Back Door Power Grab Corruption Crime Faked news

Well, DUH! Clinton Campaign, DNC Agree to Pay Fines for Payments of Steele Dossier

Views: 21

Former Secretary of State Hillary Clinton speaks during the 2022 New York State Democratic Convention in New York on Feb. 17, 2022. (Michael M. Santiago/Getty Images)

By Zachary Stieber for EPOCH TIMES    March 30, 2022

Hillary Clinton’s 2016 presidential campaign and the Democratic National Committee (DNC) likely violated federal law by not accurately describing payments made to a law firm that funneled the money to ex-British spy Christopher Steele, federal officials have ruled.

The Federal Election Commission (FEC) determined that there was probable cause to believe that the Clinton campaign and its treasurer, Elizabeth Jones, and the DNC and its treasurer, Virginia McGregor, misreported the purpose of certain spending and violated federal law, according to documents made public on March 30.

The probable violations concern the $1 million payment that the law firm Perkins Coie, retained by the parties to provide legal services ahead of the 2016 election, made in 2016 to the company Fusion GPS.

The Clinton campaign paid $175,000 to Perkins Coie in mid-2016 for what it described in disclosure reports as “legal services.” The DNC paid $849,407 to the law firm at roughly the same time for what it described as “legal and compliance consulting.”

Federal law requires political campaigns to report the name and address of each person that they pay more than $200 per year and define the purpose of the payment.

Complaints lodged with the FEC stated that the Hillary for America campaign (HFA) and the DNC stated in 2018 that the parties made sure to hire operatives through Perkins Coie to shield their conduct from scrutiny.

“By intentionally obscuring their payments through Perkins Coie and failing to publicly disclose the true purpose of those payments, HFA and the DNC were able to avoid publicly reporting on their statutorily required FEC disclosure forms the fact that they were paying Fusion GPS to perform opposition research on Trump with the intent of influencing the outcome of the 2016 presidential election,” the Coolidge-Reagan Foundation stated one complaint.

The foundation released the FEC’s determination on March 30 ahead of the agency’s own release of the documents. An FEC spokesperson didn’t dispute the authenticity of the documents.

“The FEC has up to 30 days following notification of the parties to an enforcement matter to prepare and place the relevant documents on the public record,” the spokesperson told The Epoch Times in an email. “Until then, we cannot provide comment or disclose any information.”

Instead of going toward the purposes listed on disclosure forms, the payments actually went to fund the creation of the infamous dossier compiled by Steele—an ardent opponent of Clinton’s rival Donald Trump—with the assistance of Fusion operatives.

Perkins Coie acknowledged the arrangement in a letter (pdf) sent to Fusion in 2017 and published by media outlets.

The dossier was rife with salacious, unsubstantiated claims, many of which have since been debunked by federal officials, including Department of Justice Inspector General Michael Horowitz.

The FEC found probable cause that the payments were misreported. That prompted the Clinton campaign and the DNC to agree to enter into conciliation agreements with the FEC.

The agreements stipulate that the parties will pay penalties—$8,000 for Clinton’s campaign and $105,000 for the DNC—and won’t violate the laws that they appear to have violated in the future.

The commission, upon the request of anyone filing a proper complaint concerning the matters at issue, may review compliance with the laws. If there’s a belief that any of the laws are being violated, a civil action may be started in federal court.

Trump filed a lawsuit against Clinton and others involved with the dossier on March 24.

The campaign and the DNC didn’t admit to wrongdoing. The parties didn’t respond to requests for comment.

DNC officials have said before that the party didn’t know about the arrangement between Perkins Coie and Fusion. Brian Fallon, a former spokesman for the Clinton campaign, said he wished he had known about the payments to Steele because he would have volunteered to go help him. Fallon has also said Clinton “may have known” about the research, but “the degree of exactly what she knew is beyond my knowledge.”

The FEC also determined that others didn’t violate federal laws: Steele, Fusion, Perkins Coie, and former Perkins Coie attorney Marc Elias.

The fines aren’t even a slap on the wrist !

As one commenter put it on ET: “Why didn’t the FEC forward criminal charges against her and others? Because they are just another corrupt government entity.”


Uncategorized Back Door Power Grab Crime Elections Politics Reprints from others.

FEC Complaint Says Clinton Campaign, DNC Violated Law Over Trump Dossier

Views: 9

MSM and Conservative media as well as Mueller found that the Steele Dosier was fake. Also Steele got the Phony reports that he copied were Russian documents.

Law and Crime article here.

The Democratic National Committee (DNC) and Hillary Clinton’s campaign violated campaign finance laws by failing to accurately disclose payments related to the so-called Trump Dossier, the non-partisan Campaign Legal Center said in a complaint filed today with the Federal Election Commission.

“The purpose of at least some portion of the payments to Perkins Coie was not for legal services; instead, those payments were intended to fund opposition research,” the FEC complaint reads. “This false reporting clearly failed the Commission’s requirements for disclosing the purpose of a disbursement.”

The FEC, in a memo to the Coolidge Reagan Foundation, which filed its complaint over three years ago, said it fined Clinton’s treasurer $8,000 and the DNC’s treasurer $105,000.

The memo, shared with Secrets, is to be made public in a month


Biden Pandemic Economy Opinion Politics Reprints from others.

Manchin shoots down Biden’s new billionaire tax plan

Views: 10

The Whole article can be found here.

Centrist Sen. Joe Manchin (D-W.Va.) on Tuesday shot down President Biden’s new plan to raise $360 billion in revenue by imposing a 20 percent minimum tax on billionaires, a proposal the president formally unveiled Monday in his budget request to Congress.

Manchin says he doesn’t support the president’s plan to tax the unrealized gains of billionaires, which would set a new precedent by taxing the value an asset accrues in theory before it is actually sold and converted into cash.

“You can’t tax something that’s not earned. Earned income is what we’re based on,” he told The Hill. “There’s other ways to do it. Everybody has to pay their fair share.”

“Everybody has to pay their fair share, that’s for sure. But unrealized gains is not the way to do it, as far as I’m concerned,” he added.

Manchin’s opposition means Biden’s proposal is likely dead only a day after the White House unveiled it. It could be significantly restructured to avoid taxing unrealized gains, which would pose the big challenge of trying to make up the lost revenues. Structuring a tax on unrealized capital gains is complicated because the value of assets can fluctuate.







Politics Opinion Reprints from others.

Why ex-hedge funder Dave McCormick is beating Dr. Oz in US Senate run.

Views: 34


BUTLER, PENN. — David McCormick starts most days talking to strangers before the sun is barely up. Gifted with a broad smile, vigorous handshake and sharp wit, people rarely turn him away when he tells them he is running for US Senate.

McCormick, who entered the race for Pennsylvania’s open Senate seat in mid-January, has shot from mere unknown to the top of the polls by traveling across the state in his charcoal pickup truck, meeting voters in every single county.

“That is a tall task in a 67-county state, but we have already gone to 38 since mid-January and we are not stopping until we visit several communities in each county,” he told me.

Also vying for the Senate’s GOP nomination this May is TV personality Dr. Mehmet Oz along with three others. But, despite Dr. Oz’s fame and name recognition, McCormick is the frontrunner, besting Oz by 9 points (24% to 15%), according to a recent Fox News poll.

McCormick has done it through plain talk. Today, as he faces a group of 100 grassroots Republicans at Mac’s Route 8 Café, he launches straight into his life story — from West Point grad to undersecretary in the George W. Bush administration to hedge-fund CEO — and why all that has led him to run for Senate.

McCormick woos supporters with his broad smile and vigorous handshake during a campaign stop in Coplay, Penn.
McCormick woos supporters with his broad smile and vigorous handshake during a campaign stop in Coplay, Penn.
Tom Williams/CQ-Roll Call/Sipa U

“Look, I know you all have some tough questions to ask me about who I am, why I am running and how I came to my belief systems, and might feel embarrassed to do so,” he said to the group. “Well, don’t. I want you to ask me the questions you tell your spouse after you leave that you wished you would have asked.”

In the crowd were Deborah Young and her husband, Ed Nesbel, who have gone to events hosted by the other candidates, including Dr. Oz. Young admits she was impressed by Oz’s stage presence, but she found herself drawn to McCormick’s down-to-earth charm. “Nothing he said was a laundry list of talking points that he had memorized,” said Young of McCormick.


“He is a warrior, a happy warrior, despite everything that is going on in the world,” said Ed Nesbel (pictured with wife Deborah Young) about McCormick after attending the candidate’s event in Butler, Penn.
“He is a warrior, a happy warrior, despite everything that is going on in the world,” said Ed Nesbel (pictured with wife Deborah Young) about McCormick after attending the candidate’s event in Butler, Penn.

His approach is wildly different to Dr. Oz, who is known for breezy tour de forces that often leave voters feeling like they had visited the set of “The Ellen DeGeneres Show.”

“There was a lot of show and music with Dr. Oz,” said Eric Lasure, a supervisor at Guy Chemical and a Mennonite pastor, after both men came to events in his hometown of Somerset Township.

“That is nice and all, but I need to know if a candidate shares my values before I give them my vote,” Lasure said, adding that he is leaning McCormick’s way.

Dr. Oz announces run for U.S. Senate seat in Pennsylvania

Earning voters’ support “is something sacred,” McCormick, 56, told me. “They want to trust what you are saying is a value you hold and not something you say just to win.”

Born in Washington, Penn., 30 miles outside of Pittsburgh, McCormick’s family moved when he was seven to Bloomsburg, Penn., where his father took a job as the president of the local university. A gifted student athlete, the young McCormick excelled at football, wrestling and academics, all of which helped him win a place at West Point. “After I left West Point I went to the 82nd Ranger School, Gulf War,” he said.


When he returned to the US, he earned a doctorate from Princeton, ran an online auction service in Pittsburgh, served as President George W. Bush’s undersecretary of the Treasury for international affairs, and then finally became CEO of hedge fund Bridgewater Associates in Connecticut from 2020 to 2021.

McCormick at a campaign event in Warminster, Penn. Earning voters’ support, the 56-year-old said, “is something sacred.”
McCormick at a campaign event in Warminster, Penn. Earning voters’ support, the 56-year-old said, “is something sacred.”

A father of four from his first marriage, in 2019 he married Dina Powell, who previously had served as the deputy national security adviser for strategy under former President Donald Trump. In 2022, the couple moved from Connecticut back to Pittsburgh. (McCormick still owns the family Christmas-tree farm in Bloomsburg, which also now grows soy and corn).

Opponents have criticized McCormick for being a recent Connecticut resident as well as for his hedge-fund past. Oz has been hitting him nonstop with ads, accusing McCormick of being in bed with China — a notion the former CEO finds ridiculous.

“I ran a global business that invested in 20 countries, China was one of them, about 2% of all of revenue was in China,” he said.

Currently the Senate is split 50-50; Vice President Kamala Harris has the controlling vote. This November, 34 of the 100 Senate seats are up for election, but just seven are considered tossups, which could tip the balance of power either way. Pennsylvania’s seat is one of them.
Currently the Senate is split 50-50; Vice President Kamala Harris has the controlling vote. This November, 34 of the 100 Senate seats are up for election, but just seven are considered tossups, which could tip the balance of power either way. Pennsylvania’s seat is one of them. Source:
NY Post/Mike Guillen

“Listen, I was a global businessman. I did business all around the world. That experience dealing with China is a point of strength. We need strong leaders who understand the economy. I’ve negotiated at the highest levels of our government against China and gone toe to toe with them. The world’s complicated and we need people who understand business, understand the world, understand the military and I am not going to back away from my experiences in any of them.”

Like the race for Virginia governor last November, in which GOP candidate Glenn Youngkin won by focusing on current issues like the economy, education and crime, this Senate race is all about Biden’s record and the future and nothing to do with Trump or the past. To underscore this point, McCormick ran a 30-second Super Bowl commercial last month, blasting rising inflation and the disastrous pullout from Afghanistan, amid the sound of crowds chanting “Let’s go Brandon” (code for “F–k Joe Biden”).

