Abstract
Following the coronavirus outbreaks described as severe acute respiratory syndrome (SARS) in 2003 and the Middle East respiratory syndrome (MERS) in 2012, the world has again been challenged by yet another corona virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 infections were first detected in a Chinese Province in December 2019 and then declared a pandemic by the World Health Organization in March 2020. An infection caused by SARS-CoV-2 may result in asymptomatic, uncomplicated or fatal coronavirus disease 2019 (COVID-19). Fatal disease has been linked with the uncontrolled “cytokine storm” manifesting with complications mostly in people with underlying cardiovascular and pulmonary disease conditions. The severity of COVID-19 disease and the associated mortality has been disproportionately lower in terms of number of cases and deaths in Africa and also Asia in comparison to Europe and North America. Also, persons of colour residing in Europe and North America have been identified as a highly susceptible population due to a combination of several socioeconomic factors and poor access to quality healthcare. Interestingly, this has not been the case in sub-Saharan Africa where majority of the population are even more deprived of the aforementioned factors. On the contrary, sub-Saharan Africa has recorded the lowest levels of mortality and morbidity associated with the disease, and an overwhelming proportion of infections are asymptomatic. Whilst it can be argued that these lower number of cases in Africa may be due to challenges associated with the diagnosis of the disease such as lack of trained personnel and infrastructure, the number of persons who get infected and develop symptoms is proportionally lower than those who are asymptomatic, including asymptomatic cases that are never diagnosed. This review discusses the most probable reasons for the significantly fewer cases of severe COVID-19 disease and deaths in sub-Saharan Africa.
Highlights
Following the coronavirus outbreaks described as severe acute respiratory syndrome (SARS) in 2003 and the Middle East respiratory syndrome (MERS) in 2012, the world has again been challenged by yet another corona virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
This position is further affirmed by the observation that African countries such as South Africa, which have a relatively lower infectious disease burden compared to most other sub-Saharan countries have reported generally higher numbers of severe SARS-CoV-2 cases and deaths[52]
Concluding remarks The SARS-CoV-2 pandemic has so far resulted in significant numbers of deaths in the developed world and the same was expected to happen in sub-Saharan Africa
Summary
Any reports and responses or comments on the article can be found at the end of the article. It has already been shown that BCG vaccination in children has a significant effect in reducing about 50% of the mortality associated with the incidence of sepsis and other respiratory infections[47,48] This mechanism of protection has been strongly linked to the ability of the innate cells to elicit a polarized pro-inflammatory immune response during non-specific immune reactivation[46,49]. It has been observed that SARS-CoV-2 infected persons who have been vaccinated with BCG have some level of protection against severe disease development[51] This position is further affirmed by the observation that African countries such as South Africa, which have a relatively lower infectious disease burden compared to most other sub-Saharan countries have reported generally higher numbers of severe SARS-CoV-2 cases and deaths[52]. Data availability Underlying data No data are associated with this article
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