine people have died from the disease. The head of Djibouti’s main COVID-19 response center says systematically giving COVID-19 patients the anti-malarial drug chloroquine is the main reason for the country’s low death rate.  But even scientists who see evidence of the efficacy of chloroquine caution on their use.
Ever since Djibouti discovered its first case of coronavirus in late March, the World Health Organization and the government has rolled out an aggressive program to test and trace those who have come in contact with COVID-19 patients. The approach has led to Djibouti recording 77 cases per 100,000 people, the highest in Africa.

But a death rate of only 0.5 percent, health officials in the country say, is at least in part due to the use of the antibiotic azithromycin, used for the treatment of bacterial infections, and chloroquine, an anti-malarial drug known to reduce fever and inflammation.

As of today, Djibouti has had 5,387 cases and 60 deaths.

Uganda is another African country where the authorities have opted for a widespread use of anti-malarial drugs against COVID. Malaria is prevalent in this central African state, and so is the use of chloroquine and hydroxychloroquine to fight and treat the disease. In a population of just under 43 million people, Uganda has had only 3,667 cases and only 41 deaths.

Is this the answer? The hypothesis needs proper research to determine one way or another, but in light of the possibility, the least the medical establishment in the West could do is to go beyond the “Orange Man Bad and therefore everything he says is bad” mode of thinking and have a serious look at the question. This is too important for political and ideological point scoring.