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Background: The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs)., Methods: We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes during public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach., Results: Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically., Conclusions: There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics., (© 2024. The Author(s).)

The COVID-19 pandemic (Coronavirus disease 2019) remains problematic in all its manifestations on the global stage where countless events of human-to-human exposure have led to fatal cases; thus, the aftermath being an unprecedented public health concern, with inaccessible health care and the instability of economies and financial institutions. These pose massive obstacles that can insatiably devour existing human resources causing negative impacts, especially in developing countries. Tracking the origin, dissemination and mutating strains of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on population-wide scales is a somewhat overwhelming task, with the urgent need to map the dissemination and magnitude of SARS-CoV-2 in near real-time. This review paper focuses on the poor sanitation of some waterbodies and wastewater management policies in low-income African countries, highlighting how these contribute to the COVID-19 pandemic on the continent. Since the outbreak of the novel coronavirus pandemic, there has been an upsurge in scientific literature and studies concerning SARS-CoV-2 with different opinions and findings. The current paper highlights the challenges and also summarizes the environmental aspects related to the monitoring and fate of the SARS-CoV-2 genomes in the aquatic milieu of Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

The pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) took the world by surprise. Following the first outbreak of COVID-19 in December 2019, several models have been developed to study and understand its transmission dynamics. Although the spread of COVID-19 is being slowed down by vaccination and other interventions, there is still a need to have a clear understanding of the evolution of the pandemic across countries, states and communities. To this end, there is a need to have a clearer picture of the initial spread of the disease in different regions. In this project, we used a simple SEIR model and a Bayesian inference framework to estimate the basic reproduction number of COVID-19 across Africa. Our estimates vary between 1.98 (Sudan) and 9.66 (Mauritius), with a median of 3.67 (90% CrI: 3.31–4.12). The estimates provided in this paper will help to inform COVID-19 modeling in the respective countries/regions. [ABSTRACT FROM AUTHOR]

Self-medication is an important initial response to illness in Africa. This mode of medication is often done with the help of African traditional medicines. Because of the misconception that African traditional medicines can cure/prevent all diseases, some Africans may opt for COVID-19 prevention and management by self-medicating. Thus to efficiently predict the dynamics of COVID-19 in Africa, the role of the self-medicated population needs to be taken into account. In this paper, we formulate and analyse a mathematical model for the dynamics of COVID-19 in Cameroon. The model is represented by a system of compartmental age-structured ODEs that takes into account the self-medicated population and subdivides the human population into two age classes relative to their current immune system strength. We use our model to propose policy measures that could be implemented in the course of an epidemic in order to better handle cases of self-medication. [ABSTRACT FROM AUTHOR]

INTRODUCTION Despite the fragile health systems in Africa, the continent remained less impacted by the COVID-19 pandemic, with no clear understanding of the distributional patterns across the countries and regions. This study assessed the distribution patterns of COVID-19 infection and the associated epidemiological measures across five geographical regions and the 53 African Union (AU) member countries during the first waves of the pandemic up to January 2021. METHODS This retrospective cross-sectional study utilized COVID-19 data from publicly available data repositories of the Africa Centers for Disease Control and Prevention (African CDC) and Our World in Data from February 2020 to January 2021. We conducted descriptive and inferential analyses of the reported cases, deaths, active cases, recoveries, and epidemiological measures, including morbidity and mortality rates (MMR), case fatality rate, and case ratios. RESULTS A total of 3196589 SARS-CoV-2 seropositive cases were reported in the AU during the period under review, out of which 77486 died, 536784 remained active cases, and 2582372 recovered. The mean case fatality rate in the AU was 2.21%. The Southern region recorded the highest average reported cases (149314), active cases (26156) and deaths (3942), while the Northern region recorded the highest average recoveries (121372). Conversely, the Central region recorded the least average number of reported cases (4978), recoveries (4554) and deaths (191), while the Western region logged the least average number of active cases (2274). CONCLUSIONS The Northern and Southern African regions were worse hit than other regions. However, there is a need to scale-up laboratory testing for SARS-CoV-2 in other regions of the AU to enhance proper case ascertainment, tracing and treatment of COVID-19 cases in a timely manner. ABBREVIATIONS AC: acute cases. AU: African Union. AUMCs: Africa Union Member Countries. Ag RDTs: Antigen Rapid Diagnostic Tests. CFR: case fatality rate. Africa CDC: Africa Centers for Disease Control and Prevention. CDC: US Centers for Disease Control and Prevention. SARS-CoV-2: Severe Acute Respiratory Syndrome-Corona virus-sub-type-2. COVID-19: corona virus-2019. D: COVID-19-related deaths. ERP: Emergency Response Preparedness. HICs: high-income countries. LICs: low-income countries. LMIC: low-middle- income-country. MMRs: morbidity [ABSTRACT FROM AUTHOR]

