There is a story in Malarial Africa and someone should investigate it
When I originally wrote about Covid-19 in Africa, I had no idea how drastic the differences would be between the African continent and the rest of the world. To give you an idea of the scope of how much Africa has escaped the Corona pandemic, consider these numbers. Africa is home to 1.346 billion people. In order to find a comparable population you must use the entire Western Hemisphere, which includes South America and North America which includes Central America and Mexico and then you would still need another 300 + million people. Say Russia, Spain, United Kingdom and France would about do it.
Just comparing those populations, Africa has, as of this writing, reported just over 30,000 deaths from Covid-19. Those other continents and nations with nearly the same population?
619,000 fatalities. Africa with over 20x the population of France has experienced nearly the same amount of deaths, France has slightly more. But now the interesting part.
Comparatively few of those 30,123 deaths in the continent of Africa, are in the nations colored orange on this map which I will call Malarial Africa. In the most susceptible region in the world to contract malaria, globally 94% of all malaria deaths occur in these nations, remarkably there have only been 6,309 reported covid-19 deaths as of this writing.
This includes the most populous nation in Africa, Nigeria with a population just slightly less than Brazil. While Brazil has suffered 127,000 deaths from the virus, Nigeria has lost 1,057. Brazil's Covid-19 death rate is 597 per million while Nigeria is 5. Nigeria reported its first case of Covid-19 on January 28th, Brazil's first case was reported a full month later on February 27th.
The population of density of Nigeria is 586 per square mile, Brazil has a density of 62 persons per square mile. Nigeria's largest city is Lagos with a metropolitan population of an estimated 21 million people and a density of 17,800 per square mile. Brazil's largest metropolitan area is Sao Paulo with a population of 12.25 million and a density of 16,500 per square mile. By all the important metrics used in determining how a disease should spread, these two nations should be reversed, and we did not even look at disparities in health care services or standard of livings, Nigeria's media income is one quarter of that of Brazil. But the bottom line is Brazil has had 127 times more Covid-19 deaths than Nigeria. Back to Africa.
At the very bottom of our map of Africa is, not surprisingly, South Africa. South Africa, by far, has suffered the worst on the continent from Covid-19, almost half the deaths in Africa have occured in South Africa, 14,263. It also has the highest death rate with 240 per million. Bordering South Africa to the north on the coast is Mozambique. Mozambique has virtually been untouched by the virus, it has had just 23 reported deaths in a population of over 31 million people and has a death rate of .7 per million. For all practical purposes Covid-19 does not exist in Mozambique. Mozambique, by the way, is one of the leading nations for malaria deaths in the world.
In 2018, the region was home to 93% of malaria cases and 94% of malaria deaths. In 2018, 6 countries accounted for more than half of all malaria cases worldwide: Nigeria (25%), the Democratic Republic of the Congo (12%), Uganda (5%), and Côte d'Ivoire, Mozambique and Niger (4% each)
Flying north to the top of the African continent we find Algeria. Algeria has a death rate of 35 per million. Bordering it to the south are two of our orange shaded (malaria) nations, Niger and Mali, whose combined populations are close to that of Algeria. They have death rates of 3 and 6 respectively from Covid-19.
Before I go further, it must be recognized that there are other factors that could help explain this seemingly inexplicable difference in Malarial Africa from the rest of the world. Most obvious is reporting. These are mostly very poor nations with below optimum healthcare systems to keep track of illnesses. Countering that however, is the very real fact that the World Health Organization spends considerable money and manpower in this region to monitor and combat both malaria and Ebola, so they are not without resources. Since they are such a breeding area for these two scouges and others (HIV/AIDS), the health care systems they do have are very well trained and used to dealing and monitoring infectious diseases.
Another item that could have an affect on these countries is that their shorter life spans make them generally much younger nations. Going back to our Nigeria / Brazil comparison, Nigeria's average life expectancy is 53.4 years while in Brazil it is 75.2. We know now that Covid-19 disproportionately kills the sick and elderly. However it seems that being sick enough to die at 54 is no different than 75 or 80. The number one cause of death in Nigeria is HIV/AIDS. It stands to reason that a less healthy society would argue for a larger impact on the society by the virus, not a lesser one.
Finally, there is climate. All of the nations in Malarial Africa exist in tropical climates. But then too do the South American nations of Suriname with a death rate of 145 per million, French Guiana (207) or Ecuador which is named for the Equator and has a per million death rate of 598. Tropical conditions seem to have little effect elsewhere:
In Brazil, the six cities with the highest coronavirus exposure are all on the Amazon River, according to an expansive new study from Brazilian researchers that measured antibodies in the population.
The epidemic has spread so quickly and thoroughly along the river that in remote fishing and farming communities like Tefé, people have been as likely to get the virus as in New York City, home to one of the world’s worst outbreaks.
Now that we have looked at some numbers, and listed possible caveats and explanations for those numbers, let's look at a possible reason for those seemingly dramatically lower death rates in Malarial Africa. Quinine.
For centuries Africa, in particular the nations in orange on the WHO's map have been fighting the scourge of malaria. For generations the primary tool for fighting that parasitic disease has been quinine or any of its synthetic substitutes, such as chloroquine or the infamous hydroxychloroquine.
For many years the treatment of malaria in Africa has relied on chloroquine, sulfadoxine combined with pyrimethamine, and quinine, with the latter being used mainly to treat severe cases. Quinine remains efficacious, but chloroquine and sulfadoxine-pyrimethamine are failing, and this is leading to an increase in mortality from malaria especially in East Africa.1,2
These drugs are not only used to treat malaria but also as a prophylactic to prevent one from contracting the disease. If you go to the CDC's website there is a section entitled Choosing a Drug to Prevent Malaria , you will find a list of these drugs and their applications to prevent malaria for people traveling to regions where malaria is endemic. What is used by travelers to Africa to prevent or limit malaria is obviously also used by local populations. In fact the use of these various prophylactics is so prevalent it has created drug resistant strains of the parasite which causes malaria, diminishing their effectiveness.
Drugs, such as chloroquine, have been the mainstay of malaria case management in Africa for over 50 years. Since the late 1980s, sensitivity to chloroquine has rapidly declined across much of Eastern and Southern Africa, rendering the drug useless in many countries.
One of the replacements is Hydroxychloroquine (Plaquenil). There are others and other treatments meant to overcome this resistance but they are all, for a lack of a better description, quinine based. The additives, so to speak, are meant to overcome the resistance, but quinine is still effective in combating the disease. In fact in severe cases of malaria, quinine is used if more advanced drugs are not available.
This is a overly long way of saying that Malarial Africa, for generations, have been, again for lack of a better term, inoculated, with quinine and synthetic quinine substitutes to prevent malaria. The question is; is this the reason for the lower severity and fatality rate of this large region to Covid-19? It seems to me that it is a question worthy of investigation by agencies that claim to be concerned with public health.
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