Comorbidities and the COVID-19 pandemic dynamics in Africa.

The debate around the COVID-19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio-economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID-19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post-pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID-19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS-CoV-2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non-communicable diseases account for a relatively lighter burden, they have a significant effect on COVID-19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re-organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one-size-fits-all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID-19 response framework.