Due to the high transmission rate and mortality index of the current coronavirus pandemic, many settings in Africa instituted lockdowns to reduce its rate of spread and avert exponential growth rate. At the early stage, this measure seemed to heighten awareness of the virus and subsequently minimized exponential growth of cases. However, these lockdowns have had great consequences on the weak health systems and frail economy in place in many African countries. In this paper, we examine the impact of lockdown measures in these countries and provides key recommendations in dealing with present and future pandemics. [ABSTRACT FROM AUTHOR]

• Morbidity and mortality in children due to COVID-19 remained low • Adolescents had higher reported cases than younger children • Reported cases were lower in pediatric population than adult population • Testing protocols vary between countries; reflects bias in reported cases Few data on the COVID-19 epidemiological characteristics among the pediatric population in Africa exists. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population in 15 Sub-Saharan African countries. A merge line listing dataset shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March and 1 September 2020 with a confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children's data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases, its medians, and 95% confidence intervals were calculated. 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. Adults had a higher case incidence per 100,000 people than children. The cases and deaths within the children's population were smaller than the adult population. These differences may reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children. [ABSTRACT FROM AUTHOR]

The experience of Africa and the Middle East with the COVID-19 pandemic has been unique, which can be attributed, in part, to disparities within these regions. This review describes COVID-19 emergence, epidemiology, vaccination strategies and uptake, and lessons learned within Africa and the Middle East. For vaccines to be effective in curtailing COVID-19, a global approach to vaccination is required. However, vaccine inequities exist in Africa and the Middle East, with countries with better healthcare infrastructure having advantages in acquiring and delivering vaccines. Currently, the greatest challenges to the effective rollout of COVID-19 vaccination in Africa and the Middle East are funding, healthcare resources, infrastructure, and vaccine access and hesitancy. While mechanisms to support vaccine access in low- and middle-income countries are initiated, their success has been limited and vaccine inequity is arguably the biggest hurdle to a successful response. The collection of surveillance data at both regional and global levels is also critical in response to the pandemic and provides the necessary tools and data to drive vaccine development. These considerations of the learnings can help refine the pandemic response and inform countries to better prepare for similar public health emergencies. Learnings from previous epidemics enabled African nations to respond rapidly and cohesively to the emergence of the COVID-19 pandemic; similarly, nations in the Middle East also drew on previous outbreaks of other viruses to respond robustly, although perhaps less cohesively than the African nations. The populations of Africa and the Middle East share many of the same comorbidities (with the exception of HIV in Africa) and risk factors as other regions of the world, and both have experienced multiple waves of COVID-19 infections as new genetic variants of SARS-CoV-2 have evolved. African and Middle Eastern nations have had a wide range of success in vaccine rollout and uptake due to several factors including national wealth/income, populations with varying levels of vaccine hesitancy, and a range of access to private and/or public healthcare. Current challenges, some of which are being addressed by governmental and international entities, include a lack of vaccine- and surveillance-related infrastructure, needed improvement in regulatory standards, and persistent financial strains on healthcare systems that hinder improvements in vaccine delivery. [ABSTRACT FROM AUTHOR]

