The debate around the COVID-19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio-economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarize what is known about (a) the pathophysiological processes underlying the interaction of co-infections and co-morbidities in shaping prognosis of COVID-19 patients, (b) the epidemiology of key co-infections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post-pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID-19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS-CoV-2 but also other viral infections, is of urgent importance. The role of Malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non-communicable diseases account for a relatively lighter burden, they have a significant effect on COVID-19 prognosis, and the fragility of care-delivery systems implies that adjustments to clinical procedures and re-organization of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one-size fits all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID-19 response framework.
Tropical medicine & international health : TM & IH. 2020 Oct 04 [Epub ahead of print]
A A Anjorin, A I Abioye, O E Asowata, A Soipe, M I Kazeem, I O Adesanya, M A Raji, M Adesanya, F A Oke, F J Lawal, B A Kasali, M O Omotayo
Department of Microbiology (Virology Research), Lagos State University, Ojo, Lagos, Nigeria., Population Health Science Program & Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA., Africa Health Research Institute, Durban, South Africa., Department of Medicine, Division of Nephrology, Upstate Medical University, NY, USA., Department of Biochemistry, Lagos State University, Ojo, Lagos, Nigeria., Bayou City Physicians, City, USA., Department of Microbiology and Immunology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia., Nursing Department, University of Texas at Arlington, USA., Department of Internal Medicine, Brookdale University Hospital Medical Centre, USA., Department of Infectious Diseases, Medical College of Georgia, Augusta University, USA., Independent Researcher, Seattle Washington, USA., Centre for Global Health and Division of Pediatric Global Health, Massachusetts General Hospital, Boston, USA.