COVID-19 across Africa: epidemiologic heterogeneity and necessity of contextually relevant transmission models and intervention strategies

Abstract

Coronavirus disease 2019 (COVID-19) has rapidly emerged as a global public health threat with epicenters in regions of China, parts of Europe, and larger urban centers across North America (1). By comparison, population-level COVID-19 diagnostic rates and associated morbidity and mortality have been limited to date in much of the African continent. Initially, multiple mathematical models projected substantial increases in COVID-19 incidence and related deaths across Africa, with one estimating 300 000 to 3 million people dying, although newer models have estimated lower mortality (2, 3). These models have assumed homogeneity in the transmission dynamics of respiratory pathogens between the African continent and other regions of the world as well as across the African continent. In addition, there has been limited integration of the diverse range of country-led mitigation strategies. Furthermore, these models have not included evaluation of competing health risks to COVID-19 associated with disruptions to the health and social systems in countries across the continent. Finally, they overlook the contextually specific heterogeneities in environmental, social, and structural factors that may potentiate or reduce COVID-19 risks in countries across Africa