The puzzle of the COVID-19 pandemic in Africa

More data are needed to understand the determinants of the COVID-19 pandemic across Africa The COVID-19 pandemic has been puzzling to many public health experts because Africa has reported far fewer cases and deaths from COVID-19 than predicted. As of 22 November 2020, the continent of Africa, comprising 1.3 billion people, had recorded 2,070,953 cases of COVID-19 and 49,728 deaths ( 1 ), representing ∼3.6% of total global cases ( 2 , 3 ). Because of the continent's overstrained and weak health systems, inadequate financing of health care, paucity in human resources, and challenges posed by existing endemic diseases—including HIV, tuberculosis, and malaria—earlier predictions suggested that up to 70 million Africans may be infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by June, with more than 3 million deaths ( 4 ). On page 79 of this issue, Uyoga et al. ( 5 ) report a serosurvey study (measuring the occurrence of SARS-CoV-2 antibodies) of blood donors in Kenya that suggested that the incidence of SARS-CoV-2 infection is much higher than expected from case numbers.