McCormick’s wife is ex-Deputy National Security Advisor Dina Powell (here with Ivanka Trump).
McCormick’s wife is ex-Deputy National Security Advisor Dina Powell (here with Ivanka Trump).

Both parties desperately need this Pennsylvania seat to control the balance of power in the Senate. “Republicans need to hold it and Democrats need them not to. Expect this to be not just one of the most expensive races in the country this year, but also one the most important,” said G. Terry Madonna, political science professor at Millersville University.

In Pennsylvania, voters are gradually leaning right. While Biden narrowly beat Trump for the state’s electoral votes in 2020, voters overwhelmingly chose Republicans down ballot. And the number of registered Democrats in Pennsylvania is dwindling, too. Just two years ago, Democrats had an extra 813,885 registered voters. Now, that lead has dwindled to 580,320.

McCormick meets with former President Donald Trump at the ex-commander in chief’s NJ golf club in 2016.
McCormick meets with former President Donald Trump at the ex-commander in chief’s NJ golf club in 2016.

Which is why McCormick feels strongly he can beat one of the three Democrats in the general election this November. (The Current Democratic front-runner is Lt. Gov. John Fetterman.)

Once a “reluctant bystander,” McCormick said he finally threw his hat in the ring as the economy plummeted, the politics of the pandemic became untenable, the border crisis deepened, and he felt the military had gone astray, especially after the country’s exit from Afghanistan.

Dr. Oz (right) has been hitting McCormick with ads, criticizing him for his recent Connecticut residency and accusing him of being in bed with China.
Dr. Oz (right) has been hitting McCormick with ads, criticizing him for his recent Connecticut residency and accusing him of being in bed with China.

“There are two things going on in the military that I’m worried about,” he said. “First, they are becoming a force that has a sustainability focus and a social engineering focus, as opposed to a war fighting focus. The second thing is that we’re not innovating quickly enough.”

Two weeks ago, he toured the border between Yuma, Ariz., and Mexico. When he came home, he talked to local law enforcement and rehabilitation specialists about how drug trafficking has impacted people in the state.

McCormick said he plans to visit voters in every county in his 67-county state. “We have already gone to 38 since mid-January and we are not stopping,” he said.
McCormick said he plans to visit voters in every county in his 67-county state. “We have already gone to 38 since mid-January and we are not stopping,” he said.
Tom Williams/CQ-Roll Call/Sipa U

“The border doesn’t stay at the border, it comes to our hometowns, cities and schools in the form of opioids and meth and crime and we can’t just stand here and do nothing,” he said.

That kind of concern for both country and state resonates with Young and Nesbel. After meeting with McCormick, the couple left with a sign supporting him for Senate.

“He is a warrior, a happy warrior, despite everything that is going on in the world,” Nesbel said. “I like his dedication to service to country and his optimism about the country. It’s something we rarely hear in politics.”


Opinion Politics Progressive Racism Reprints from others.

Justin Trudeau Gets Wrecked After Daring to Lecture the EU Parliament About Democracy.

Views: 40

The lack of self-awareness among the global elites is stunning. After Canadian Prime Minister Trudeau cracked down on protestors in his own country and sent his henchwoman, Finance Minister Chrystia Freeland, to freeze the assets of protesting truck drivers and their supporters, he traveled to Brussels to speak to the European Parliament. His theme was the threats to democracy posed by Russia’s invasion of Ukraine and the growing distrust of governments in the West in the face of economic uncertainty.

From the National Post:

Prime Minister Justin Trudeau is making a plea to European leaders to come together as democracies in the face of Russia’s unprovoked invasion of Ukraine and tackle rising uncertainties citizens have about the future.

Trudeau said economic frustrations are threatening the stability of the world and driving a deep uncertainty about the future and distrust of government.

He also said democracies face a new threat from Russian President Valdimir Putin and his attack on Ukraine, which Trudeau called a violation of international law with the targeting and killing of civilians in hospitals and residential buildings.

Trudeau said the war in Ukraine poses a security threat not only to Europe, but to western democracies and the world.

“Putin’s attack on Ukraine is an attack on the values that form the pillars of all democracies. We have a responsibility to make the case to people about why these values matter so much — not just to Ukrainians but to us all,” Trudeau said in his remarks.

You can almost hear him speaking earnestly in his near-whisper, can’t you? Luckily, a few EU parliamentarians offered him more than a mirror. During his allotted time to speak at the meeting, Mislav Kolakusic, a Croatian member of the European Parliament (MEP), criticized the Canadian government’s hardline approach to protests by truck drivers in Ottawa.

After Trudeau waxed poetic about democracy, Kolakusic held nothing back: “Freedom, the right to choose, the right to life, the right to health, the right to work for many of us are fundamental human rights for which millions of citizens of Europe and the world have laid down their lives to defend our rights and the rights of our children which we have acquired over the centuries.”


He continued, “Many of us, including myself, are willing to risk our own freedom and our own lives. Unfortunately, today, there are those among us who trample on these fundamental values.”

Croatians are all too familiar with authoritarian rule in the modern age.

Speaking directly to Trudeau, he added, “Canada, once a symbol of the modern world, has become a symbol of civil rights violations under your quasi-liberal boot in recent months. We watched how you trample women with horses, how you block the bank accounts of single parents so that they can’t even pay their children’s education and medicine, that they can’t pay utilities, mortgages for their homes.”

Romanian MEP Cristian Terhes issued a statement announcing his decision not to attend Trudeau’s speech.  It was just as brutal as Kolakusic’s comments: “You can’t come and teach democracy lessons to Putin from the European Parliament when you trample with horse hooves your own citizens who are demanding that their fundamental rights be respected.”

In another paragraph, he asserted that Trudeau is no better than Putin. “When you, a politician from the ‘west,’ implement in your home methods of repression and the trampling of the rights of your own citizens, who demand their rights be respected, as Putin does at home, you are no better than him.”

Terhes went on to criticize Western leaders more generally. “These imposter leaders of today’s west have brought the world into the chaos we find ourselves in today, precisely because they have strayed from the values that made the ‘west’ a free and prosperous world.” He added, “The departure of western leaders from these values (individual liberty, respect for rights and freedoms, etc.) not only made them lose their moral ascendancy but allowed the rise of tyrants like Putin.”

Then Terhes articulated something Americans are noticing about the current global skirmish: “Between the Russian imperialist tyranny, promoted by Putin, and the neo-Marxist tyranny pretending to be progressivism promoted by the likes of Trudeau, in which people are deprived of their rights and freedoms, becoming objects of the state, I do not choose any.”

Of course, if you suggest that something seems off with the conflict, you will be called a Putin stooge. Just ask Tucker Carlson or Tulsi Gabbard.

Terhes was just as plain-spoken during the crackdown in Ottawa. “He’s exactly like a tyrant, a dictator. He’s like Ceaușescu in Romania,” he said. “If even you doubt, if you raise doubts about the [COVID] vaccines, you’re outcasted.”

Hopefully, Trudeau returned home demoralized. Maybe he will send Freeland after his detractors in Brussels. It is probably too much to expect that President Biden will receive similar truth bombs from members of the EU Parliament during his attendance at a meeting of NATO. However, with the two-tiered justice system that is obvious to anyone to the right of Hilary Clinton, the blatant corruption of the Biden family detailed on Hunter Biden’s laptop, and a corporate media and oligarchy intent on burying stories critical of our regime, how far are we from a Western oligarchy similar to the one Putin oversees?


The Courts Corruption Elections Politics

Judge Tosses Maryland Congressional Map Over ‘Extreme Partisan Gerrymandering’

Views: 31

The Maryland State Capitol Building in Annapolis, Md., in a file image. By Zachary Stieber for Epoch Times  March 26, 2022

A Maryland judge on March 25 threw out a congressional map lawmakers recently enacted, ruling that it was a product of “extreme partisan gerrymandering.”

Anne Arundel County Senior Judge Lynne Battaglia, an appointee of former Democrat Gov. Glendening, found that the map unconstitutionally was aimed at reducing the power of Republican voters because it shifted the only GOP member of Congress representing Maryland, Rep. Andy Harris (R-Md.), into a different district, where he was likely to lose.

The new map, approved by Democrat state lawmakers in Maryland in late 2021, left Democrats with an estimated advantage in every single one of the eight congressional districts, according to the Princeton Gerrymandering Project.

Further, Sean Trende, an elections analyst tapped by plaintiffs, found through voting simulations that Democrats would likely win all eight districts.

Trende testified in the case that the map was drawn “with an intent to hurt the Republican party’s chances of letting anyone in Congress” and “dilutes and diminishes the ability of Republicans to elect candidates of choice.”

Allan Lichtman, another analyst, told the court that Trende’s analysis was lacking and that he believed the map was actually tilted towards Republicans compared to previous maps, which would lead to the GOP gaining seats in the 2022 midterm elections. But he drew criticism from the judge when he falsely said the map did not pit Harris against Rep. Kewisi Mfume (D-Md.) in Maryland’s Seventh Congressional District—Harris moved to Cambridge after the map was enacted so he could defend the seat he holds—and he acknowledged under cross-examination that Democrats did not lose seats during midterm elections during former President Barack Obama’s time in office.

Battaglia said she found Trende’s testimony and analysis compelling and ruled that the map “is an outlier and product of extreme partisan gerrymandering.”

She ordered the General Assembly to develop a new plan “that is constitutional.”

The ruling came after voters represented by Fair Maps Maryland and Judicial Watch sued over the map.

“Judge Battaglia’s ruling confirms what we have all known for years—Maryland is ground zero for gerrymandering, our districts and political reality reek of it, and there is abundant proof that it is occurring,” Doug Mayer, spokesman for Fair Maps Maryland, said in a statement.

“This key court victory against abusive partisan gerrymandering by Democrats in Maryland could set a national precedent,” Judicial Watch President Tom Fitton.

Members of the legislature on the General Assembly commission that was in charge of making the map did not respond to requests for comment.

Maryland  Sen. Bill Ferguson and state Del. Adrienne Jones, both Democrats and members of the panel, said in a joint statement after the map was enacted that it “provides cleaner lines and more compact districts while keeping a significant portion of Marylanders in their current districts, ensuring continuity of representation.”

Maryland Attorney General Brian Frosh, a Democrat, has not decided on whether an appeal will be lodged, his office told The Epoch Times in an email.

Maryland Gov. Larry Hogan, a Republican who formed a body that recommended a different map, said the ruling “puts in plain view the partisan, secretive, and rigged process that led to the legislature’s illegal and unconstitutional maps” and called on lawmakers to adopt the map drawn up by the body.


COVID Drugs Politics

Kansas Senate Passes Bill to Authorize the Prescriptions of Ivermectin and Hydroxychloroquine and Child Vaccine Exemptions

Views: 9

Kansas state senators passed a bill early Thursday that would authorize the prescriptions of off-label drugs for Covid-19 treatment, such as Ivermectin and hydroxychloroquine. The bill also exempts children from being vaccinated if “such immunizations would violate sincerely held religious beliefs.”

Senate Sub. for HB 2280, as amended, concerns prescribing and dispensing of drugs for off-label use and religious exemptions for childhood vaccines, the bill stated.

The bill was passed with 21 voted yes, and 16 voted no.

Capital-Journal reported:

The Senate worked on a host of bills into the early morning hours in a marathon session. The off-label drug bill, HB 2280, passed 21-16 shortly before 1:30 a.m.

“Thousands of Kansans and hundreds of thousands of Americans have died because of this propaganda that shut down early treatment,” said Sen. Mark Steffen, R-Hutchinson. “I fully believe that this passage of this bill through the Senate will gain national attention and help be a very important part of getting the care to the people who need it.”

The bill would allow doctors to prescribe ivermectin, hydroxychloroquine and any other FDA-approved drug that isn’t a controlled substance for an off-label use to prevent or treat COVID-19.

It further requires pharmacists to fill the prescriptions, removing their professional discretion to refuse to fill a prescription, unless they find a reason other than the connection to COVID-19.

“With this provision, a doctor can write a prescription for abortion medication under the guise of COVID, and the pharmacist must fill it,” said Cindy Holscher, D-Overland Park, who opposed the bill.