Objectives: The Coronavirus Disease 2019 (COVID-19) vaccine coverage rates for various countries were analyzed to observe how the rates varied across continents as of May 6, 2023. We also aimed to determine their correlation with COVID-19 statistics (cases/fatalities/tests). Methods: The "Our World in Data" website was searched to extract the vaccine coverage rates as of 1 July 2021, 1 January 2022, 1 July 2022, 1 January 2023, and 6 May 2023 for each country included in the study. Data on COVID-19 were obtained from the "Worldometer" website. Statistics were presented both cumulatively and yearly. Results: This analysis included 180 countries. The analysis of variance test showed a statistically significant difference in the COVID-19 vaccine coverage rates and COVID-19 data, except for the Case-fatality rate (CFR), between continents, with Africa having the lowest. The Independent t-test showed that countries with 50% or higher vaccination coverage had higher rates of cases, deaths, and tests but a lower CFR in 2022, higher median age, and higher Gross Domestic Product. Similarly, in early 2023 (till May 5), there was a notable difference in the rate of cases and deaths. Furthermore, there was a clear positive correlation between vaccine coverage rates and all other data, except for CFRs, which had a negative correlation. Conclusions: Inconsistencies in COVID-19 data, including vaccination coverage, across continents emphasize the importance of establishing uniform standards for identifying and diagnosing cases, ensuring fair vaccine distribution, and equipping all countries with essential diagnostic resources to prepare for future emergencies. [ABSTRACT FROM AUTHOR]

Background: The Coronavirus Disease (COVID-19) caused by SARS-CoV-2 infections remains a significant health challenge worldwide. There is paucity of evidence on the influence of the universal health coverage (UHC) and global health security (GHS) nexus on SARS-CoV-2 infection risk and outcomes. This study aimed to investigate the effects of UHC and GHS nexus and interplay on SARS-CoV-2 infection rate and case-fatality rates (CFR) in Africa. Methods: The study employed descriptive methods to analyze the data drawn from multiple sources as well used structural equation modeling (SEM) with maximum likelihood estimation to model and assess the relationships between independent and dependent variables by performing path analysis. Results: In Africa, 100% and 18% of the effects of GHS on SARS-CoV-2 infection and RT-PCR CFR, respectively were direct. Increased SARS-CoV-2 CFR was associated with median age of the national population (β = -0.1244, [95% CI: -0.24, -0.01], P = 0.031); COVID-19 infection rate (β = -0.370, [95% CI: -0.66, -0.08], P = 0.012); and prevalence of obesity among adults aged 18 + years (β = 0.128, [95% CI: 0.06,0.20], P = 0.0001) were statistically significant. SARS-CoV-2 infection rates were strongly linked to median age of the national population (β = 0.118, [95% CI: 0.02,0.22 ], P = 0.024); population density per square kilometer, (β = -0.003, [95% CI: -0.0058, -0.00059], P = 0.016) and UHC for service coverage index (β = 0.089, [95% CI: 0.04,0.14, P = 0.001) in which their relationship was statistically significant. Conclusions: The study shade a light that UHC for service coverage, and median age of the national population, population density have significant effect on COVID-19 infection rate while COVID-19 infection rate, median age of the national population and prevalence of obesity among adults aged 18 + years were associated with COVID-19 case-fatality rate. Both, UHC and GHS do not emerge to protect against COVID-19-related case fatality rate. [ABSTRACT FROM AUTHOR]

