Extract from Lancet
In The Lancet, Stephanie Salyer and colleagues’ comprehensive and elegant cross-sectional analysis of COVID-19 case counts, response measures, and mortality rates highlights the diversity of the COVID-19 burden and response across Africa.1
Between Feb 14 and Dec 31, 2020, 2 763 421 COVID-19 cases and 65 602 deaths were reported in African countries, accounting for 3·4% of the 82 312 150 cases and 3·6% of the 1 798 994 deaths reported globally. Their Article shows the variable effects of COVID-19 across Africa, which more severely affected the Northern and Southern regions during both waves of the pandemic.
Strikingly, 43% of the reported COVID-19 cases and 46% of the deaths occurred in the Southern region, in contrast to 3% of the reported cases and 2% of the deaths in the Central region. At the end of 2020, there was clear asymmetry in the pandemic’s toll: nine countries (South Africa, Morocco, Tunisia, Egypt, Ethiopia, Libya, Algeria, Kenya, and Nigeria) accounted for 82·6% (2 283 613) of the cases reported and five countries (South Africa, Egypt, Morocco, Tunisia, and Algeria) accounted for 77% of the deaths reported.
Although the statistics reported by Salyer and colleagues are sobering, they are limited by incomplete data for surveillance, testing, and reporting of COVID-19 cases, as well as potentially inconsistent case definitions. Thus, it is possible that the toll of COVID-19 on African countries could be higher than reported here, especially within some demographic strata.
The pandemic response, notably lockdown measures, also varied across African countries according to whether cases were high or low. The data used by Salyer and colleagues to show these associations came from various sources—both official government reports and unofficial data sources that were verified by an official source before they were included in this analysis. Although the authors were meticulous in ensuring the accuracy of case and mortality estimates, incomplete official case reporting leads us to question whether case and mortality estimates fully reflect the pandemic’s toll in all African countries.
Consideration needs to be given as to why Africa is home to 17% of the world’s population but only 3·4% of the global COVID-19 cases.2 Among many possible answers are differences in population structure, comorbidities, pre-existing cross-reactive SARS-CoV-2 immunity, household composition, lifestyle factors such as mobility and population mixing, and varying effectiveness of different response strategies. These points emphasise the authors’ call for robust, clear, and timely data reporting as a critical step towards combating the pandemic.