Another piece protects doctors from board of healing arts investigations connected to the pandemic, prohibiting any “recommendation, prescription, use or opinion” on COVID-19 treatments from being considered unprofessional conduct.

The bill also expands existing religious exemptions for childhood wellness vaccines at schools and day cares. It effectively creates a new exemption where any parent can claim a moral or ethical exemption to any youth vaccinations.



Corruption How sick is this? Progressive Racism

WOKE: NYC’s “Chief Medical Officer” :Mocking Designation for White Moms

Views: 33

The left’s rhetorical war on women and white people has infested the “objective” field of medicine and is escalating to absurd lengths.

In the latest salvo, the clownish chief medical officer of New York City referred to pregnant women as “birthing people” and specifically marginalized white moms with this dehumanizing designation.

Dr. Michelle Morse is New York’s first “chief medical officer,” and she was specifically chosen for this new post because of her focus on pushing “racial equity.”

That’s PC speak for “whatever helps black people.”

“Dr. Morse’s experience has combined the best of public health, social medicine, anti-racism education, and activism,” Health Commissioner Dr. Dave Chokshi said in a February 2021 news release announcing her appointment.

“Health equity requires leaders who propel change and I am grateful that she has joined the Department to help us create a healthier, more equitable, city,” Chokshi said.

On Wednesday, Morse made the case for taxpayer-funded doulas (that’s like a midwife without the health care training) targeting pregnant black and brown women.

The far-left activist claimed minority women need free doulas because the mortality rate of black mothers in New York is higher than for white moms.

Naturally, Morse blamed this alleged disparity on sham systemic racism and not on the post- and pre-birth health habits of white vs. black mothers.

In her bizarre tweets, she specifically referenced “Black and Puerto Rican mothers” while dismissing white moms as “non-Hispanic White birthing people.”

“Mortality rates of birthing people are too high, and babies born to Black and Puerto Rican mothers in this city are three times more likely to die in their first year of life than babies born to non-Hispanic White birthing people,” Morse said.

Numerous Twitter users slammed Morse for her degrading categorization of pregnant women as “birthing people.”

Many also called Morse out for her shady dig at white moms.

Morse’s racist tweets promoted New York Mayor Eric Adams’ multimillion-dollar, taxpayer-funded program to provide free doulas in 33 minority neighborhoods.

In a news release Wednesday, Adams — who once mocked white cops using the racial slur “crackers” — said the program was part of an effort to help black and Hispanic mothers.

“All three initiatives are part of Mayor Adams’ mission to reduce health inequities in New York City, particularly amongst marginalized Black and Latino/a families and pregnant people,” the release said.

“Maternal and infant health inequities are rooted in generations of structural racism and disinvestment,” it said.

“In New York City, Black women are nine times more likely to die of a pregnancy-related cause than white women, and their rate of infant mortality is more than three times higher. For Puerto Ricans, the infant mortality rate is twice that of white New Yorkers.”

While many Americans are struggling with soaring grocery and gas prices, some of our tax dollars are being used to help only certain groups under racist Democratic leadership.

A birth doula remains with the mother during birth, offering relaxation and breathing technique support, as well as comforting services like massage, and assistance with labor positions; however, doulas are not medically trained, and cannot deliver babies. A doula is not a substitute for having a woman’s partner at the birth. Doulas encourage participation from the partner, and offer support and reassurance to the partner as well.

Comment: so these non-medically trained people are going to lower mortality rates how?


COVID Biden Pandemic

What Could Explain the Lower COVID-19 Burden in Africa despite Considerable Circulation of the SARS-CoV-2 Virus? No Tony the Fauch.

Views: 54

Department of Cultures, Societies, and Global Studies, Northeastern University, 201 Renaissance Park, 360 Huntington Ave., Boston, MA 02115, USA
Department of Public Health, Institute of Tropical Medicine, B-2000 Antwerp, Belgium
DUNDEX (Deployable U.N.-Experienced Development Experts), FX68 Belturbet, Ireland
School of Public Health, University of Illinois at Chicago, Chicago, IL 60607, USA
School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
Researcher Africa Institute for Health Policy Foundation, Nairobi 020, Kenya
T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
Author to whom correspondence should be addressed.
Academic Editors: Anthony R. Mawson and Paul B. Tchounwou
Int. J. Environ. Res. Public Health 2021, 18(16), 8638;
Received: 7 July 2021 / Revised: 13 August 2021 / Accepted: 13 August 2021 / Published: 16 August 2021
(This article belongs to the Collection Outbreak of a Novel Coronavirus: A Global Health Threat)


The differential spread and impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing Coronavirus Disease 2019 (COVID-19), across regions is a major focus for researchers and policy makers. Africa has attracted tremendous attention, due to predictions of catastrophic impacts that have not yet materialized. Early in the pandemic, the seemingly low African case count was largely attributed to low testing and case reporting. However, there is reason to consider that many African countries attenuated the spread and impacts early on. Factors explaining low spread include early government community-wide actions, population distribution, social contacts, and ecology of human habitation. While recent data from seroprevalence studies posit more extensive circulation of the virus, continuing low COVID-19 burden may be explained by the demographic pyramid, prevalence of pre-existing conditions, trained immunity, genetics, and broader sociocultural dynamics. Though all these prongs contribute to the observed profile of COVID-19 in Africa, some provide stronger evidence than others. This review is important to expand what is known about the differential impacts of pandemics, enhancing scientific understanding and gearing appropriate public health responses. Furthermore, it highlights potential lessons to draw from Africa for global health on assumptions regarding deadly viral pandemics, given its long experience with infectious diseases.

1. Background

As of 11 August 2021, approximately 7.1 million confirmed COVID-19 cases were reported in Africa continentwide [1]. Now, a year and a half since the first infection was reported in Egypt on 14 February 2020, Africa has accounted for just 3.5% of 204.2 million lab-confirmed cases [2], despite containing 12.5% of the global population [3]. Africa’s share of deaths is just 4.1% of the 4.3 million reported globally [2]. These numbers significantly defy early predictions of mass COVID-19 catastrophe [4,5,6,7]. The doom and gloom predictions were based on what was known about how the disease is transmitted, and how socially deprived settings, unsanitary living conditions, and weak health systems, which are common throughout the continent, could exacerbate spread and subsequent disease burden [6,8,9]. To date, mass infection spread, high rates of severe disease, and excess mortality due to COVID-19 on the continent have not been reported [10]. One important exception is South Africa, which carries a substantial 35% of the confirmed cases and 42% of total deaths among the 55 countries on the continent [1]. This leads to questioning the differences in reporting between African countries, as South Africa makes up only 4.8% of the 1.2 billion people living in Africa and has conducted a disproportionate 24% of the 50.6 million tests administered, as of 17 June 2021 [1].
Because of low testing capacities, Africa has conducted the least number of tests of all global regions given its population size [1,11], but has exceeded the Africa Centers for Disease Control and Prevention (Africa CDC) targets of 8000 tests per million [1]. This should be seriously considered as having contributed to an underestimation of cases [12]. Several seroprevalence studies offer insights on the extent of spread in the continent. For example, a cross-sectional household study in Zambia reported much higher infections than reported via the limited normative testing, which showed only one confirmed case reported for every 92 community infections [13]. Small antibody studies among healthcare workers in hospitals have reported up to a 36% prevalence in Kinshasa, DRC [14], 45.1% in Ibadan, Nigeria [15], and 12.3% in Blantyre, Malawi [16], during the period of May to June 2020. Studies among blood donors in Kenya and South Africa from April to June 2020 report anti-SARS-CoV-2-IgG seroprevalence of, respectively, 4.5% nationally [17] and 60% among South African black populations, seven times that of in-country white populations [18]. Two studies reported SARS-CoV-2-IgG positivity of 23.7% in workers of low socio-economic status in Cape Town, South Africa [19], and 25.1% in gold mine workers and administrative staff in Ivory Coast [20]. These studies collected blood samples between April and October 2020 during the first wave of the COVID-19 spread throughout the continent, with the second wave largely peaking around December 2020 [21]. While these studies offer insights, the results are variable. A true picture requires more and larger antibody studies in other geographies and populations over time [22]. Additionally, these data should be interpreted with caution, as none of these tests have been validated in African-specific contexts where it is possible that cross-reactivity with other prevalent viruses, micro-organisms, and hypergammaglobulinemia due to malaria exposure may influence the sensitivity and/or specificity of these tests, potentially leading to either an underestimation or overestimation of seroprevalence [14,23,24,25,26,27].
The integrity of reporting case and death data in Africa has been repeatedly called into question. For instance, in January 2021, The New York Times published an article titled “A Continent Where the Dead Are Not Counted” [28]. However, while only 34.6% of countries globally have complete death registration data in the Civil Registration and Vital Statistics (CRVS), most African countries have a system in place [29], and there is no evidence that COVID-19 mortality data is less accurately reported in Africa than elsewhere. Only Tanzania ceased reporting COVID-19 cases or deaths since May 2020 [1]. The World Mortality Dataset reports the undercounting of COVID-19 deaths from many of the 77 countries included in the dataset, such as the U.S., U.K., and Russia, with South Africa, Egypt, and Mauritius being the only African countries listed [30]. While there are some reports of excess deaths from the continent [30,31], these may well be more due to the adverse indirect effects of pandemic prevention measures, such as lockdowns, causing a wide range of difficulties such as food shortages, and a near unilateral focus on COVID-19, diverting resources from treating other diseases and health conditions [32]. Despite having several limitations [33], data from an autopsy study in a small sample of deaths from a teaching hospital in Zambia indicated the underestimation of COVID-19 mortality is a problem in Africa [34]. Nevertheless, rapid mortality assessments for COVID-19 that is underway in some countries [35,36,37,38] could reveal a more complete picture. Expectedly, due to weak health systems, recent data show that Africa has a higher mortality in those with critical COVID-19 illness than elsewhere, with a mortality rate of 48.2% compared with a global average of 31.5% [39].
While various studies have postulated that demographic profile, early actions such as lockdowns, community factors, and possibly population-specific innate immune factors that are yet undetermined [9,12,40] have played a role in the apparently lower COVID-19 burden, the data and speculation still leave many questions unanswered [41,42]. Several articles in the popular media [43,44] postulate hypotheses, but to our knowledge there has not yet been a complete scholarly review. We are beginning to understand that context and history matter a great deal [45,46,47]. The first modelling of the pandemic for nearly all countries in Africa, based on multiple context-specific covariates, has more closely predicted what has been observed [48]. Here, a set of hypotheses to explore observations regarding SARS-CoV-2 spread and a comparatively low COVID-19 disease burden in the African region are examined. An analysis of factors underlying the spread and burden is important because of the potential for valuable global public health lessons, expanding on what is known regarding deadly viral pandemics, population and systems-level preparedness, and subsequent response.

2. On SARS-CoV-2 Spread

To understand the full picture of COVID-19 in Africa, we must first examine how spread patterns emerged, and what variables could have influenced these patterns. While recent data have shown extensive SARS-CoV-2 spread in the continent, this was not always thought to be the case, and the extent of the spread compared with other global regions is still somewhat debated. Below, we present three main areas of interest regarding viral propagation in an Africa-specific context.