What are the effects of Corona Virus Disease 19 (COVID-19) on inflation, unemployment, and GDP in Africa? Using geo-coded cross-sectional data taken from the World Health Organization and International Monetary Fund, we investigate the spatial distribution of COVID-19 and its effects on inflation, unemployment, and Gross Domestic Product (GDP) in Africa by employing the Geographic Information System (GIS), multivariate analysis of covariance (MANCOVA), and spatial statistics. The entire dataset was analyzed using Stata, ArcGIS, and R software. The result shows (1) that there is evidence of a spatial pattern of COVID-19 cases and death rate clustering behavior in Africa, verifying the existence of spatial autocorrelation. The result also reveals (2) that COVID-19 has a negative effect on unemployment, inflation, and GDP in Africa. We confirmed that (3) temperature, rainfall, and humidity were statistically significantly associated with the spread of the COVID-19 pandemic in Africa. The comparison of the GDP of African countries before and after the pandemic shows (4) a large decrease in GDP, the highest in Seychelles (23 percent). The result of the study shows (5) that there has been a significant increase in inflation and unemployment rates in all countries since the outbreak of the pandemic as compared to the time before the outbreak. There is also evidence that (6) there is a significant relationship between death rate due to COVID-19 and population density; temperature with COVID-19 cases and death rate; and precipitation with death rate due to COVID-19. Therefore, respective governments and the international community need to pay attention to controlling/reducing the impact of COVID-19 on inflation, unemployment, and GDP, focusing on the indicated demographic and environmental variables. [ABSTRACT FROM AUTHOR]

A continent-wide Africa Task Force for Coronavirus with its six technical working groups was formed to prepare adequately and respond to the novel Coronavirus disease (COVID-19) outbreak in Africa. This research in practice article aimed to describe how the infection prevention and control (IPC) technical working group (TWG) supported Africa Centre for Disease Control and Prevention (Africa CDC) in preparedness and response to COVID-19 on the continent. To effectively address the multifaceted IPC TWG mandate of organizing training and implementing rigorous IPC measures at healthcare service delivery points, the working group was sub-divided into four sub-groups—Guidelines, Training, Research, and Logistics. The action framework was used to describe the experiences of each subgroup. The guidelines subgroup developed 14 guidance documents and two advisories; all of which were published in English. In addition, five of these documents were translated and published in Arabic, while three others were translated and published in French and Portuguese. Challenges faced in the guidelines subgroup included the primary development of the Africa CDC website in English, and the need to revise previously issued guidelines. The training subgroup engaged the Infection Control Africa Network as technical experts to carry out in-person training of IPC focal persons and port health personnel across the African continent. Challenges faced included the difficulty in conducting face-to-face IPC training and onsite technical support due to the lockdown. The research subgroup developed an interactive COVID-19 Research Tracker on the Africa CDC website and conducted a context-based operation and implementation research. The lack of understanding of Africa CDC's capacity to lead her own research was the major challenge faced by the research subgroup. The logistics subgroup assisted African Union (AU) member states to identify their IPC supply needs through capacity building for IPC quantification. A notable challenge faced by the logistics subgroup was the initial lack of experts on IPC logistics and quantifications, which was later addressed by the recruitment of professionals. In conclusion, IPC cannot be built overnight nor can it be promoted abruptly during outbreaks of diseases. Thus, the Africa CDC should build strong national IPC programmes and support such programmes with trained and competent professionals. [ABSTRACT FROM AUTHOR]

An accumulating body of evidence shows that various ethnicities are differentially affected by SARS-COV-2 infection. Moreover, some evidence shows that due to the vaccine inequity and millions of people living with HIV, a major catastrophe could occur in African countries that possibly affects the whole world. Given the possibility that Neanderthal genes confer a slight increase in susceptibility, this difference, at least to some extent, might possibly decrease the risk of the emergence of new SARS-CoV-2 variants among black people in Africa. Recent studies show less death and fewer cases among the ethnic group classified as "Black Africans". Although Neanderthal DNA might explain some differences in morbidity and mortality of COVID-19, a multitude of confounders complicate things to where drawing definite conclusions is hard or even impossible. Using selective-pressure-free treatments (e.g. low dose radiotherapy) for COVID-19 pneumonia would be of crucial importance everywhere, but particularly in sub-Saharan Africa, where "long COVID" in millions of people with HIV paves the road for the more frequent emergence of new variants. [ABSTRACT FROM AUTHOR]

