There are no Covid fears here.
The district's Covid-19 response center has registered just 11 cases since the beginning of the Pandemic. The regional hospital has a lot of malaria patients. The door to the isolation ward is bolted shut. There are no masks in sight as people cram together for weddings, soccer matches, and concerts.
Sierra Leone, a nation of eight million on the coast of Western Africa, feels like it was spared from a plague as it passed overhead. There is a great mystery surrounding the Pandemic in Africa.
The low rate of coronaviruses infections, hospitalizations and deaths in West and Central Africa is the focus of a debate that has divided scientists on the continent and beyond. Is the sick or dead not counted? Why is it that Covid has done less damage here? How have we missed it if it has been as vicious?
Austin Demby, Sierra Leone's health minister, said in an interview that the answers are relevant not just to us, but have implications for the public good.
The African Union's push to get 70% of Africans to bevaccinated against the virus this year has sparked debate about whether it is the best use of health care resources.
In the first months of the Pandemic, there was fear that Covid might destroy Africa, tearing through countries with weak health systems like Sierra Leone, where there are only three doctors for every 100,000 people. The high prevalence of diseases was seen as a sign of disaster.
That has not happened. The first iteration of the virus that raced around the world had a minimal impact here. Delta and Omicron ravaged South Africa, yet the rest of the continent did not record the same death tolls.
There is no longer a question of whether Covid has spread in Africa. It has.
Most of the population in sub-Saharan countries have some kind of immunity to the disease, according to studies that tested blood samples. Only 14 percent of the population has received any kind of Covid vaccine.
A new W.H.O.-led analysis, not yet peer-reviewed, synthesized surveys from across the continent, found that 65 percent of Africans had been exposed to the disease by the third quarter of 2021, higher than the rate in many parts of the world. When the data was gathered, only 4% of Africans had beenvaccinated.
The virus is in Africa. Is it killing fewer people?
Speculation has focused on the youth of Africans. Their median age is 19 years, compared with 43 in Europe and 38 in the United States. Only 3 percent of the population is 65 or older in sub-Saharan Africa. Less people have lived long enough to develop health issues that can lead to death from Covid, such as cardiovascular disease, diabetes, chronic respiratory disease and cancer. The low number of reported cases could be due to the fact that young people are often asymptomatic.
There are many other hypotheses that have been floated. The fact that a lot of life is spent outdoors could be preventing spread. The population density is low in many areas. It is possible that exposure to other pathogens, including coronaviruses and deadly infections, has offered protection.
It has become harder to accept these theories since Covid tore through South and Southeast Asia. The population of India is young with a median age of 28 and the country has relatively high temperatures. The researchers found that the Delta variant caused millions of deaths in India. India has seen high Covid fatality rates, as well as high rates of infections with malaria and other coronaviruses.
Is Covid deaths in Africa not counted?
Most global Covid trackers don't register any cases in Sierra Leone because testing for the virus isn't possible there. There are no cases to report with no testing. A research project at Njala University has found that 78 percent of people have an immunity to the coronaviruses. Since the start of the Pandemic, 125 Covid deaths have been reported in Sierra Leone.
Most people die in their homes because they can't get to a hospital or because their families take them there. Civil authorities do not register many deaths.
This pattern is common in Africa. According to a recent survey by the United Nations Economic Commission for Africa, official registration systems captured only one death.
South Africa is the only sub-Saharan country where every death is counted. The data shows that Covid has killed a lot of people in that country, far more than has been reported. Between May 2020 and September 2021, excess mortality data shows that more people died from natural causes than was predicted. Surges in death rates are similar to those in Covid cases.
According to Dr. Lawrence Mwananyanda, a Boston University epidemiologist and special adviser to the president of Zambia, the impact in the country had been just as bad as in South Africa, but that the deaths had not been captured by a weaker registration system. 4,000 Covid-19 deaths have been reported by the country of 18 million people.
If that is happening in South Africa, why should it happen here? He said that South Africa has a better health system, which should mean a lower death rate.
The research team he led found that 87 percent of the bodies in the hospital's mortuary were contaminated with Covid. What is different is that we have very poor data.
The Economist has tracked excess deaths throughout the Pandemic and found that there are similar rates of death in Africa. Sondre Solstad, who runs the Africa model, said that there had been between one million and two million excess deaths on the continent.
He said that it would be beautiful if Africans were spared.
Many scientists disagree with each other. It is not possible that hundreds of thousands or millions of Covid deaths could have gone undetected.
We haven't seen massive burials in Africa. If that had happened, we would have seen it, said Dr. Thierno Bald, who runs the W.H.O.'s Covid emergency response in Africa.
A death in Africa never goes un recorded, as much as we are poor at record-keeping. For someone sitting in New York hypothesizing that they weren't recorded, the perception is real. You know if there are deaths in the media and in your social circle.
Dr. Demby is the health minister in Sierra Leone. He said there was no evidence of excess deaths.
Which could be keeping the death rate low?
He acknowledged that health surveillance is weak, and that the experience of the epidemic of 2014–2018. He said citizens have been on alert for an infectious agent that could be killing people in their communities. He said that they would not pack into events if that were the case.
The death toll in Africa is likely to be similar to that of South Africa, according to a member of the African Centers for Disease Control and Prevention Covid task force. South Africans are more vulnerable to Covid than people from the other side of the world.
He said it was clear that a lot of people weren't going to the hospital with respiratory distress. Some older people who die of strokes and other Covid-caused causes are not being identified as coronaviruses deaths, because the young population is a key factor. Many people are not making it to the hospital, and their deaths are not registered. Others are not falling ill at the rates seen elsewhere, and that is a mystery that needs to be solved.
It is relevant to things as basic as vaccine development and treatment, according to Dr. Prabhat Jha, who heads the Centre for Global Health Research in Toronto.
Researchers working with Dr. Jha are looking for an increase in revenue from obituaries at radio stations in Sierra Leonean towns over the past two years to try to see if deaths could have been missed.
The lower rates of illness and death should be driving a rethinking of policy according to some organizations working on the Covid vaccine effort. John Johnson, an adviser for Doctors Without Borders, said that it made sense a year ago when it seemed like vaccines might provide long-term immunity and make it possible to end Covid-19 transmission. Collective immunity no longer looks doable now that protection has waned. An immunization strategy that focuses on protecting the most vulnerable would be a better use of resources.
Is this the most important thing to try to do in countries where there are bigger problems with diseases like Malaria, with diseases like Malaria, with diseases like Malaria, with diseases like Malaria, with diseases like Malaria, with diseases like Malaria, with diseases like Malaria, with diseases like Malaria, He asked if this was what we want to spend our resources on in those countries.
He said that the new variant of Covid poses the greatest risk in places with older populations and high levels of comorbidities.
Other experts warned that scaling back efforts to vaccine sub-Saharan Africans could lead to tragedy.
We can't assume that Africa can go the way of India.
He warned that a new variant as infectious as Omicron but more lethal than Delta could emerge and leave Africans vulnerable.
He said that we should avoid the idea that all Africa is safe.
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