2.1. Early Government Measures and Messaging

Many governments in Africa enacted early response measures to the pandemic [49,50,51,52]. On 5 February 2020, even before there was a single case reported in the continent, the Africa CDC had established the Africa Taskforce for Coronavirus (AFCOR), and on 22 April 2020, the WHO highlighted examples of how Africa was leading the global response. By 15 April 2020, 96% of the 50 African countries examined had in place at least five ‘stringent public health and social measures’ to prepare for the emerging pandemic [21]. Less international connectivity, early border closures, and lockdowns to prevent viral importation from international flight arrivals, especially from China [8], were associated with a lower case load [53]. Modelling studies also found reduced connectivity/travel at regional, national, and international levels as having an important early impact on slowing the spread [48,54].
Destructive epidemics are not new phenomena for Africa. The continent is constantly dealing with abundant infectious disease (e.g., malaria, yellow fever, tuberculosis, Ebola, polio) [55]. Due to their familiarity with these epidemics, many governments have developed effective public health programs with messaging aimed at unifying the community and highlighting the need for preventative action among individuals [56,57]; for example, the case of the response to Ebola in Western Africa [58,59,60] and to the HIV/AIDS epidemic in Uganda [61]. A similar unity around public health messaging has emerged around COVID-19 in many countries, including outside Africa in Vietnam (e.g., “Fighting the epidemic is like fighting against the enemy”) [12]. It is very possible that a certain baseline individual and community preparedness, awareness, and adherence to government public health recommendations on non-pharmaceutical interventions, and a readiness to adapt to a new epidemic had significant implications in stunting disease spread in the community.
Recent studies point to cultural adherence to government recommendations as being important for mitigating SARS-CoV-2 spread [62,63]. But are Africans, on average, more willing than other populations to respect in-country public health guidelines? Several surveys on adherence to masking, social distancing, and hand hygiene have been conducted in multiple countries, some of which are nationally representative [64]. Studies from Nigeria, Malawi, Ethiopia, Ghana, Kenya, and the DRC showed that although most participants had a good knowledge about COVID-19 transmission modes and prevention mechanisms that were consistent over place and time, there were gaps in the practices that prevent COVID-19 [65,66,67,68,69]. Studies further determined that individuals’ age, sex, educational status, occupation, and income level were associated with COVID-19 related practices [65,67,70,71]. From these studies, it can be concluded that awareness and (non)adherence to NPIs does not explain low reported cases.

2.2. Population Distribution and Structure of Social Networks

Population structure and spatial distribution strongly predict the patterns of SARS-CoV-2 transmission in communities [72,73]. Analysis of spatial and temporal clustering of populations shows a correlation between density/crowding and viral reproduction number [72]. Africa is the least urbanized global region, with 55% of the continent’s population living in rural areas with wide variations across countries [74,75]. Modelling shows greater reproduction rates in urban areas [48,76], and epidemiological data are skewed towards higher cases in urban areas across all countries [54,77]. A similar pattern was observed for Ebola [78]. South Africa, clearly the COVID-19 exception in the continent, is a rapidly urbanizing outlier, as only 30% of its population live in rural areas [75]. Nigeria, on the other hand, models the trends seen in the continent as a whole, with approximately a 50% rural population [75] and a low COVID-19 burden [1]. Limited research in Africa also shows significantly more intergenerational contacts in rural as compared to urban areas [79]. Researchers posit this distribution, household size, and patterns of age-structured social contacts modify the spread of epidemics [48,76,79,80]. Furthermore, a recent study depicts the effect that the nature of social networks and mobility have on COVID-19 transmission [81]. Communities with increased social capital tend to see worse disease outbreaks overall [81,82], although this is not always the case [83]. An increased feeling of integration and connection to society is beneficial in terms of social support, which could potentially benefit individual health outcomes, but may generally have negative consequences for containing infectious disease spread due to increased human contact [80].
The limited research conducted on social contact in Sub-Saharan Africa (SSA) shows that enhancing social distance mitigation strategies, particularly for elderly populations, would result in mortality decreases, but not to the extent that these changes would have in higher income settings, which tend to have increased proportions of elderly cohorts in the population [9]. The small slice of the African population who are older (only 3% of the African population is 65+) [3] live overwhelmingly at home, often with extended families spanning multiple generations. This alone explains a huge discrepancy in cases, as roughly one third to one half of deaths in wealthy countries, such as the U.S., have resulted from superspreading events in elderly nursing homes and assisted living facilities, providing the rationale for prioritizing the inoculation of these older individuals [84,85]. While multiple family homes generally have more people in a shared space than the typical single-family homes of Western countries, this slightly increased risk of within-household spread is offset by the significantly decreased risk of large-scale superspreading events in the community, often caused by congregate nursing home settings [86]. Despite an increasing trend of elders being cared for in long-term care facilities in Africa [87], especially in South Africa [88], this is still far less commonly practiced than in Western countries, Asia [89], or Latin America [90,91].

2.3. A Largely Outdoor Existence

Because infected persons transmit the virus through coughing, sneezing, talking, singing, and breathing [92], living environments matter. Further, viability and infectivity are influenced by environmental conditions [46,93]. Studies show that coronavirus transmission, while also possible outdoors [94], is concentrated in indoor settings where it is estimated to be about 19 times higher [95]. While most likely only minimally contributing to viral spread, built environments requiring ventilation, air-conditioning/heating, wastewater, and sewer systems have been shown to carry the virus that may escape through aerosolization [96,97,98]. These systems are generally in urban areas and are almost entirely lacking in rural Africa where most people live. In contrast, respondents in the U.S. National Human Activity Pattern Survey reported spending over 90% of time in enclosed environments, either in buildings or in their cars [96,99].
African livelihoods that are largely dependent on agriculture and pastoralism favor dawn-to-dusk outdoor lifestyles, with shelters used mostly for sleeping. Research shows people in rural areas spend far more time outdoors as compared to urban areas [100]. Even in the case of sleeping, these homes are often well ventilated with outside air, significantly reducing the chance of viral transmission when compared to tightly enclosed indoor spaces in developed countries. Additionally, higher temperatures and UV light intensity have been shown to predict SARS-CoV-2 spread [101,102], although the evidence is inconsistent [103]. Prolonged, year-round outdoor living with direct exposure to UV light in mostly warm and tropical climates could partially explain reduced transmission [46], perhaps due to endogenously produced vitamin D, which is suggested in some studies, including a systematic review and meta-analysis, to attenuate COVID-19 symptom severity [104,105]. Vitamin D supplements are under several ongoing clinical investigations [106].
As a final note regarding the extent of transmission, even if the SARS-CoV-2 virus is more widespread than reported as seroprevalence data suggest, there still has been much less morbidity and mortality observed. The proposed factors reviewed above provide some insight into how African-specific transmission patterns have emerged and evolved over time.

3. Factors Mitigating COVID-19 Burden in Africa

Even though case and death reporting has certainly been less reliable in Africa, there has been very little evidence of increased overall mortality or widespread COVID-19 disease, with the exceptions of South Africa and northern African countries. We now examine what could possibly explain this somewhat perplexing situation.

3.1. Demographic Pyramid

It is beyond doubt that the demographic pyramid is significantly related to decreased COVID-19 burden. It is well documented that COVID-19 burden is heavily skewed towards older populations [107,108], as demonstrated by a study of 17 million COVID-19 cases [109]. Compared with a reference demographic group of 5–17 years, the demographic of 65–74 years is 35 times more likely to become hospitalized from SARS-CoV-2 infection, and 1100 times more likely to die from COVID-19, with these risks increasing significantly in even higher age groups [108,109]. Africa has the youngest population among all global regions, with a median age of 19.7 years [25,51]. Conversely, the median ages among the hardest hit countries are much higher: 26.8 years in India [110], 31.4 years in Brazil [111], 38.5 years in the U.S. [112], and 40.5 years in the U.K. [113]. Modelling clearly shows that the COVID-19 mortality for Africa tracks this similar age pattern [48,54], and this is confirmed by actual current mortality data [114]. Through conducting a simple linear regression to show between-region differences, regressing cumulative mortality per 1 million population on the ratio of population aged 65+ vs. aged 15–64, the R2 = 0.283 is found, meaning that the variance in mortality accounted for by age structure is 28.3% (Figure 1) [2,75,115]; the cumulative mortality figures used here are for the period since the beginning of the pandemic through 17 June 2021, as reported on (accessed on 17 June 2021), which utilizes Johns Hopkins University Centers for Systems Science and Engineering COVID-19 data [2]. These data provide evidence that despite the considerable spread of infection, COVID-19 disease and mortality burden in younger African populations is comparatively absent. However, South Africa shows a much higher mortality than many countries with a similar age structure, including India and Egypt, meaning that other factors are also at play.
Figure 1. This analysis is based on data extracted from accessed on 17 June 2021, retaining data on countries with populations of at least 1 million, for which complete data were available for the analyses done. Among these countries, as one would expect, COVID-19 mortality is strongly correlated with age structure. Note the concentration of purple dots in the bottom left, indicating comparatively low COVID-19 mortality and young age structure among most African countries. The Pearson’s R2 for cumulative COVID-19 mortality and the ratio of persons aged 65+ to those aged 15–64 is 0.283; for example, 28.3% of the between-country variance in cumulative COVID-19 mortality can be accounted for by age structure alone.

3.2. Pre-Existing Conditions

It is well known that people with pre-existing conditions, such as diabetes, chronic respiratory diseases, obesity, and hypertension have a greatly increased risk of moderate to severe complications from COVID-19 infection [53,116,117]. Broadly, these conditions are considerably less prevalent in low income and lower middle income countries (LICs and LMICs) when compared to higher income countries (HICs) [9,118], providing an additional possible explanation for why COVID-19 burden is more reduced in the African continent. Indeed, African countries have a low prevalence of NCDs (only accounting for 29.8% of total burden of disease in SSA, with the majority of burden coming from infectious disease) [119], compared to 88% in the US and 74% in Brazil [120], which align with the impact of pre-existing conditions on increasingly severe complications and death from COVID-19 [9,116]. South Africa, which accounts for nearly 40% of all reported COVID-19 cases and deaths in the continent [2], reports an exceptionally high burden of NCDs [119,121]. However, some research suggests that the prevalence of infectious disease can similarly exacerbate COVID-19 burden and may actually indicate that regions with high infectious disease and low NCD prevalence (such as in Africa) are not advantaged [9,25]. For instance, a recent cohort study in South Africa suggested that HIV was associated with a doubling of mortality risk of COVID-19 [122]. This is potentially significant to consider in explaining why South Africa has a disproportionate COVID-19 burden in the continent, given that it also has the greatest number of people living with HIV/AIDS in the world [123]. More studies are needed, however, before this potential association can be determined.

