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

BACKGROUND

COVID-19 has impacted the world immensely since its discovery in the city of Wuhan, China, in December 2019.^1,2 As of June 27, 2021, approximately 181.9 million COVID-19 cases have been confirmed with more than 3.9 million deaths.³ COVID-19 has dramatically impacted the Americas, Europe, and Asia. As of June 27, 2021, in the Americas, 73.1 million confirmed COVID-19 cases with 1.9 million deaths have been reported, 47.8 million confirmed cases with more than 1 million deaths in Europe, and 55.4 million confirmed cases with 784,965 deaths in Asia.⁴

The impact of COVID-19 in Africa has been substantially lower compared to countries in the Americas, Europe, and Asia. The World Health Organization (WHO) African Region reported more than 3.9 million confirmed cases and 94,217 deaths, as of June 27, 2021.⁵ Moreover, the mortality rate of COVID-19 per million in Africa is considerably lower than in all other WHO regions other than the Western Pacific (Table 1).^5–11 Public health preparedness is a significant aspect in the success of reducing COVID-19 transmission. Lessons learned from countries across Eastern Asia imply the need for community-oriented strategies and rapid response from public health officials to successfully contain the COVID-19 pandemic.¹² Strategies such as early case identification, widespread laboratory testing and screening, outbreak mitigation (up to and including lockdowns), contact tracing, …