THE AFRICAN MIRACLE: why COVID-19 seems to spread slowly in Sub-Saharan Africa

Sub-Saharan Africa has high prevalence of several infectious diseases when compared to other areas, mostly due to deficient healthcare systems, poverty and low education levels, and the tropical setting, facilitating zoonosis and dissemination of pathogens. However, “miraculously”, COVID-19 is not affecting the area as much as expected in terms of both incidence and severity. What is happening? This paper aims to present and discuss plausible explanations for the “African miracle”. COVID-19 is not spreading quickly in Sub-Saharan Africa perhaps due to a combination of the following factors: (1) late entry, after the World Health Organization (WHO) published several guidelines, including the Strategic Preparedness and Response Plan, (2) relatively low rate of migration, especially international, (3) low population density, with most people in rural areas, (4) experience in management of deadly infectious diseases, (5) well-coordinated response, according to WHO guidelines, (6) predominance of younger populations, (7) cross immunity due to high prevalence of other infectious diseases and related countrywide vaccination programs, and (8) high temperature and humidity, associated with low prevalence of COVID-19. It is an oversimplification to assume that COVID-19 would affect Sub-Saharan Africa severely simply as a function of the vulnerable healthcare systems or poverty.