3.3. Trained Immunity

The phenomenon of trained immunity may be tempering the COVID-19 burden in the continent. Here, we focus on four elements underlying this hypothesis: (i) BCG vaccinations, (ii) exposure to varied commensal microorganisms, or the “hygiene hypothesis”, (iii) prevalence of infectious diseases, and (iv) historical use of herbal plants and remedies.
(i) Live vaccines activate innate immune systems, conferring protection against future infections from other pathogens [124,125,126,127,128,129], which researchers believe may have the potential to also attenuate consequences of infection with SARS-CoV-2 [130]. Recent data suggest that regions with mandated BCG vaccinations have had lower COVID-19 disease burden [131], which may speak to an association between BCG vaccination rate and population COVID-19 burden. Children vaccinated with BCG could have a lower infection risk with SARS-CoV-2 [132], continuing well into adulthood. Interestingly, and applicable to COVID-19, BCG vaccination was shown to be especially protective against complications of other respiratory viral infections, supported by studies in Guinea-Bissau and South Africa [133,134]. Additionally, in rodent models, BCG reduces viral load from infection by influenza A and herpes simplex virus type 2 (HSV2) [135,136], with a mediation by a boosted innate, nonspecific immune defense via increased cytokine production and macrophage action. It is not known if BCG immunity confers such protection in older populations [132], but this has been suggested by some research [137]. This is hypothesized in part from observations in countries that lagged behind other efforts to disseminate BCG, such as Iran and Somalia, which have incurred a significant death toll from COVID-19. Still, it is possible that countries with earlier BCG administration campaigns have contributed to the protection of older populations from heavy COVID-19 burden, through childhood inoculation for tuberculosis [137]. Because COVID-19 complications are often a result of significant systemic inflammation [138,139], the fact that inoculation with BCG boosts an innate immunity that subsequently lowers the extent of inflammation [132] indicates that it could be a pathway by which BCG attenuates infection of SARS-CoV-2. Of course, controlled clinical trials are needed to verify this hypothesis. While this varies, most African countries have high BCG coverage [140], with the notable exception of Somalia, due to the long-standing civil wars interfering with child vaccination programs. As noted in one study, countries without universal policies for BCG vaccination (such as Italy, the U.K., Spain, and the U.S.) have experienced much more severe disease burden compared to countries with universal programs (including most African countries and Japan, for example) [137]. However, this association may be primarily due to other factors; for example, countries that have a BCG vaccine mandate may tend to have stricter public health measures in place that could indirectly affect population COVID-19 burden, instead of the effect being driven primarily by BCG vaccination. Furthermore, if this BCG hypothesis turns out to have some merit, countries in Africa with similar levels of BCG coverage and population structure should show comparable COVID-19 burden.
(ii) The so-called “hygiene hypothesis” posits that some environments advantage populations against certain forms of infection and disease, due to chronic exposure to a multi-microbial environment, potentially producing protective immune effects when encountering new pathogens [130,141]. There has been some concern regarding regions that use ultra-hygienic practices, exemplified by the overuse of hand sanitizer and other disinfection practices in many countries, as inadvertently creating a disadvantage for confronting new immune challenges such as SARS-CoV-2 [130]. Accordingly, non-specific immunity would be weakened and may have implications for disrupting the adaptive composition of commensal organisms on the skin, gastrointestinal tract, and other organ systems [130]. Because COVID-19 is a relatively new viral problem, it may take a while before conclusive statements can be made about the role of the microbial environment on infection susceptibility, but researchers agree that this hypothesis is plausible [130], in part indicated by the aforementioned dichotomy of burden between richer and poorer countries [142,143]. Higher income countries (with a few exceptions) have suffered much greater COVID-19 burdens (specifically, hospitalization and death rates) than the poorest countries, on average [2]. Such data raise the consideration that richer countries could be maladaptively over-sanitizing.
(iii) Given that 22 of the 25 most vulnerable countries to infectious disease epidemics are in Africa (the other three being Afghanistan, Haiti, and Yemen) [144], the continent carries the heaviest burden of infectious diseases, including the impoverishing neglected tropical diseases (NTDs) [145,146]. During 2018 alone, SSA faced 96 disease outbreaks in 36 of 47 countries [55]. This pathogenic environment precipitates the wide use of antibiotics, antimalarials, and other drugs to treat NTDs, such as azithromycin and ivermectin often distributed through mass drug administrations [147,148,149,150,151], which might counteract to mitigate COVID-19 morbidity. In particular, used widely over several decades in SSA, ivermectin has been spotlighted as a potential treatment for COVID-19 [152,153], including by the NIH [154,155]. Researchers have postulated that “circulating viruses or parasites in the African subcontinent” could explain high SARS-CoV-2 antibody seropositivity [14]. For instance, of 228 million cases of malaria worldwide in 2018, 93% were in SSA [156]. Notably, South Africa is not generally endemic for malaria and other NTDs [157]. Intense malaria exposure (which is frequent in many rural areas in SSA and much less so in urban areas, and not at all in South Africa or in northern Africa countries) has a strong influence on the immune system and could contribute to a better trained immunity [158,159]. It is possible that infection by malaria alone may overstimulate the immune system and confer an immune advantage when compared to nonexposed populations. To further investigate this potential role, as very few to no communities outside of Africa are holo-endemic for the disease [160], mechanistic studies would be needed to determine if there is cross-immunity between malaria and SARS-CoV-2 exposure.
(iv) Yet to be measured, the historical use of natural medicine for primary care [161,162,163] and widespread belief of self-medication with these for COVID-19 in Africa has triggered a WHO-AFRO expert panel in September 2020 to endorse a protocol for the clinical investigation of herbal medicine for COVID-19 [164]. During 30 March–1 April 2021, the Third Regional Consultation with Experts and Researchers on the Contribution of Traditional Medicine to COVID-19 Response in the African Region was held, with contributions from scores of scientists and countries. The case for exploring natural medicine in the fight against COVID-19 is justified [165]. Although African countries such as Madagascar have endorsed the wide use of a traditional therapeutic agent to fight COVID-19, there are no published scientific data that would lend support to this claim. (accessed on 7 July 2021) reports that several studies are underway, including Chinese traditional herbal medicines [166]. The establishment in Africa of a Regional Expert Advisory Committee on Traditional Medicine for COVID-19 compromising 25 members speaks to the widespread use of and belief in herbal medicine as possible means of prevention or cure of COVID-19.

3.4. Genetics

Recent work suggests that there is a role for genetics in COVID-19 trajectory, and in differentially affecting separate populations [167,168]. Some genetic immunological factors could possibly be playing a role in shielding Africa from the brunt of the pandemic [41]. For example, SARS-CoV-2 infects human cells largely through its interactions with the ACE2 receptor, involved in regulating blood pressure dynamics [6,117,169]. Populations varying in the expression of the ACE2 protein may have different baseline ‘openness’ for infection. African people have been shown to respond less effectively to ACE inhibitors for treatment of blood pressure, and have less expression of ACE2; therefore, there is potential for a more difficult route that the virus must maneuver to infect cells in this population [6,169]. There also may be genetic susceptibility via the 3p21.31 gene cluster, as one GWAS study showed ABO blood group A as having the highest risk of COVID-19-associated respiratory failure, with group O having the lowest risk [170]. Studies have shown that African populations have a particularly high proportion of O-positivity at nearly 50%, which is higher than in White and Asian populations [171,172,173]. It is possible that this increased O prevalence could be conferring a greater protective effect in African populations compared with other groups with less O prevalence; however, no studies have concluded this. While this hypothesis is somewhat challenged by the particularly heavy COVID-19 burden facing African Americans in the U.S. [174], who would likely share some or most of these genetic advantages [175,176], elevated levels of NCDs are observed more in African Americans than in continental African populations [119,177,178], which could help explain this discrepancy along with other adverse socioeconomic and cultural factors.

3.5. Broader Sociocultural Implications

Importantly, inequality of distribution of income (standardized by the GINI co-efficient) appears to be at least partially correlated with increasing disease burden of COVID-19, as South Africa (with a value of 63.1, among the highest in the world) and Brazil (54.7) [179] have been hit hard by COVID-19. One study of the top 50 countries with the highest numbers of cases suggests that increased income inequality was associated with increased severe cases and mortality [53]. Across the US, Brazil, South Africa, and Europe, increased mortality has been reported among minority groups such as Africans and Asians [180,181]. Three countries (South Africa, Brazil, the U.S.) seem to have similar risk profiles: long historical cleavages of institutional racism and inequality [182,183] that exacerbate COVID-19 vulnerabilities among large Black populations. The role in which inequality and poverty play totally depends on the behavior and the biological/immunological factors that they influence. For example, in New York and in other U.S. cities, poor people have difficulty isolating themselves, as they commonly utilize public transportation, share living spaces with more people, work in crowded environments, and overall, have lower social mobility [184]. In contrast, in many African cities, the social and political elites are the ones who can afford to live and work in airconditioned closed spaces, increasing susceptibility to infection through close, indoor contact with others [185]. However, this should not be generalized as the case in every African country, as work has also pointed to the similar theme of poorer populations facing a higher burden, such as in South Africa, with the elites largely shielded from the virus [186].

4. Conclusions

Relatively low severity and death due to COVID-19 in Africa presents somewhat of a paradox [41,42,187]. Despite early ‘doomsday’ predictions for Africa, the continent succeeded in stemming the first wave of SARS-CoV-2 spread [188], although the second wave was more severe [21]. On the whole, the factors discussed here have contributed to modulating disease spread and severity; however, the strength of evidence of each varies. A third wave that is currently underway in many countries appears to bring more consequential morbidity and mortality concerns, and possible impacts [189], especially as early government measures have been relaxed in many countries [21]. Driven by more virulent and potentially lethal variants, such as Delta, this third wave may prove far more challenging for weaker health systems to cope with, leading to increased hospitalizations and deaths [190]. Future waves are also likely. Alongside facing the lowest quality of health systems [9,191], the continent will be significantly challenged if it faces an excessive COVID-19 disease burden [192]. Estimates already show that many excess deaths, especially in the SSA region, will result not from COVID-19 but from disruptions in programs addressing malnutrition [193], HIV/AIDS [194], malaria [195], and maternal and child health deaths [32], along with interruptions in the implementation of immunization programs [196]. Therefore, a range of policy options taking this into account, as well as considering economic and socio-cultural characteristics including the expected benefits and harms of control measures (e.g., adverse effects on education and livelihoods) [7,42], need to be implemented.
It is likely that SARS-CoV-2 has already been widely disseminated through Africa, yet evidently without having had the severe consequences of COVID-19 burden, such as the significant uptick in hospitalizations and deaths that many other regions have experienced [25]. If so, widespread infection is likely to also result in widespread natural immunity [197]. While the true picture of infections and mortality in the continent has yet to fully emerge, the quality of data for other diseases, such as HIV/AIDS, indicates that Africa has the capacity to collect and report valid disease surveillance data [198], which should give a degree of confidence in the existing COVID-19 data and the ability for the continent to do better. Nevertheless, improving completeness of data collection and reporting is an ongoing mission for Africa and elsewhere [30,199]. Strengthening lab capacities, validating current rapid tests in the context of other infectious diseases, and standardizing data and survey reporting will also expand the true picture [42]. Additionally, before the COVID-19 pandemic in 2019, researchers and policy makers from Africa called for a new model of public health in the 21st Century, precisely to prepare for this kind of pandemic [200]. Now, as the pandemic evolves, the vaccine rollout needs to be especially accelerated to reach more people, as the continent lags with less than 5% of its population having received at least one shot as of August 2021 [201]. We also urge the continuation of measures for which there is clear evidence of effectiveness [202]. While what has been observed is a comparatively low morbidity and mortality from COVID-19 in Africa, the continent faces a significant threat with the current progression of the pandemic that may change what has been seen thus far [203]. Still, as our assessment here shows, the unique experience of African countries may offer salient lessons for the rest of the world, given their long experience with infectious diseases and outbreak readiness [56,57

Author Contributions

Conceptualization, W.V.D., D.A., R.C.B., S.H. and R.G.W.; writing—original draft preparation, R.G.W. and J.L.H.; writing—review and editing, R.G.W., J.L.H., W.V.D., D.A., R.C.B., S.H., U.A. and M.A.; visualization, S.H. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.


