Trying to Solve a COVID Mystery: Africa’s Low Death Rates

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KAMAKWIE, Sierra Leone — There are no COVID fears here.

The district’s COVID-19 response center has registered just 11 cases since the start of the pandemic, and no deaths. At the regional hospital, the wards are packed — with malaria patients. The door to the COVID isolation ward is bolted shut and overgrown with weeds. People cram together for weddings, soccer matches, concerts, with no masks in sight.

Sierra Leone, a nation of 8 million on the coast of Western Africa, feels like a land inexplicably spared as a plague passed overhead. What has happened — or hasn’t happened — here and in much of sub-Saharan Africa is a great mystery of the pandemic.

The low rate of coronavirus infections, hospitalizations and deaths in West and Central Africa is the focus of a debate that has divided scientists on the continent and beyond. Have the sick or dead simply not been counted? If COVID has in fact done less damage here, why is that? If it has been just as vicious, how have we missed it?

The answers “are relevant not just to us, but have implications for the greater public good,” said Austin Demby, Sierra Leone’s health minister, in an interview in Freetown, the capital.

The assertion that COVID isn’t as big a threat in Africa has sparked debate about whether the African Union’s push to vaccinate 70% of Africans against the virus this year is the best use of health care resources, given that the devastation from other pathogens, such as malaria, appears to be much higher.

In the first months of the pandemic, there was fear that COVID might eviscerate Africa, tearing through countries with health systems as weak as Sierra Leone’s, where there are just three doctors for every 100,000 people, according to the World Health Organization. The high prevalence of malaria, HIV, tuberculosis and malnutrition was seen as kindling for disaster.

That has not happened. The first iteration of the virus that raced around the world had comparatively minimal impact here. The beta variant ravaged South Africa, as did delta and omicron, yet much of the rest of the continent did not record similar death tolls.

Into Year Three of the pandemic, new research shows there is no longer any question of whether COVID has spread widely in Africa. It has.

Studies that tested blood samples for antibodies to SARS-CoV-2, the official name for the virus that causes COVID, show that about two-thirds of the population in most sub-Saharan countries do indeed have those antibodies. Since only 14% of the population has received any kind of COVID vaccination, the antibodies are overwhelmingly from infection.

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