Why is the COVID death rate so low in Africa?
Well, it could just be poor statistics-taking and reporting. But apparently the death rate has not gone up, either, and a rise in that would be more noticeable. So it seems the low rate of (and/or better prognosis from) COVID in much of Africa is real.
Could it be, could it possibly be – the widespread use of hydroxychloroquine?
You’d never know from this article that such a thing is even a possibility. The Science article discusses the data from Africa – it’s even titled “The pandemic appears to have spared Africa so far. Scientists are struggling to explain why” – but nary a whisper about the drug.
Is the drug already widely taken in African countries where malaria is endemic? I’ve been trying to discover whether that is the case, and I’m hesitant to say it is because I read somewhere, months ago, that malaria in Africa became resistant to the drug some years ago and so it’s no longer all that widely used there. I can’t seem to find that information at the moment.
However, hydroxychloroquine and possibly its predecessor chloroquine certainly have been used in Africa for COVID. In fact, some countries in Africa using it for that purpose did not stop doing so even when the bogus Lancet article came out, unlike most of Europe. Perhaps that happened because in Africa they are very familiar with the drug and its risks and/or lack of risk. Also, they’re probably not so heavily invested in the business of discrediting Trump at all costs. At any rate, several made a bold decision to keep going with the drug (see also this).
There is also this practice (the article is from early April):
Despite loud appeals for caution, Africans are rushing to embrace chloroquine, the venerable anti-malaria drug touted as a possible treatment for coronavirus.
From hospitals in Senegal to pharmaceutical companies in South Africa and street sellers in Cameroon, chloroquine has fired hopes of a medicinal fix against a virus that is set to scythe through Africa’s poorly protected countries.
Chloroquine and derivatives such as hydroxychloroquine have been used for decades as cheap and safe drugs against malaria, although their effectiveness in this field is now undermined by growing parasite resistance…
…in many settings across Africa, chloroquine has been placed in the front line against coronavirus.
Its rise stems partly from desperation, given Africa’s meager capacity to deal with a pandemic on the scale seen in Europe or the United States.
Burkina Faso, Cameroon and South Africa have swiftly authorized hospitals to treat virus patients with the drugs.
Around half of infected people in Senegal are already being prescribed hydroxychloroquine, Moussa Seydi, a professor at Dakar’s Fann Hospital, told AFP last Thursday.
Every patient who was recommended the drug accepted it, “with no exceptions,” he said.
In Democratic Republic of Congo, President Felix Tshisekedi last week declared it was “urgent” to produce chloroquine “in industrial quantities”.
My guess is that their long experience with the drug makes both the medical establishment and the population unafraid of it. There is also a black market:
“Local people have been buying it, apparently without prescription, which is dangerous.”
…Alice Desclaux, a doctor at the Institute of Development Research (IRD) in Senegal, said the risks from self-medication from chloroquine were largely rooted in illegal sales.
“Chloroquine has always been on sale informally in Africa,” she said.
“It’s still used to cause abortions” and even for attempted suicide, Desclaux said.
In one backstreet pharmacy in Douala, Cameroon’s economic hub, the manager said he had run out of stock. For anyone who wished to order some, “careful, the price has gone up,” he said…
The chloroquine craze is not just affecting the black market for drugs — it is also spurring the production of counterfeit medications.
The whole article is worth reading, although it’s from an early point in the pandemic. It could explain a lot.
And this is from an article written in June:
In Senegal and Madagascar for example, COVID-19 patients on hydroxychloroquine and the herbal remedy Artemisia annua have been observed to recover faster from the disease with lower deaths. In both countries, even with rising cases, recovery rates from Covid19 are much higher – consistent with the observations in most malaria prone countries. Interestingly, malaria is not prevalent in Africa’s Covid-19 hotspots of South Africa and North Africa.
Fascinating, I think.
Not lots of old, fat people with diabetes living in Africa. Additionally, their immune systems have plenty of pathogens to cope with without going into auto-immune overdrive.
In short, if Italy, for example, had the age profile of Africa as a whole, the death toll would have been 90% lower.
Well I’m just glad the continent dodged this one bullet.
I’m guessing that when a patient is already dying from multiple co-morbidities, they just don’t bother testing for COVID-19.
I would bet any area that has problems with malaria, would see no major influence from COVID due to the widespread use of quinine products.
The “Scientists are struggling to explain why” bit is certainly a deft—and cute—touch….
(Speaking of struggling scientists, oh my, how those Lancet editors struggled….)
Yancey Ward:
There is a low percentage of elderly people in Africa, but there is a large number. For example, Nigeria had about 6 million people over 65 a few years ago, and my guess is that the numbers have increased. And diabetes is also on the rise in sub-Saharan Africa. For example, in 2016 it was reported that 5 million Nigerians were currently diagnosed with it (written in 2016, and I bet the numbers are higher now).
I agree with you, though, that a significant amount of the difference in COVID outcomes has to do with population demographics. But certainly not all of it.
COVID-19 is most deadly to the old, the obese, and people who don’t get much vitamin D. I suspect that African people who matched that profile died of other causes already. Widespread use of HCQ for malaria prevention is just another factor.
India reports a remarkably low death rate as well. Articles I’ve looked at mention the relative youth of the population and prior exposure to other forms of coronavirus, but India is also a country that had on hand tens of millions of doses of HCQ when this began.
