Since COVID-19 became a pandemic, projection models were developed for Africa, with the assumption that SARS-CoV-2 has an exponential pattern of transmission. Crowded social life and poor personal hygiene in Africa can be conducive for COVID-19 spread. However, as of July 20, 2020, only about 9691 COVID-19 deaths have been reported from African continent among a population of 1.34 billion (compared to 143 000/328.2 million in the US alone). Although the number of infected subjects increased considerably during mid-July 2020 reaching about 597223 confirmed cases, the case fatality remained remarkably low in Africa [1]. According to the WHO, COVID-19 in Africa will likely “smoulder” ie, spread from hotspots at a slow, but steady pace rather than exponentially as elsewhere worldwide (https://www.afro.who.int/news/new-who-estimates-190-000-people-could-die-COVID-19- africa-if-not-controlled; last accessed July 21, 2020). Whether this paradox is due to genetics and immunity, comparatively young population, lower rates of comorbidities or just due to limited testing and late arriver of the pathogen in the continent, the low COVID-19 morbidity in African countries, with its fragile health care system, continues to puzzle experts. Herein, we outlined current concepts about potential players behind this low COVID-19 related mortality in Africa. Copyright © 2020 The Author(s)