We would like to thank Daniel Halperin, Mead Over, Norman Hearst, and Alan Whiteside for their contributions to the development of this paper.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Coronavirus Disease 2019 (COVID-19) Dashboard. Africa Centres for Disease Control and Prevention. 2021. Available online: (accessed on 4 August 2021).
  2. Johns Hopkins Coronavirus Resource Center. Global Map. 2021. Available online: (accessed on 6 October 2020).
  3. United Nations Population Division. World Population Prospects. 2019. Available online: (accessed on 1 May 2021).
  4. El-Sadr, W.M.; Justman, J. Africa in the path of Covid-19. N. Engl. J. Med. 2020, 383, e11. [Google Scholar] [CrossRef]
  5. Pearson, A.C.; Van Schalkwyk, C.; Foss, A.M.; O’Reilly, K.M.; SACEMA Modelling and Analysis Response Team; CMMID COVID-19 Working Group; Pulliam, J.R. Projected early spread of COVID-19 in Africa through 1 June 2020. Eurosurveillance 2020, 25, 2000543. [Google Scholar] [CrossRef]
  6. Quaresima, V.; Naldini, M.M.; Cirillo, D.M. The prospects for the SARS -CoV-2 pandemic in Africa. EMBO Mol. Med. 2020, 12, e12488. [Google Scholar] [CrossRef]
  7. Mueller, V.; Sheriff, G.; Keeler, C.; Jehn, M. COVID-19 policy modeling in sub-Saharan Africa. Appl. Econ. Perspect. Policy 2020, 43, 24–38. [Google Scholar] [CrossRef]
  8. Gilbert, M.; Pullano, G.; Pinotti, F.; Valdano, E.; Poletto, C.; Boëlle, P.-Y.; D’Ortenzio, E.; Yazdanpanah, Y.; Eholie, S.P.; Altmann, M.; et al. Preparedness and vulnerability of African countries against importations of COVID-19: A modelling study. Lancet 2020, 395, 871–877. [Google Scholar] [CrossRef]
  9. Walker, P.G.T.; Whittaker, C.; Watson, O.J.; Baguelin, M.; Winskill, P.; Hamlet, A.; Djafaara, B.A.; Cucunubá, Z.; Mesa, D.O.; Green, W.; et al. The impact of COVID-19 and strategies for mitigation and suppression in low- and middle-income countries. Science 2020, 369, 413–422. [Google Scholar] [CrossRef]
  10. Fokoua-Maxime, D.C.; Amor-Ndjabo, M.; Ankobil, A.; Victor-Kiyung, M.; Franck-Metomb, S.; Choukem, S.P. Does sub-Saharan Africa truly defy the forecasts of the COVID-19 pandemic? Response from population data. medRxiv 2020. [Google Scholar] [CrossRef]
  11. Dzinamarira, T.; Dzobo, M.; Chitungo, I. COVID-19: A perspective on Africa’s capacity and response. J. Med. Virol. 2020, 92, 2465–2472. [Google Scholar] [CrossRef] [PubMed]
  12. Ogunleye, O.O.; Basu, D.; Mueller, D.; Sneddon, J.; Seaton, R.A.; Yinka-Ogunleye, A.F.; Wamboga, J.; Miljković, N.; Mwita, J.C.; Rwegerera, G.M.; et al. Response to the Novel Corona Virus (COVID-19) Pandemic Across Africa: Successes, Challenges, and Implications for the future. Front. Pharmacol. 2020, 11. [Google Scholar] [CrossRef] [PubMed]
  13. Mulenga, L.B.; Hines, J.Z.; Fwoloshi, S.; Chirwa, L.; Siwingwa, M.; Yingst, S.; Wolkon, A.; Barradas, D.T.; Favaloro, J.; Zulu, J.E.; et al. Prevalence of SARS-CoV-2 in six districts in Zambia in July 2020: A cross-sectional cluster sample survey. Lancet Glob. Health 2021, 9, e773–e781. [Google Scholar] [CrossRef]
  14. Ndaye, A.N.; Hoxha, A.; Madinga, J.; Mariën, J.; Peeters, M.; Leendertz, F.H.; Mundeke, S.A.; Ariën, K.K.; Tanfumu, J.-J.M.; Kingebeni, P.M.; et al. Challenges in interpreting SARS-CoV-2 serological results in African countries. Lancet Glob. Health 2021, 9, e588–e589. [Google Scholar] [CrossRef]
  15. Olayanju, O.; Bamidele, O.; Edem, F.; Eseile, B.; Amoo, A.; Nwaokenye, J.; Udeh, C.; Oluwole, G.; Odok, G.; Awah, N. SARS-CoV-2 seropositivity in asymptomatic frontline health workers in Ibadan, Nigeria. Am. J. Trop. Med. Hyg. 2021, 104, 91–94. [Google Scholar] [CrossRef] [PubMed]
  16. Chibwana, M.G.; Jere, K.C.; Kamn’gona, R.; Mandolo, J.; Katunga-Phiri, V.; Tembo, D.; Mitole, N.; Musasa, S.; Sichone, S.; Lakudzala, A.; et al. High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi. medRxiv 2020. [Google Scholar] [CrossRef]
  17. Uyoga, S.; Adetifa, I.M.O.; Karanja, H.K.; Nyagwange, J.; Tuju, J.; Wanjiku, P.; Aman, R.; Mwangangi, M.; Amoth, P.; Kasera, K.; et al. Seroprevalence of anti–SARS-CoV-2 IgG antibodies in Kenyan blood donors. Science 2020, 371, 79–82. [Google Scholar] [CrossRef]
  18. Sykes, W.; Mhlanga, L.; Swanevelder, R.; Glatt, T.N.; Grebe, E.; Coleman, C.; Pieterson, N.; Cable, R.; Welte, A.; van der Berg, K.; et al. Prevalence of anti-SARS-CoV-2 antibodies among blood donors in Northern Cape, KwaZulu-Natal, Eastern Cape, and Free State provinces of south Africa in January 2021. Res. Sq. 2021. [Google Scholar] [CrossRef]
  19. Shaw, J.A.; Meiring, M.; Cummins, T.; Chegou, N.N.; Claassen, C.; Du Plessis, N.; Flinn, M.; Hiemstra, A.; Kleynhans, L.; Leukes, V.; et al. Higher SARS-CoV-2 seroprevalence in workers with lower socioeconomic status in Cape Town, South Africa. PLoS ONE 2021, 16, e0247852. [Google Scholar] [CrossRef] [PubMed]
  20. Milleliri, J.M.; Coulibaly, D.; Nyobe, B.; Rey, J.-L.; Lamontagne, F.; Hocqueloux, L.; Giaché, S.; Valery, A.; Prazuck, T. SARS-CoV-2 infection in Ivory Coast: A serosurveillance survey among gold mine workers. Am. J. Trop. Med. Hyg. 2021, 104, 1709–1712. [Google Scholar] [CrossRef]
  21. Salyer, S.J.; Maeda, J.; Sembuche, S.; Kebede, Y.; Tshangela, A.; Moussif, M.; Ihekweazu, C.; Mayet, N.; Abate, E.; Ouma, A.O.; et al. The first and second waves of the COVID-19 pandemic in Africa: A cross-sectional study. Lancet 2021, 397, 1265–1275. [Google Scholar] [CrossRef]
  22. Usuf, E.; Roca, A. Seroprevalence surveys in sub-Saharan Africa: What do they tell us? Lancet Glob. Health 2021, 9, e724–e725. [Google Scholar] [CrossRef]
  23. Tso, F.Y.; Lidenge, S.J.; Peña, P.B.; Clegg, A.A.; Ngowi, J.R.; Mwaiselage, J.; Ngalamika, O.; Julius, P.; West, J.T.; Wood, C. High prevalence of pre-existing serological cross-reactivity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in sub-Saharan Africa. Int. J. Infect. Dis. 2020, 102, 577–583. [Google Scholar] [CrossRef]
  24. Yadouleton, A.; Sander, A.-L.; Moreira-Soto, A.; Tchibozo, C.; Hounkanrin, G.; Badou, Y.; Fischer, C.; Krause, N.; Akogbeto, P.; Filho, E.F.D.O.; et al. Limited specificity of serologic tests for SARS-CoV-2 antibody detection, Benin. Emerg. Infect. Dis. 2021, 27, 233–237. [Google Scholar] [CrossRef] [PubMed]
  25. Wang, L.; Dong, S.; Zhao, Y.; Gao, Y.; Wang, J.; Yu, M.; Xu, F.; Chai, Y. Epidemic characteristics of COVID-19 in Africa. Front. Phys. 2020, 8. [Google Scholar] [CrossRef]
  26. Chanda-Kapata, P.; Kapata, N.; Zumla, A. COVID-19 and malaria: A symptom screening challenge for malaria endemic countries. Int. J. Infect. Dis. 2020, 94, 151–153. [Google Scholar] [CrossRef]
  27. Jacobs, J.; Kühne, V.; Lunguya, O.; Affolabi, D.; Hardy, L.; Vandenberg, O. Implementing COVID-19 (SARS-CoV-2) rapid diagnostic tests in sub-Saharan Africa: A review. Front. Med. 2020, 7, 557797. [Google Scholar] [CrossRef]
  28. Maclean, R. A continent where the dead are not counted. The New York Times, 1 February 2021. [Google Scholar]
  29. United Nations. Report on the Status of Civil Registration and Vital Statistics in Africa; Economic Commission for Africa: Addis Abeba, Ethiopia, 2017.
  30. Karlinsky, A.; Kobak, D. The world mortality dataset: Tracking excess mortality across countries during the COVID-19 pandemic. medRxiv 2021. [Google Scholar] [CrossRef]
  31. Cardoso, K. Measuring Africa’s Data Gap: The Cost of Not Counting the Dead. 2021. Available online: (accessed on 22 February 2021).
  32. Roberton, T.; Carter, E.; Chou, V.B.; Stegmuller, A.R.; Jackson, B.D.; Tam, Y.; Sawadogo-Lewis, T.; Walker, N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study. Lancet Glob. Health 2020, 8, e901–e908. [Google Scholar] [CrossRef]
  33. Tembo, J.; Maluzi, K.; Egbe, F.; Bates, M. Covid-19 in Africa. BMJ 2021, 372, 457. [Google Scholar] [CrossRef] [PubMed]
  34. Mwananyanda, L.; Gill, C.J.; MacLeod, W.; Kwenda, G.; Pieciak, R.; Mupila, Z.; Lapidot, R.; Mupeta, F.; Forman, L.; Ziko, L.; et al. Covid-19 deaths in Africa: Prospective systematic postmortem surveillance study. BMJ 2021, 372. [Google Scholar] [CrossRef]
  35. Africa Centres for Disease Control and Prevention. Revealing the Toll of COVID-19: A Technical Package for Member States. Available online: (accessed on 22 June 2020).
  36. Setel, P.; AbouZahr, C.; Atuheire, E.B.; Bratschi, M.; Cercone, E.; Chinganya, O.; Clapham, B.; Clark, S.J.; Congdon, C.; De Savigny, D.; et al. Mortality surveillance during the COVID-19 pandemic. Bull. World Health Organ. 2020, 98, 374. [Google Scholar] [CrossRef] [PubMed]
  37. Post, L.A.; Argaw, S.T.; Jones, C.; Moss, C.B.; Resnick, D.; Singh, L.N.; Murphy, R.L.; Achenbach, C.J.; White, J.; Issa, T.Z.; et al. A SARS-CoV-2 surveillance system in sub-Saharan Africa: Modeling study for persistence and transmission to inform policy. J. Med. Internet Res. 2020, 22, e24248. [Google Scholar] [CrossRef]
  38. Rapid Mortality Surveillance for COVID-19 in West Africa. African Field Epidemiology Network (AFENET). Available online: (accessed on 8 April 2021).
  39. Biccard, B.M.; Gopalan, P.D.; Miller, M.; Michell, W.L.; Thomson, D.; Ademuyiwa, A.; Aniteye, E.; Calligaro, G.; Chaibou, M.S.; Dhufera, H.T.; et al. Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): A multicentre, prospective, observational cohort study. Lancet 2021, 397, 1885–1894. [Google Scholar] [CrossRef]
  40. Mehtar, S.; Preiser, W.; Lakhe, N.A.; Bousso, A.; TamFum, J.-J.M.; Kallay, O.; Seydi, M.; Zumla, P.S.A.; Nachega, J.B. Limiting the spread of COVID-19 in Africa: One size mitigation strategies do not fit all countries. Lancet Glob. Health 2020, 8, e881–e883. [Google Scholar] [CrossRef]
  41. Ghosh, D.; Bernstein, J.A.; Mersha, T.B. COVID-19 pandemic: The African paradox. J. Glob. Health 2020, 10, 020348. [Google Scholar] [CrossRef] [PubMed]
  42. Maeda, J.M.; Nkengasong, J.N. The puzzle of the COVID-19 pandemic in Africa. Science 2020, 371, 27–28. [Google Scholar] [CrossRef] [PubMed]
  43. Mukherjee, S. Why Does the Pandemic Seem to Be Hitting Some Countries Harder Than Others. 2021. Available online: (accessed on 22 February 2021).
