As the world is recoiling from a devastating pandemic wave, Africa seems to have mostly weathered the storm -- despite being considered one of the most at-risk areas.
It seemed like a recipe for disaster. Many of the healthcare systems on the continent are inadequate, suffering from insufficient funding, trained staff, and vital equipment (such as ventilators). To make matters even worse, even basic supplies like soap and water are subject to shortages.
Many experts feared the worst, especially as socially distancing would be difficult to enforce in areas where people work day to day. Testing was scarce, and in addition to the coronavirus burden, there were also the challenges of diseases such as malaria, AIDS, tuberculosis, and cholera. Yet after the first stage of the pandemic, Africa seems to be surprisingly resilient.
It's not just that the number of cases is relatively low -- after all, the official number of cases still depends on how many tests you do, and Africa arguably misses more cases than other areas. In a recent study, Sophie Uyoga at the Kenya Medical Research Institute–Wellcome Trust Research Programme found that 5.6% of Kenyans (for a sample size of 3000 blood donors) had antibodies for SARS-CoV-2. This would put Kenya's infection rate around the same level as Spain's, yet Kenya's fatalities are much lower than expected for this rate; and this is happening as antibody tests generally tend to underestimate infection rates, as some people don't develop detectable antibodies.
It's not just Kenya, either. A survey of 500 asymptomatic health care workers in Blantyre, Malawi found an infection rate of 12.3% among them -- again, comparable to that of countries that suffered the brunt of COVID-19, and yet there were 8 times fewer fatalities than expected for this rate.
So it's not that the disease isn't spreading through Africa -- it's spreading like wildfire, just like in Spain or Italy a couple of months ago -- but the effects aren't that striking. You can miss the number of cases by not performing tests, you might even miss the number of hospitalizations, but you can't hide coffins. How come Africa hasn't experienced a rise in mortality like other areas?
There's no clear-cut answer, but one possible answer is that Africa's youthfulness is protecting it. The median age in Africa is under 20 years, compared to over 40 years in Europe and around 35 in North America. The population in African cities, which are crowded and more vulnerable than the rest of the country, tend to be even lower than the average for the rural parts of the continent.
This theory is good news for Africa on one hand, but it also comes with a warning: when the virus starts to spread to the rural areas where population age is more advanced, the outcomes could be worse.