Comorbidities and the COVID‐19 pandemic dynamics in Africa

Abstract

The debate around the COVID‐19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio‐economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID‐19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post‐pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID‐19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS‐CoV‐2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non‐communicable diseases account for a relatively lighter burden, they have a significant effect on COVID‐19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re‐organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one‐size‐fits‐all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID‐19 response framework.

Epidemiological profile of SARS-CoV-2 among selected regions in Ghana: A cross-sectional retrospective study

“…Deaths which occurred after laboratory samples tested positive were not reported back to our Centre. A large number of deaths from COVID-19 pandemic have occurred in the United States, China, the United Kingdom, Italy, Iran and Spain, with relatively fewer deaths recorded in Africa [ 35 ]. The relatively lower death toll of COVID-19 in Africa may be due to differences in genetic or climatic factors, or perhaps the impact is yet to be felt [ 35 ].…”

“…A large number of deaths from COVID-19 pandemic have occurred in the United States, China, the United Kingdom, Italy, Iran and Spain, with relatively fewer deaths recorded in Africa [ 35 ]. The relatively lower death toll of COVID-19 in Africa may be due to differences in genetic or climatic factors, or perhaps the impact is yet to be felt [ 35 ]. Studies have shown that comorbidities have the tendency of increasing individual’s susceptibility to COVID-19, especially among the elderly [ 36 ].…”

“…Studies have shown that comorbidities have the tendency of increasing individual's susceptibility to COVID-19, especially among the elderly [36]. Chronic non-communicable diseases have been noted to have significant influence on COVID-19 prognosis, although these conditions account for a relatively lighter burden in Africa compared to developed countries [35]. Many of the poorer outcomes, including increased mortality due to COVID-19 have been related to cardiovascular comorbid conditions [37][38][39].…”

The SARS-CoV-2 pandemic: A syndemic perspective

“…Actually, the low intensity and lethality of the national epidemics in most African countries suggest hypothetical protective interactions of the high burden of tuberculosis (and/or BCG coverage) and tropical parasitic diseases, along with the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs [ [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] ]. However, the detection of a new variant of the SARS-CoV-2 in South Africa (variant 501Y·V2) in middle December 2020 with preliminary studies suggesting that the variant is associated with a higher viral load, which may suggest potential for increased transmissibility, might challenge the low transmissibility, low lethality trend observed so far in most African Countries [ 81 ].…”

Social Inclusion and Immunisation

“…There is a real threat of vaccine-preventable disease outbreaks because of COVID-19 related disruptions to routine immunisation (IRC, 2021 Children are unlikely to be the first recipients of COVID-19 vaccine, as they generally are in malaria immunisation programmes (Blair in Sisay et al, 2020: 7). Children aged five years and younger are the most vulnerable age group affected by malaria, although this age group has been relatively spared from COVID-19 mortality and severe morbidity so far (Anjorin et al, 2020). Multiple immunisation programmes running concurrently with COVID-19 vaccination will have long-term benefits.…”