For more than two years after the emergence of COVID-19 (Coronavirus Disease-2019), significant regional differences in morbidity persist. These differences clearly show lower incidence rates in several regions of the African and Asian continents. The work reported here aimed to test the hypothesis of a pre-pandemic natural immunity acquired by some human populations in central and western Africa, which would, therefore, pose the hypothesis of an original antigenic sin with a virus antigenically close to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). To identify such pre-existing immunity, sera samples collected before the emergence of COVID-19 were tested to detect the presence of IgG reacting antibodies against SARS-CoV-2 proteins of major significance. Sera samples from French blood donors collected before the pandemic served as a control. The results showed a statistically significant difference of antibodies prevalence between the collected samples in Africa and the control samples collected in France. Given the novelty of our results, our next step consists in highlighting neutralizing antibodies to evaluate their potential for pre-pandemic protective acquired immunity against SARS-CoV-2. In conclusion, our results suggest that, in the investigated African sub-regions, the tested populations could have been potentially and partially pre-exposed, before the COVID-19 pandemic, to the antigens of a yet non-identified Coronaviruses. [ABSTRACT FROM AUTHOR]

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that cause coronavirus disease 2019 (COVID-19) have afflicted millions worldwide. Understanding the underlying spatial and temporal dynamics can help orient timely public health policies and optimize the targeting of non-pharmaceutical interventions and vaccines to the most vulnerable populations, particularly in resource-constrained settings. The review systematically summarises important methodological aspects and specificities of spatial approaches applied to COVID-19 in Africa. Methods: Thematically selected keywords will be used to search for refereed studies in the following electronic databases PubMed, SCOPUS, MEDLINE, CINHAL, and Coronavirus Research Database from January 2020 to February 2022. Two independent reviewers will screen the title, abstracts, and full texts against predefined eligibility criteria based on the study's characteristics, methodological relevance, and quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 procedures will be adhered to during the reporting process. Discussion: COVID-19 modeling remains in its infancy, and research is needed to characterize uncertainty and validate various modeling regimes appropriately. It is anticipated that the review will aid spatial, spatio-temporal modeling decisions necessary for mitigating the current and future pandemics. Systematic review registration: CRD42021279767 [ABSTRACT FROM AUTHOR]

Objective: The declaration of the coronavirus disease (COVID-19), a pandemic in early 2020, has seen an upsurge in research globally to fill gaps in the epidemiology of the SARS-CoV-2 virus impact on health care and clinical management, as well as possible prevention and treatment modalities. Published literature on the different types of COVID-19 research conducted globally is varied and is particularly limited in Africa. This study sets out to describe the COVID-19-related research registered and conducted on the African continent.Methods: This is a cross-sectional study of all COVID-19-related studies available in the WHO's International Clinical Trials Registry Platform (ICTRP) repository. We extracted studies registered from March 1, 2020, to July 15, 2021. A descriptive analysis of the extracted data was performed, and the findings were presented.Results: At extraction, a total of 12,533 COVID-19-related studies were listed on the ICTRP portal. We included 9803 studies, after excluding 2060 duplicate records and 686 records without a site/country. While 9347 studies (96%) were conducted outside of Africa, only 456 studies (4%) were conducted in the African continent, of which 270 (59.2%) were interventional studies, and 184 (40.4%) were observational studies. About 80% of the studies were conducted in Egypt and South Africa, and most of these involved testing of drugs and biologicals.Conclusion: The African continent hosts considerably fewer COVID-19-related research compared to other parts of the world. This may have implications on scientific evidence available for implementing COVID-19 control efforts. There is, therefore, a need for local funding and ownership of research projects and north-south collaboration in research. [ABSTRACT FROM AUTHOR]