There are many medical studies which support hydroxychloroquine. This is a good source. https://c19study.com/
I encountered a discussion (sadly, not in English) about the contribution of good ventilation with respect to viral load in various warmer climes.
The Left’s blood lust not satisfied with their 20th century death toll of 100 MILLION+ they’ve got off to an early start with Covid-19 deaths. In blocking a low cost cure, the blood of much of Covid-19’s dead lays upon their hands, The foremost US mass killer being NY Gov. Cuomo, whose manslaughter rate is only exceeded by China’s Xi.
Om actually made a compassionate comment. His emotions are easy to read. Is the world officially ending now?
Good job polarizing Service to Other. You may make it yet.
The foremost US mass killer being NY Gov. Cuomo, whose manslaughter rate is only exceeded by China’s Xi.
Right.
And Americans with guns or whatever arms, don’t touch C mo. They know who their massas are. The slaves are to Obey orders to suffer and die.
It sounds like there’s a considerable number of variables in play. While it’s an interesting idea, that HCQ or CQ is making the contribution here, I think we should disentangle the factors brought up before seizing on this explanation definitely.
Also, maybe consider patterns of urban vs. rural population density and which strains are involved in Africa vs. elsewhere. I would think the extraordinarily packed nature of African cities would generally have caused a COVID outbreak, or any outbreak for that matter, to flame out early, so an early big steep curve upward, then… well, I don’t know if it would tail off fast or what. But something to think about. Does anybody have any actually reliable data about how the regional death rates looked in Q2?
Here is another very unusual CV profile – Singapore. The site Worldometer, which is good for sorting data and making per capita comparisons, shows Singapore as having one of the highest infection rates (nearly 10,000 per million), but an astonishingly low death rate – under 30 total in a population of 5 million, barely 5 per million. In other words the case fatality rate is about 1 in 200 or 0.05 percent. Most of the “better” countries are 1 to 2 percent, the European countries that had it worse are over 5%, some (Italy, UK) over 10%. US is about 3%. Testing regimes may account for some variation but Singapore is a real outlier. Why? It is mostly ethnic Chinese and I doubt the population is that young.
More widespread use of (and lack of stigma against using/prescribing) HCQ likely had an effect, but more importantly, African countries are not “pro-virus” as they are in the Western world. They don’t want to burden their populations with even more fear, so they don’t overtest to the point where false positives become significant or patients testing positive are tallied multiple times. They don’t test people on death’s door for the virus hoping that it will come back positive (or falsely positive) so they can add another covid death to the tally. Remember, wasn’t it one of the presidents in Africa (Tanzania?) that sent in tests performed on goats and inanimate objects and said a bunch of them came back positive?
Th most completely lucid sceptical account in graphs of the great Covid-19pandemic bust, here
https://www.youtube.com/watch?v=8UvFhIFzaac
The death threat does look like a bad flu season, mostly not much different from other bad flu seasons.
Still, there are demographic skews and death by hypoxia – both unlike typical or “normal” such seasons.
The all death mortality assembled here even finds mask wearing….ineffective at reducing deaths.
FOAF — “Singapore is a real outlier. Why? It is mostly ethnic Chinese and I doubt the population is that young.”
Young, yes. Most of the virus came to Singapore from young guest workers (South Asian, not Chinese) who lived in crowded dormitories, I think this alone accounts for the observed skew: youth who resist death by Covid-19, but yet susceptible to efficient infectious spreading events. Because vectors enhanced it.
Could Vitamin D be more effective than Remdesivir? Or HCQ and Ivermectin? And just as cheap and even safer?
https://www.youtube.com/watch?v=V8Ks9fUh2k8
This possibility is raised in a blind, randomised pilot hospital study from Spain. It found that no one in the Vit D group died, while those getting only HCQ saw 2 die and with many more with complications.
This could well be the cheapest best front line treatment for Covid-19 yet. Still, poorly studied and hugely under-recognised as a treatment option – until now. Perhaps.
The study is well designed but with few participants, such as in a pilot study. A possible magic bullet?
The poorer African countries have no health care system for most of their population, so any deaths wouldn’t be attributed to COVID-19.
Most of life occurs outdoors, other than sleeping, and the average lifespan is less, so there are fewer old people.
Plus there is a suggestion of cross reactivity immunity from other viruses.
This possibility is raised in a blind, randomised pilot hospital study from Spain. It found that no one in the Vit D group died, while those getting only HCQ saw 2 die and with many more with complications.
Put patients underneath sun, near naked. They will get better. Put them in hospitals on ventilators, cut off from sun, they die fast.
Possibly less deficient in VitaminD due to more exposure to sunlight?
“…only HCQ…”
Except that one is NOT SUPPOSED to take HCQ by itself. You take it together with a zinc supplement at the very least.
This is not new.
(And if one decides that HCQ must be avoided at allcosts because Trump mouthed it—and Fauci “confirmed”(!) that it was “merely anecdotal”(!)—then Quercetin can be taken instead. But here too, TOGETHER with zinc. Others recommend adding Vitamins C and D.)
Barry, this study was done in Spain. Apparently HCQ (plus antibiotic, (if indicated as needed) has become standard treatment at hospitals there, at some point during summer months.
I agree – I’d want zinc added, too! Now, I know that Trump coverage in Europe is around 100% negative. But Trump and the US USA side show there, not commonplace influence.
Check in with Dr. Sanity. She has experience with HCQ via Lupus patients, and has said she has no qualms about prescribing the drug.