  44. Leonhardt, D. A Covid mystery. The New York Times, 8 March 2021. [Google Scholar]
  45. Van Damme, W.; Dahake, R.; Delamou, A.; Ingelbeen, B.; Wouters, E.; Vanham, G.; Van De Pas, R.; Dossou, J.-P.; Ir, P.; Abimbola, S.; et al. The COVID-19 pandemic: Diverse contexts; different epidemics—How and why? BMJ Glob. Health 2020, 5, e003098. [Google Scholar] [CrossRef]
  46. Van Damme, W.; Dahake, R.; van de Pas, R.; Vanham, G.; Assefa, Y. COVID-19: Does the infectious inoculum dose-response relationship contribute to understanding heterogeneity in disease severity and transmission dynamics? Med. Hypotheses 2020, 146, 110431. [Google Scholar] [CrossRef]
  47. Cabore, J.W.; Karamagi, H.C.; Kipruto, H.; Asamani, J.A.; Droti, B.; Seydi, A.B.W.; Titi-Ofei, R.; Impouma, B.; Yao, M.; Yoti, Z.; et al. The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African region: A predictive model. BMJ Glob. Health 2020, 5, e002647. [Google Scholar] [CrossRef]
  48. Achoki, T.; Alam, U.; Were, L.; Gebremedhin, T.; Senkubuge, F.; Lesego, A.; Liu, S.; Wamai, R.; Kinfu, Y. COVID-19 pandemic in the African continent: Forecasts of cumulative cases, new infections, and mortality. medRxiv 2020. [Google Scholar] [CrossRef]
  49. Kuguyo, O.; Kengne, A.P.; Dandara, C. Singapore COVID-19 pandemic response as a successful model framework for low-resource health care settings in Africa? OMICS J. Integr. Biol. 2020, 24, 470–478. [Google Scholar] [CrossRef]
  50. Lone, S.A.; Ahmad, A. COVID-19 pandemic—An African perspective. Emerg. Microbes Infect. 2020, 9, 1300–1308. [Google Scholar] [CrossRef]
  51. Gaye, B.; Khoury, S.; Cene, C.W.; Kingue, S.; N’Guetta, R.; Lassale, C.; Baldé, D.; Diop, I.B.; Dowd, J.B.; Mills, M.C.; et al. Socio-demographic and epidemiological consideration of Africa’s COVID-19 response: What is the possible pandemic course? Nat. Med. 2020, 26, 996–999. [Google Scholar] [CrossRef] [PubMed]
  52. Moore, J. What African nations are teaching the west about fighting the coronavirus. The New Yorker, 15 May 2020. [Google Scholar]
  53. Chaudhry, R.; Dranitsaris, G.; Mubashir, T.; Bartoszko, J.; Riazi, S. A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes. EClinicalMedicine 2020, 25, 100464. [Google Scholar] [CrossRef]
  54. Rice, B.L.; Annapragada, A.; Baker, R.E.; Bruijning, M.; Dotse-Gborgbortsi, W.; Mensah, K.; Miller, I.F.; Motaze, N.V.; Raherinandrasana, A.; Rajeev, M.; et al. Variation in SARS-CoV-2 outbreaks across sub-Saharan Africa. Nat. Med. 2021, 27, 447–453. [Google Scholar] [CrossRef] [PubMed]
  55. Mboussou, F.; Ndumbi, P.; Ngom, R.; Kassamali, Z.; Ogundiran, O.; Van Beek, J.; Williams, G.; Okot, C.; Hamblion, E.L.; Impouma, B. Infectious disease outbreaks in the African region: Overview of events reported to the World Health Organization in 2018. Epidemiol. Infect. 2019, 147, e307. [Google Scholar] [CrossRef]
  56. Alam, U.; Nabyonga-Orem, J.; Mohammed, A.; Malac, D.R.; Nkengasong, J.N.; Moeti, M.R. Redesigning health systems for global heath security. Lancet Glob. Health 2021, 9, e393–e394. [Google Scholar] [CrossRef]
  57. Holst, C.; Sukums, F.; Radovanovic, D.; Ngowi, B.; Noll, J.; Winkler, A.S. Sub-Saharan Africa—The new breeding ground for global digital health. Lancet Digit. Health 2020, 2, e160–e162. [Google Scholar] [CrossRef]
  58. Wilkinson, A.; Parker, M.; Martineau, F.; Leach, M. Engaging “communities”: Anthropological insights from the west African Ebola epidemic. Philos. Trans. R. Soc. B Biol. Sci. 2017, 372, 20160305. [Google Scholar] [CrossRef]
  59. Laverack, G.; Manoncourt, E. Key experiences of community engagement and social mobilization in the Ebola response. Glob. Health Promot. 2015, 23, 79–82. [Google Scholar] [CrossRef]
  60. Shuaib, F.; Gunnala, R.; Musa, E.O.; Mahoney, F.J.; Oguntimehin, O.; Nguku, P.M.; Nyanti, S.B.; Knight, N.; Gwarzo, N.S.; Idigbe, O.; et al. Ebola virus disease outbreak—Nigeria, July–September 2014. MMWR Morb. Mortal. Wkly. Rep. 2014, 63, 867–872. [Google Scholar]
  61. Slutkin, G.; Okware, S.; Naamara, W.; Sutherland, D.; Flanagan, D.; Carael, M.; Blas, E.; DeLay, P.; Tarantola, D. How Uganda reversed its HIV epidemic. AIDS Behav. 2006, 10, 351–360. [Google Scholar] [CrossRef] [PubMed]
  62. Al-Hasan, A.; Yim, D.; Khuntia, J. Citizens’ adherence to COVID-19 mitigation recommendations by the government: A 3-country comparative evaluation using web-based cross-sectional survey data. J. Med. Internet Res. 2020, 22, e20634. [Google Scholar] [CrossRef] [PubMed]
  63. Margraf, J.; Brailovskaia, J.; Schneider, S. Behavioral measures to fight COVID-19: An 8-country study of perceived usefulness, adherence and their predictors. PLoS ONE 2020, 15, e0243523. [Google Scholar] [CrossRef]
  64. SSRN. LSMS-Supported High-Frequency Phone Surveys on COVID-19. 2020. Available online: (accessed on 8 April 2021).
  65. Isah, M.B.; Abdulsalam, M.; Bello, A.; Ibrahim, M.I.; Usman, A.; Nasir, A.; Abdulkadir, B.; Ibrahim, K.M.; Sani, A.; Aliu, M.; et al. Coronavirus disease 2019 (COVID-19): A cross-sectional survey of the knowledge, attitudes, practices (KAP) and misconceptions in the general population of Katsina State, Nigeria. UMYU J. Microbiol. Res. 2021, 6, 24–37. [Google Scholar] [CrossRef]
  66. Banda, J.; Dube, A.; Brumfield, S.; Amoah, A.; Crampin, A.; Reniers, G.; Helleringer, S. Knowledge, risk perceptions, and behaviors related to the COVID-19 pandemic in Malawi. Demogr. Res. 2021, 44, 459–480. [Google Scholar] [CrossRef]
  67. Defar, A.; Molla, G.; Abdella, S.; Tessema, M.; Ahmed, M.; Tadele, A.; Getachew, F.; Hailegiorgis, B.; Tigabu, E.; Ababor, S.; et al. Knowledge, practice and associated factors towards the prevention of COVID-19 among high-risk groups: A cross-sectional study in Addis Ababa, Ethiopia. PLoS ONE 2021, 16, e0248420. [Google Scholar] [CrossRef]
  68. Serwaa, D.; Lamptey, E.; Appiah, A.B.; Senkyire, E.K.; Ameyaw, J.K. Knowledge, risk perception and preparedness towards coronavirus disease-2019 (COVID-19) outbreak among Ghanaians: A quick online cross-sectional survey. Pan Afr. Med. J. 2020, 35. [Google Scholar] [CrossRef]
  69. Ditekemena, J.D.; Nkamba, D.M.; Muhindo, H.M.; Siewe, J.N.F.; Luhata, C.; Bergh, R.V.D.; Kitoto, A.T.; Van Damme, W.; Muyembe, J.J.; Colebunders, R. Factors associated with adherence to COVID-19 prevention measures in the Democratic Republic of the Congo (DRC): Results of an online survey. BMJ Open 2021, 11, e043356. [Google Scholar] [CrossRef] [PubMed]
  70. Hedima, E.W.; Michael, S.A.; David, E.A. Knowledge and risk perception of the novel coronavirus disease 2019 among adult Nigerians: A cross-sectional study. medRxiv 2020. [Google Scholar] [CrossRef]
  71. Olum, R.; Chekwech, G.; Wekha, G.; Nassozi, D.R.; Bongomin, F. Coronavirus disease-2019: Knowledge, attitude, and practices of health care workers at Makerere University Teaching Hospitals, Uganda. Front. Public Health 2020, 8, 181. [Google Scholar] [CrossRef]
  72. Rader, B.; Scarpino, S.V.; Nande, A.; Hill, A.L.; Adlam, B.; Reiner, R.C.; Pigott, D.M.; Gutierrez, B.; Zarebski, A.E.; Shrestha, M.; et al. Crowding and the shape of COVID-19 epidemics. Nat. Med. 2020, 26, 1829–1834. [Google Scholar] [CrossRef]
  73. Nadini, M.; Zino, L.; Rizzo, A.; Porfiri, M. A multi-agent model to study epidemic spreading and vaccination strategies in an urban-like environment. Appl. Netw. Sci. 2020, 5, 1–30. [Google Scholar] [CrossRef] [PubMed]
  74. Nkalu, C.N.; Edeme, R.K.; Nchege, J.; Arazu, O.W. Rural-urban population growth, economic growth and urban agglomeration in sub-Saharan Africa: What does Williamson-Kuznets hypothesis say? J. Asian Afr. Stud. 2019, 54, 1247–1261. [Google Scholar] [CrossRef]
  75. United Nations Department of Economic and Social Affairs. World Urbanization Prospects. 2018. Available online: (accessed on 8 April 2021).
  76. Diop, B.Z.; Ngom, M.; Biyong, C.P.; Biyong, J.N.P. The relatively young and rural population may limit the spread and severity of COVID-19 in Africa: A modelling study. BMJ Glob. Health 2020, 5, e002699. [Google Scholar] [CrossRef] [PubMed]
  77. Chirisa, I.; Mutambisi, T.; Chivenge, M.; Mabaso, E.; Matamanda, A.R.; Ncube, R. The urban penalty of COVID-19 lockdowns across the globe: Manifestations and lessons for anglophone sub-Saharan Africa. GeoJournal 2020, 1–14. [Google Scholar] [CrossRef] [PubMed]
  78. Yang, W.; Zhang, W.; Kargbo, D.; Yang, R.; Chen, Y.; Chen, Z.; Kamara, A.; Kargbo, B.; Kandula, S.; Karspeck, A.; et al. Transmission network of the 2014–2015 Ebola epidemic in Sierra Leone. J. R. Soc. Interface 2015, 12, 20150536. [Google Scholar] [CrossRef]
  79. Kiti, M.C.; Kinyanjui, T.; Koech, D.; Munywoki, P.K.; Medley, G.; Nokes, D.J. Quantifying age-related rates of social contact using diaries in a rural coastal population of Kenya. PLoS ONE 2014, 9, e104786. [Google Scholar] [CrossRef]
  80. Mossong, J.; Hens, N.; Jit, M.; Beutels, P.; Auranen, K.; Mikolajczyk, R.; Massari, M.; Salmaso, S.; Tomba, G.S.; Wallinga, J.; et al. Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS Med. 2008, 5, e74. [Google Scholar] [CrossRef]
  81. Fraser, T.; Aldrich, D.P. The dual effect of social ties on COVID-19 spread in Japan. Sci. Rep. 2021, 11, 1–12. [Google Scholar] [CrossRef]
  82. Fraser, T. Japanese social capital and social vulnerability indices: Measuring drivers of community resilience 2000–2017. Int. J. Disaster Risk Reduct. 2020, 52, 101965. [Google Scholar] [CrossRef]
  83. Arachchi, J.I.; Managi, S. The role of social capital in COVID-19 deaths. BMC Public Health 2021, 21, 1–9. [Google Scholar] [CrossRef]
  84. Cash, R.; Patel, V. Has COVID-19 subverted global health? Lancet 2020, 395, 1687–1688. [Google Scholar] [CrossRef]
  85. Sugg, M.M.; Spaulding, T.J.; Lane, S.J.; Runkle, J.D.; Harden, S.R.; Hege, A.; Iyer, L.S. Mapping community-level determinants of COVID-19 transmission in nursing homes: A multi-scale approach. Sci. Total Environ. 2020, 752, 141946. [Google Scholar] [CrossRef]
