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Low morbidity and mortality in Africa so far https://www.sciencemag.org/news/2020/08/pandemic-appears-have-spared-africa-so-far-scientists-are-struggling-explain-why Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors (KEMRI, Wellcome, London School of Hygiene and Tropical Medicine) https://www.medrxiv.org/content/10.1101/2020.07.27.20162693v1.full.pdf Methods Measured IgG prevalence Blood samples from April 30 to June 16, 2020 Account was taken of the non-random sampling Results Complete data were available for 3,098 donors Aged 15-64 years Crude overall seroprevalence was 5.6% Population-weighted, test - adjusted national seroprevalence was 5.2% Seroprevalence was highest in the 3 largest urban Counties - Mombasa, Nairobi, Kisumu Kenya, population 52m (2.7m infections) Conclusions Estimate that 1 in 20 adults in Kenya had SARS-CoV-2 antibodies during the study period Median date of the survey Cases, 2093 Deaths, 71 (IFR = 0.0026) Hospitals not reporting many COVID admissions Several orders of magnitude difference High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi (Malawi-Liverpool-Wellcome) https://www.medrxiv.org/content/10.1101/2020.07.30.20164970v2.full.pdf Background In low-income countries Public health measures difficult Socioeconomic constraints Therefore, potential rapid and severe pandemic Picture so far difficult to access, low testing levels SARS-CoV-2 serosurvey among health care workers in Blantyre Estimate the cumulative incidence Methods 500 otherwise asymptomatic HCWs from Blantyre 22 May 2020 to 19 June 2020 Serum samples were collected from all 500 Results Eighty four participants tested positive for SARS-CoV-2 antibodies Who were from different parts of the city 12.3 % Suggesting that local transmission was high and that virus may have been circulating for some time in Blantyre Using age - stratified infection fatality estimates reported from elsewhere; There should have been eight times the number of reported deaths. Reported number of deaths in Blantyre at the time = 17 Malawi, predicted 5,295 deaths, but 51 reported Conclusions High seroprevalence Discrepancy in the predicted versus reported deaths Early exposure but slow progression of COVID-19 epidemic in urban Malawi Mozambique https://clubofmozambique.com/news/mozambique-2-5-per-cent-of-pemba-population-has-coronavirus-antibodies-167192/ https://www.sciencemag.org/news/2020/08/pandemic-appears-have-spared-africa-so-far-scientists-are-struggling-explain-why Survey of 10,000 people in 2 cities, Nampula and Pemba Antibodies, 3% to 10% of participants Market vendors, health workers Mozambique only has 16 confirmed COVID-19 deaths. Cameroon Similar reports from Doctors Without Borders Explanations Africa misses many more cases due to reduced antigen testing E.g. Kenya testing about 10% Spain or Canada Nigeria, testing about 2% that of Spain or Canada Kenya does not have an overall rise in mortality South Africa, excess natural deaths, 4 times COVID death figures https://www.samrc.ac.za/sites/default/files/files/2020-08-05/weekly28July2020.pdf Median ages Spain = 45 Italy = 47 UK = 40.5 Kenya = 20 Malawi = 18 (Africa number may go higher with more rural spread) ? Africans have had more exposure to other coronaviruses ? Regular exposure to malaria or other infectious diseases ? Genetic factors protect the Kenyan population from severe disease. Research Institute for Development, (France) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-2-global-serologic-study-for-covid-19 Will test thousands for antibodies in Guinea, Senegal, Benin, Ghana, Cameroon, and the Democratic Republic of the Congo October Implications “herd immunity” Shielding

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