Introduction: Coronavirus disease-19 (COVID-19), which started in late December, 2019, has spread to affect 216 countries and territories around the world. Globally, the number of cases of SARS-CoV-2 infection has been growing exponentially. There is pressure on countries to flatten the curves and break transmission. Most countries are practicing partial or total lockdown, vaccination, massive education on hygiene, social distancing, isolation of cases, quarantine of exposed and various screening approaches such as temperature and symptom-based screening to break the transmission. Some studies outside Africa have found the screening for fever using non-contact thermometers to lack good sensitivity for detecting SARS-CoV-2 infection. The aim of this study was to determine the usefulness of clinical symptoms in accurately predicting a final diagnosis of COVID-19 disease in the Ghanaian setting. Method: The study analysed screening and test data of COVID-19 suspected, probable and contacts for the months of March to August 2020. A total of 1,986 participants presenting to Tamale Teaching hospital were included in the study. Logistic regression and receiver operator characteristics (ROC) analysis were carried out. Results: Overall SARS-CoV-2 positivity rate was 16.8%. Those with symptoms had significantly higher positivity rate (21.6%) compared with asymptomatic (17.0%) [chi-squared 15.5, p-value, <0.001]. Patients that were positive for SARS-CoV-2 were 5.9 [3.9–8.8] times more likely to have loss of sense of smell and 5.9 [3.8–9.3] times more likely to having loss of sense of taste. Using history of fever as a screening tool correctly picked up only 14.8% of all true positives of SARS-CoV-2 infection and failed to pick up 86.2% of positive cases. Using cough alone would detect 22.4% and miss 87.6%. Non-contact thermometer used alone, as a screening tool for COVID-19 at a cut-off of 37.8 would only pick 4.8% of positive SARS-CoV-2 infected patients. Conclusion: The use of fever alone or other symptoms individually [or in combination] as a screening tool for SARS-CoV-2 infection is not worthwhile based on ROC analysis. Use of temperature check as a COVID-19 screening tool to allow people into public space irrespective of the temperature cut-off is of little benefit in diagnosing infected persons. We recommend the use of facemask, hand hygiene, social distancing as effective means of preventing infection. [ABSTRACT FROM AUTHOR]

Background: Traditional medicines based on herbal extracts have been proposed as affordable treatments for patients suffering from coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Teas and drinks containing extracts of Artemisia annua and Artemisia afra have been widely used in Africa in efforts to prevent SARS-CoV-2 infection and fight COVID-19. Methods: The plant extracts and Covid-Organics drink produced in Madagascar were tested for plaque reduction using both feline coronavirus and SARS-CoV-2 in vitro. Their cytotoxicities were also investigated. Results: Several extracts as well as Covid-Organics inhibited SARS-CoV-2 and FCoV infection at concentrations that did not affect cell viability. Conclusions: Some plant extracts show inhibitory activity against FCoV and SARS-CoV-2. However, it remains unclear whether peak plasma concentrations in humans can reach levels needed to inhibit viral infection following consumption of teas or Covid-Organics. Clinical studies are required to evaluate the utility of these drinks for COVID-19 prevention or treatment of patients. [ABSTRACT FROM AUTHOR]

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has expanded into a global pandemic, with more than 220 million affected persons and almost 4.6 million deaths by 8 September 2021. In particular, Europe and the Americas have been heavily affected by high infection and death rates. In contrast, much lower infection rates and mortality have been reported generally in Africa, particularly in the sub-Saharan region (with the exception of the Southern Africa region). There are different hypotheses for this African paradox, including less testing, the young age of the population, genetic disposition, and behavioral and epidemiological factors. In the present review, we address different immunological factors and their correlation with genetic factors, pre-existing immune status, and differences in cytokine induction patterns. We also focus on epidemiological factors, such as specific medication coverage, helminth distribution, and malaria endemics in the sub-Saharan region. An analysis combining different factors is presented that highlights the central role of the NF-κB signaling pathway in the African paradox. Importantly, insights into the interplay of different factors with the underlying immune pathological mechanisms for COVID-19 can provide a better understanding of the disease and the development of new targets for more efficient treatment strategies. [ABSTRACT FROM AUTHOR]