COVID-19 In Africa:Experts Try To Unravel Mystery Behind Baffling Low Rate Of Deaths And Infection

   

 Could there be a link between poverty, crowded accommodation, and Africa's bafflingly low infection and death rates from the pandemic? Experts try to unravel the mystery. 

As the number of infections dips sharply in South Africa, and stays relatively low across much of the continent, experts are reaching towards a startling hypothesis.

Crowded townships. Poor hygiene. The impossibility of social distancing in communities, where large families often share a single room.

Crowded townships. Poor hygiene. The impossibility of social distancing in communities, where large families often share a single room.

For months health experts have been warning that living conditions in poor, urban communities across Africa are likely to contribute to a rapid spread of coronavirus.

"Population density is such a key factor. If you don't have the ability to social distance, the virus spreads," said Professor Salim Abdool Karim, the head of South Africa's ministerial advisory team on Covid-19.

But what if the opposite is also true?

What if those same crowded conditions also offer a possible solution to the mystery that has been perplexing experts on the continent for months?

What if - and this is putting it rather crudely - poverty proves to be the best defence against Covid-19?

It's an enigma'

Let's start with that mystery.

In the early stages of the pandemic, all the experts and all the modelling agreed that Africa was in trouble.

"I thought we were heading towards a disaster, a complete meltdown," said Professor Shabir Madhi, South Africa's top virologist.

Even the most optimistic predictions showed that the nation's hospitals - and the continent's most developed health system - would be quickly overwhelmed.

And yet, today South Africa is coming out from its first wave of infections with a Covid-19 death rate about seven times lower than the UK's.

   

• What can explain low spread of coronavirus in Africa?

Even if deaths have been under-reported here - perhaps by a factor of two - South Africa has still performed interestingly well, as have many other parts of the continent, where hospital beds remain stubbornly empty, and where infection graphs have almost entirely shunned the pronounced peaks and sharp angles seen in so many other parts of the world.

"Most African countries don't have a peak. I don't understand why. I'm completely at sea," said Prof Karim, a leading voice on South Africa's pandemic response.

Professor Madhi concords: "This is an enigma. It's completely unbelievable."

For a while now, experts have suggested a youthful population as the best explanation for Africa's relatively low infection rates. After all, the average age on the continent is about half that in Europe.

Far fewer Africans are into their 80s, and so are less likely to succumb to the virus as a result.

"Age is the highest risk factor. Africa's young population protects it," stated Tim Bromfield, a regional director of the Tony Blair Institute for Global Change.

But as the pandemic goes on, and the statistical evidence builds up, analysts seem increasingly reluctant to give demographics all the credit for this continent's successes.

"Age is not such a big factor," stressed Prof Karim.

Early, and aggressive lockdowns here in South Africa and elsewhere on the continent have clearly played a vital role.

Clear messaging about masks and the provision of oxygen supplies might have also been significant.

Other theories such as  the impact of altitude or warmer temperatures, have generally been pushed aside.

Some experts warn that a vast and poorly connected continent could simply be biding its time, and that the virus might strike hard in the coming months.

"I would not venture to say that Africa is over its worst. I'm not sure whether one day the epidemic is going to spread like crazy here," Prof Karim stated.

Other coronaviruses

But in recent days, scientists at the Vaccine and Infectious Disease Analytics unit, at Baragwanath hospital in Soweto, have been wondering if the missing factor - the answer to what they see as the continent's pandemic mystery - may be lying inside a glorified chest freezer in their laboratory, on the outskirts of Johannesburg.

The freezer, whose temperature is kept at minus 180C, thanks to liquid nitrogen - has metal cannisters storing five-year-old human blood samples.

Or to be more specific, extracts from blood cells - known as PBMCs - obtained during an earlier influenza vaccine trial in Soweto.

The idea is that, by studying the PBMCs, the scientists could find evidence that people had been widely infected by other coronaviruses - those, for instance, responsible for several common colds - and that, as a result, they may enjoy some degree of immunity to Covid-19.

"It's a hypothesis. Some level of pre-existing cross-protective immunity… might explain why the epidemic didn't unfold [the way it did in other parts of the world]," Prof Madhi stated,explaining that data from scientists in the US appeared to support the hypothesis.

Colds and flu are, of course, commonplace across  the world.

But the South African scientists wondered whether, because those viruses spread more effectively in overcrowded neighbourhoods, poorer communities could have been more widely at risk and therefore, enjoy a larger degree of immunity towards Covid-19.

The same, of course, could apply to other parts of the world, including India, with similar challenges.

"The protection could be much more intense in highly populated areas, in African settings. It might explain why the majority [on the continent] have asymptomatic or mild infections,"  Prof Madhi stated.

"I can't think of anything else that would explain the numbers of completely asymptomatic people we're seeing. The numbers are completely unbelievable," he stated,exploring the irony of the possibility that Africa's entrenched poverty may "for once" work in favour of the continent.

Sceptics though could point to countries such as Brazil, with its crowded favelas, and its high infection rate.

Unfortunately, as the scientists began preparing to test the PBMC samples in their laboratory, they spotted a challenge.

A quality-control test revealed that the icy temperature inside the cryo-containers had fluctuated over time - too much for the rigorous standards required for such a vital and delicate experiment.

"We're very disappointed. We were all ready but unfortunately this thing happened," Doctor Gaurav Kwatra, who was leading the experiment stated.

There was no-one to blame - not even South Africa's notorious power-cuts. It was just one of those things.

• 
  

 tweet reports that a team of these experts is now busy hunting for new samples to test, but that may take months. In the meantime, the mystery of Africa's relatively mild pandemic lives on.