Seven months into the Coronavirus (Covid-19) pandemic and cases in Africa have continued to puzzled both commentators and experts. Africa’s low infection and mortality rates have maintained a queer from the eerie projections despite the continent identifying with critical indicators to support such. A central indicator is the general ill-equipped and inaccessible health care system that lacks specialty and capacity to minimise the mortality rates in Africa. Such that by the first recorded case of Covid-19 on the continent, there were fewer than 3,000 ventilators and a shortage of skilled doctors for a population of over 1billion. Yet, Africa’s Covid-19 mortality rate is just 3% compared to continents with a robust health care system and fewer population such as North America (31%) and Europe (32%).

Other systems and infrastructure that supports healthy living and preventive measures against transmission of Covid-19 such as water, sanitation and hygiene are also limited in Africa. The recent identification of Covid-19 within sewage systems and the high prevalence of open defecation across the continent has failed to translate into a spike in Covid-19 transmission as compared with other continents. Even within densely and sprawling populated cities where preventive measures such as handwashing, social distancing and lockdown were adopted and implemented early, insufficient resources to sustain these measures have actioned negligible outcomes. Although testing determines the extent of infections, the low ratio in mortality to infection cases in Africa differs from data seen in North America and Europe.

Some commentators have questioned the reliability of Africa’s data; however, such is quickly rebuffed given the same data reporting system was used and credited during the 2016 Ebola epidemy. Thoughts of a less virulent strain in Africa is not supported by sufficient evidence even though there over 200 genetic mutations of Covid-19 have been identified. More confronting is the growing complacency due to disbelief in Covid-19 pandemic and weariness from prolonged preventive measures has actioned a negligible spike or second wave of infection in Africa as compared to other continents. So, why Africa’s Covid-19 infection and mortality rates have stayed far below projected has become a focal ‘puzzle and worry’.

Are the disparities between current data and projections made on critical indicators suggesting an eccentric use of indicators within Africa’s context? A holistic evaluation of these critical factors as a preventive tool rather than causative may be sufficient to provide the contextual lens to view and espouse Africa’s low infection and mortality rates due to Covid-19. Africa’s limited health care system may have contributed to the prevention of an eerie projection due to an increased microbial exposure that primes the immune response to Covid-19 pandemic. The yearly exposure to similar RNA viruses such as influenza A (H1N1) virus due to limited health care resources for seasonal vaccination within the continent illustrates a probable mechanism for an improved immune response to Covid-19.

The high prevalence of malaria within the continent and its shared symptoms with Covid-19 may also improve the tolerance of most (a)symptomatic Covid-19 infected Africans and as such, retain ambulatory requirements. Further, developed tolerance to the side effects of antimalarials such as chloroquine fosters provides dual benefits to the use of these medicines in Covid-19 management across the continent. Other benefits of limited health care and infrastructural systems to the Covid-19 rates in Africa is its significant contributions to a low prevalence of immune-mediated disorders such as allergic diseases as compared to Europe or the Americas.

Allergic diseases are mostly modulated by ACE II cells in the respiratory tract; the high-affinity binding of Covid-19 spike proteins to this cell initiates the cascade of systemic symptoms. The low rate of allergic diseases in Africa supports the ambulatory requirements as compared to the need for specialised interventions as predominantly observed in North America and Europe. Given the impacts of Covid-19 on other systems, the high prevalence of co-morbidities such as hypertension and diabetes within developed countries of North America and Europe worsens the mortality rates, unlike in Africa. Besides, the close link between most non-communicable diseases and age indicates a reduced vulnerability to Covid-19 amongst Africa’s young population (median age of 18years) as compared with an ageing population in North America and Europe.

Combine with the continents’ predominant agrarian economy and limited infrastructure such as transportation, African’s young population are mostly engaged in outdoor activities that expose them to tropical sunlight. The interaction between exposure to UV lights and the immune system alongside recent studies on the influence of temperature and humidity may further espouse Covid-19 data within the tropical continent. In addition, the continents’ agrarian economy supports the relative access to farm produce than processed foods, which encourages a viable and diverse microbiome that is central to human immunology. Although data are scarce, Africa’s agrarian and less industrialised economy may have been beneficial given the relationship between pollution and Covid-19 infection as compared to other industrialised continents.

Further, the recent outbreaks of Ebola and Lassa fever have ramped up Africa’s response systems and experience in disease control. For instance, the accessibility to social media in Africa’s most populated country — Nigeria, enables the proactive dissemination of realtime preventive measures through the NCDC social media handles. Such systems and experience may explain the disparity in data between Africa and South America, despite the relative similarity in critical indicators. Even within the epicentre of Africa’s Covid-19 — South Africa, updating the countries strategy such as permitting natural immunity is placed as a priority to other critical indicators. Thus, the holistic evaluation of these critical and sundry indicators makes a clear case of preventive tools against the Covid-19 pandemic in Africa and supports current data.

This evaluation espouses the need for a place-specific approach to a pandemic, as seen in the herd immunity approach in Sweden and recent commentary on South Africa. Yet, thoughts of a second wave and commentaries have indicated Africa may be heading towards an eerie projection. Such projections highlight Africa’s critical indicators as temporary preventive measures, and at its breakpoint, a reverse effect may occur, leading to spikes in infection and mortality rate. For instance, the lockdown-induced disruption in the supply chain of essential medicines for preventing HIV, TB and malaria worsens the immune response of patients within the continent; such co-morbidities effects a higher fatality outcome from Covid-19.

While the containment measures may have disrupted progress made in these critical indicators, it also supports restriction in business travels in and out of the continent with a further lull in economic growth. With job losses, migration of more Africans towards the rural areas cuts off access to essential medicines and contact tracing, especially against Polio. Africa’s agrarian economy is also being threatened by food insecurity due to locust infestation and climate change, and this may lead to malnutrition and mass displacement of Africans. Consequently, the eerie projection of mortality rates in Africa will be off Covid-19 than from Covid-19.

Overall, Africa’s critical and sundry factors have provided over 7months of temporary leave from the eerie projection and mortality rates of Covid-19. At the breakpoint of these indicators, each country within the continents must develop country-specific strategies against a second wave or spike in Covid-19. Even within Seychelles and Eritrea where there have been zero fatalities, there is a need to set up clinics and interventions to manage the long-term symptoms of Covid-19 in both (a)symptomatic patients. More so, given a likely difficulty in the distribution of a vaccine in Africa, each country must prepare for a smoulder of Covid-19 by ramping up contact tracing and preventive measures.

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