Africa has now recorded over 2 million cases of COVID-19 but relatively few deaths at just under 51,000. (1)
In contrast Europe has recorded 16 million cases and 362,000 deaths. (2)
The USA has recorded 13 million cases and 264,000 deaths. (3)
Asia has recorded very similar figures to Europe, 16 million cases and 281,000 deaths across the continent. (4)
Africa
Africa appears to have escaped the worst of the pandemic although some countries are experiencing a second wave of infections. These include Kenya, Algeria, Uganda, Sudan, Mali, Chad, Liberia, Niger and Mauritius.
Four other countries, South Africa, Mauritania, Zimbabwe and Egypt appear from the available data to be just starting a potential second wave. (1)
As discussed in the previous blog pieces “COVID-19 and the low Income Countries” and “Africa and COVID-19” the low figures may reflect a lack of testing capacity and the official death numbers do not always correlate with eye witness reports on the ground of mass, night time burials.
When these two pieces were written, the fear was that Africa would soon be overwhelmed by COVID-19 and rapidly overtake the situation seen in Europe and North America. Whilst it was hoped that the continent could be afforded some protection from factors such as its younger population, warmer climate and the fact so many live in rural areas, at the start of the pandemic it was by no means clear what the unfolding scenario for the continent would be.
Has the age of its population helped protect Africa?
In May 2020 the WHO (World Health Organisation), expressed some very cautious optimism that the younger population demographic of Africa may be having a protective effect in an illness that seemed to be disproportionately affecting the elderly. (5) (6)
Older people, and especially those aged 70 and over, are the most vulnerable to COVID-19. As the pandemic has progressed throughout 2020, countries with an older age structure and the concomitant burden of associated disease have been hit the hardest. In the UK the average age of a person dying from COVID-19 is 82 years old. (7)
Countries with younger age structures may get lots of cases but they have a much lower mortality rate. Plus, younger people are less likely to need hospital admission and specialist treatment if they do contract COVID-19 so hospitals do not become overwhelmed.
In Europe 25.5% of the population are aged 60 and over. In Africa just 5.6% of the population are aged 60 and over. (8)
Africa has the youngest population in the world with 60% of the continent’s population aged 25 and under. This is in stark contrast to Europe where only around 24% are aged 25 and under. (9) (10)
Care homes and nursing homes have been the worst hit places for COVID-19 deaths in Europe and the US where disease outbreaks have spread rapidly around the home. Such institutions are virtually unheard of in Africa where the norm is for people to return to their rural homes when they retire and leave the urban areas. (11)
Without a doubt, the fact Africa has a young population has protected it from some of the scenarios seen in Europe and North America where hospitals have been overwhelmed with COVID-19 cases and death rates have soared.
The African Climate
It was theorised that the climate of Africa, particularly places in Sub-Saharan Africa, would be too warm for the virus to thrive. Researchers in the University of Maryland in the US looked for potential correlations between temperature, humidity and latitude, and the spread of Covid-19.
There were no conditions that stopped the virus from spreading but they found that it spread more easily in lower temperatures and humidity.
In Africa, those countries with more tropical climates appear to have fared better than those more to the north and south which are further away from the tropics. (12)
The climate, in some parts of Africa at least, may have protected it from infection.
Rural versus Urban Living
Taking the continent as a whole there is around a 50:50 split between the percentage of people living in rural areas versus in towns and cities. With such a large continent there is huge variation between countries. For example in Niger 84% of the population live in rural areas, in Ethiopia it is 79% and in Burundi it is 86%. This contrasts sharply with South Africa, Libya and Algeria where the figures are 34%, 20% and 27% respectively. (13)
Rural areas with their lower population densities allow for natural social distancing. Coupled with an under-developed transport system in many countries, contact between people is further decreased. Low levels of travel, both within countries and internationally, has played a part in preventing disease transmission.
Experience of other Serious Diseases
Communities already familiar with infectious diseases such as polio, Ebola and HIV may have found themselves better placed to launch rapid public health measures than their Western counterparts.
Many countries in Africa are experienced in isolating infected people and tracing their contacts. The Democratic Republic of Congo was already screening travellers for Ebola and was able to extend this quickly to include Covid-19. Nigeria quickly equipped their community polio vaccination teams to educate people about COVID-19. (14)
The infrastructure needed for disease prevention was in place in many regions, a sure advantage in combating a new infection.
The Influence of Race on COVID-19
It is now well established that people, especially men, from a BAME background living in the West are at higher risk of serious disease and dying from COVID-19. (15)
This led to the natural conclusion that huge swathes of Asia, the Caribbean and Africa were particularly vulnerable to COVID-19 and would see catastrophic death rates. However, thus far this has not been realised and COVID-19 has had a less severe impact than expected in these regions. (16)
It is still not clear why the BAME community is disproportionately represented in the COVID-19 statistics of Western countries but a link that is purely genetic now seems less plausible. Factors relating to health, occupation and socio-economical status are likely to be playing a role too. (17)
Asia
The Indian sub-continent in particular has been severely impacted by COVID-19. India alone has recorded over 9 million cases and nearly 135,000 deaths. The peak of the pandemic does appear to be over in India and case numbers are beginning to fall. (18)
In July 2020 in the piece on India (click here to read) it was noted that in giving just a few hours’ notice of a complete lockdown, the government may have inadvertently hastened the spread of the virus. Tens of millions of migrant workers were left stranded and desperate to get back home from the cities to rural villages. Unwittingly this mass movement of workers within the country probably took COVID-19 from cities such as Delhi, Mumbai and Kolkata to every part of India. (19)
Up to a fifth of all deaths are never registered in India, and only a quarter of the registered deaths are actually certified by a doctor, which makes it likely that the death number in India far exceeds the official one. (20)
Iran has been badly hit by the pandemic with just under 1 million cases and 47,000 deaths. (21)
The country is under tight restrictions, though not a full lockdown, with Iranian officials saying family gatherings, officially banned, are the reason behind the increasing numbers. (22)
China continues to appear to have overcome the pandemic with their figures suggesting very few cases and no deaths since 18 May 2020. Suffice it to say that scientists the world over remain sceptical about this claim. (23) (24)
Bangladesh, Pakistan, Indonesia and the Philippines are amongst the many Asian countries with COVID-19 outbreaks that closely mimic those seen in Europe. (25)
In Conclusion
Most countries in Asia have followed similar disease trajectories as those in Europe and North America. Africa however does appear to be faring better with some of the worst predictions for the continent not yet realised. Although a lack of testing capacity could explain lower case numbers, and pre-existing community health programmes have lent themselves to tackling the pandemic, these alone are unlikely to be the reason for the low numbers. I suspect Africa’s huge advantage in tackling COVID-19 is having a younger population. With a disease that disproportionately targets older people, and especially the extreme elderly, for once Africa has found itself ahead of the rest of the world where this particular infectious disease is concerned.
(3) https://apps.who.int/iris/bitstream/handle/10665/332150/SITREP_COVID-19_WHOAFRO_20200520-eng.pdf
(25) https://www.worldometers.info/coronavirus/