  86. Otieno, S. COVID-19: Africa’s Eldery May Benefit from Social Structures. 2021. Available online: (accessed on 8 April 2021).
  87. Lloyd-Sherlock, P.; Ebrahim, S.; Geffen, L.; McKee, M. Bearing the brunt of Covid-19: Older people in low and middle income countries. BMJ 2020, 368, 1052. [Google Scholar] [CrossRef]
  88. Cowper, B.; Jassat, W.; Pretorius, P.; Geffen, L.; Legodu, C.; Singh, S.; Blumberg, L. COVID-19 in long-term care facilities in South Africa: No time for complacency. S. Afr. Med. J. 2020, 110, 962. [Google Scholar] [CrossRef]
  89. Adamek, M.E.; Balaswamy, S. Long term care for elders in developing countries in Asia and Africa: A systematic review. Gerontology 2016, 56, 413. [Google Scholar] [CrossRef]
  90. Cafagna, G.A.; Aranco, N.; Ibarrarán, P.; Oliveri, M.L.; Medellín, N.; Stampini, M. Age with Care: Long-Term Care in Latin America and the Caribbean. 2019. Available online: (accessed on 2 May 2021).
  91. Caruso, M.; Galiani, S.; Ibarrarán, P. Long-Term Care in Latin America and the Caribbean? Theory Policy Considerations. 2017. Available online: (accessed on 2 May 2021).
  92. World Health Organization. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations. Available online: (accessed on 8 April 2021).
  93. Dietz, L.; Horve, P.F.; Coil, D.A.; Fretz, M.; Eisen, J.A.; Wymelenberg, K.V.D. 2019 novel Coronavirus (COVID-19) pandemic: Built environment considerations to reduce transmission. mSystems 2020, 5. [Google Scholar] [CrossRef] [PubMed]
  94. Setti, L.; Passarini, F.; De Gennaro, G.; Barbieri, P.; Perrone, M.G.; Borelli, M.; Palmisani, J.; Di Gilio, A.; Torboli, V.; Fontana, F.; et al. SARS-Cov-2RNA found on particulate matter of Bergamo in northern Italy: First evidence. Environ. Res. 2020, 188, 109754. [Google Scholar] [CrossRef] [PubMed]
  95. Bulfone, T.C.; Malekinejad, M.; Rutherford, G.W.; Razani, N. Outdoor transmission of SARS-CoV-2 and other respiratory viruses: A systematic review. J. Infect. Dis. 2020, 223, 550–561. [Google Scholar] [CrossRef]
  96. Senatore, V.; Zarra, T.; Buonerba, A.; Choo, K.-H.; Hasan, S.W.; Korshin, G.; Li, C.-W.; Ksibi, M.; Belgiorno, V.; Naddeo, V. Indoor versus outdoor transmission of SARS-COV-2: Environmental factors in virus spread and underestimated sources of risk. Euro Mediterr. J. Environ. Integr. 2021, 6, 1–9. [Google Scholar] [CrossRef]
  97. Rowe, B.; Canosa, A.; Drouffe, J.; Mitchell, J. Simple quantitative assessment of the outdoor versus indoor airborne transmission of viruses and COVID-19. Environ. Res. 2021, 198, 111189. [Google Scholar] [CrossRef] [PubMed]
  98. Naddeo, V.; Liu, H. Editorial perspectives: 2019 novel coronavirus (SARS-CoV-2): What is its fate in urban water cycle and how can the water research community respond? Environ. Sci. Water Res. Technol. 2020, 6, 1213–1216. [Google Scholar] [CrossRef]
  99. Klepeis, N.E.; Nelson, W.C.; Ott, W.R.; Robinson, J.P.; Tsang, A.M.; Switzer, P.; Behar, J.V.; Hern, S.C.; Engelmann, W.H. The national human activity pattern survey (NHAPS): A resource for assessing exposure to environmental pollutants. J. Expo. Sci. Environ. Epidemiol. 2001, 11, 231–252. [Google Scholar] [CrossRef]
  100. Matz, C.J.; Stieb, D.M.; Brion, O. Urban-rural differences in daily time-activity patterns, occupational activity and housing characteristics. Environ. Health 2015, 14, 1–11. [Google Scholar] [CrossRef]
  101. Merow, C.; Urban, M.C. Seasonality and uncertainty in global COVID-19 growth rates. Proc. Natl. Acad. Sci. USA 2020, 117, 27456–27464. [Google Scholar] [CrossRef] [PubMed]
  102. Wang, J.; Tang, K.; Feng, K.; Lin, X.; Lv, W.; Chen, K.; Wang, F. Impact of temperature and relative humidity on the transmission of COVID-19: A modelling study in China and the United States. BMJ Open 2021, 11, e043863. [Google Scholar] [CrossRef]
  103. Kerr, G.H.; Badr, H.S.; Gardner, L.M.; Perez-Saez, J.; Zaitchik, B.F. Associations between meteorology and COVID-19 in early studies: Inconsistencies, uncertainties, and recommendations. One Health 2021, 12, 100225. [Google Scholar] [CrossRef] [PubMed]
  104. Rhodes, J.M.; Subramanian, S.; Laird, E.; Kenny, R.A. Letter: Low population mortality from COVID-19 in countries south of latitude 35° North supports vitamin D as a factor determining severity. Authors’ reply. Aliment. Pharmacol. Ther. 2020, 52, 412–413. [Google Scholar] [CrossRef]
  105. Pereira, M.; Damascena, A.D.; Azevedo, L.M.G.; Oliveira, T.D.A.; Santana, J.D.M. Vitamin D deficiency aggravates COVID-19: Systematic review and meta-analysis. Crit. Rev. Food Sci. Nutr. 2020, 1–9. [Google Scholar] [CrossRef]
  106. 2021. Available online: (accessed on 8 April 2021).
  107. Levin, A.T.; Hanage, W.P.; Owusu-Boaitey, N.; Cochran, K.B.; Walsh, S.P.; Meyerowitz-Katz, G. Assessing the age specificity of infection fatality rates for COVID-19: Systematic review, meta-analysis, and public policy implications. Eur. J. Epidemiol. 2020, 35, 1123–1138. [Google Scholar] [CrossRef]
  108. Centers for Disease Control and Prevention (CDC). Risk for COVID-19 Infection, Hospitalization, and Death by Age Group. 2019. Available online: (accessed on 8 April 2021).
  109. Williamson, E.J.; Walker, A.J.; Bhaskaran, K.; Bacon, S.; Bates, C.; Morton, C.E.; Curtis, H.J.; Mehrkar, A.; Evans, D.; Inglesby, P.; et al. Factors associated with COVID-19-related death using OpenSAFELY. Nat. Cell Biol. 2020, 584, 430–436. [Google Scholar] [CrossRef]
  110. Census of India. Office of the Registrar General and Census Commissioner, India. 2021. Available online: (accessed on 8 April 2021).
  111. Brazil Institute of Geography and Statistics. Projections and Estimates of the Population of Brazil. 2021. Available online: (accessed on 8 April 2021).
  112. United States Census Bureau. People and Population Data—United States of America. Available online: (accessed on 8 April 2021).
  113. United Kingdom Office for National Statistics. United Kingdom 2011 Census Data. 2011. Available online: (accessed on 8 April 2021).
  114. Lawal, Y. Africa’s low COVID-19 mortality rate: A paradox? Int. J. Infect. Dis. 2020, 102, 118–122. [Google Scholar] [CrossRef]
  115. COVID-19 Data Explorer. Oxford. 2020. Available online: (accessed on 19 February 2021).
  116. Zhou, F.; Yu, T.; Du, R.; Fan, G.; Liu, Y.; Liu, Z.; Xiang, J.; Wang, Y.; Song, B.; Gu, X.; et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020, 395, 1054–1062. [Google Scholar] [CrossRef]
  117. Chakafana, G.; Mutithu, D.; Hoevelmann, J.; Ntusi, N.; Sliwa, K. Interplay of COVID-19 and cardiovascular diseases in Africa: An observational snapshot. Clin. Res. Cardiol. 2020, 109, 1460–1468. [Google Scholar] [CrossRef]
  118. Hughes, G.D.; Mbamalu, O.N.; Okonji, C.O.; Puoane, T.R. The impact of health disparities on COVID-19 outcomes: Early findings from a high-income country and two middle-income countries. J. Racial Ethn. Health Disparities 2021, 1–8. [Google Scholar] [CrossRef]
  119. Gouda, H.N.; Charlson, F.; Sorsdahl, K.; Ahmadzada, S.; Ferrari, A.; Erskine, H.; Leung, J.; Santamauro, D.; Lund, C.; Aminde, L.N.; et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990–2017: Results from the Global Burden of Disease Study 2017. Lancet Glob. Health 2019, 7, e1375–e1387. [Google Scholar] [CrossRef]
  120. World Health Organization. Noncommunicable Diseases Country Profile 2018; World Health Organization: Geneva, Switzerland, 2018. [Google Scholar]
  121. Osetinsky, B.; Hontelez, J.A.C.; Lurie, M.N.; McGarvey, S.T.; Bloomfield, G.S.; Pastakia, S.D.; Wamai, R.; Bärnighausen, T.; de Vlas, S.J.; Galárraga, O. Epidemiological and health systems implications of evolving HIV and hypertension in south Africa and Kenya. Health Aff. 2019, 38, 1173–1181. [Google Scholar] [CrossRef] [PubMed]
  122. Davies, M.-A. HIV and risk of COVID-19 death: A population cohort study from the Western Cape province, south Africa. medRxiv 2020. [Google Scholar] [CrossRef]
  123. UNAIDS. HIV and AIDS Estimates. South Africa 2019 Country Factsheet. 2019. Available online: (accessed on 8 April 2021).
  124. Lee, Y.J.; Jang, Y.H.; Seo, S.-U.; Chang, J.; Seong, B.L. Non-specific effect of vaccines: Immediate protection against respiratory syncytial virus infection by a live attenuated influenza vaccine. Front. Microbiol. 2018, 9, 83. [Google Scholar] [CrossRef] [PubMed]
  125. Uthayakumar, D.; Paris, S.; Chapat, L.; Freyburger, L.; Poulet, H.; De Luca, K. Non-specific effects of vaccines illustrated through the BCG example: From observations to demonstrations. Front. Immunol. 2018, 9, 2869. [Google Scholar] [CrossRef] [PubMed]
  126. Benn, C.S.; Netea, M.G.; Selin, L.; Aaby, P. A small jab—A big effect: Nonspecific immunomodulation by vaccines. Trends Immunol. 2013, 34, 431–439. [Google Scholar] [CrossRef] [PubMed]
  127. Parmar, K.; Siddiqui, A.; Nugent, K. Bacillus Calmette-Guerin vaccine and nonspecific immunity. Am. J. Med. Sci. 2021, 361, 683–689. [Google Scholar] [CrossRef]
  128. Blok, B.A.; Arts, R.J.W.; Van Crevel, R.; Benn, C.S.; Netea, M.G. Trained innate immunity as underlying mechanism for the long-term, nonspecific effects of vaccines. J. Leukoc. Biol. 2015, 98, 347–356. [Google Scholar] [CrossRef]
  129. Clem, A.S. Fundamentals of vaccine immunology. J. Glob. Infect. Dis. 2011, 3, 73–78. [Google Scholar] [CrossRef] [PubMed]
  130. Sehrawat, S.; Rouse, B.T. Does the hygiene hypothesis apply to COVID-19 susceptibility? Microbes Infect. 2020, 22, 400–402. [Google Scholar] [CrossRef]
  131. Gursel, M.; Gursel, I. Is global BCG vaccination-induced trained immunity relevant to the progression of SARS-CoV-2 pandemic? Allergy 2020, 75, 1815–1819. [Google Scholar] [CrossRef]
  132. O’Neill, L.A.J.; Netea, M.G. BCG-induced trained immunity: Can it offer protection against COVID-19? Nat. Rev. Immunol. 2020, 20, 335–337. [Google Scholar] [CrossRef] [PubMed]
  133. Stensballe, L.G.; Nante, E.; Jensen, I.P.; Kofoed, P.-E.; Poulsen, A.; Jensen, H.; Newport, M.; Marchant, A.; Aaby, P. Acute lower respiratory tract infections and respiratory syncytial virus in infants in Guinea-Bissau: A beneficial effect of BCG vaccination for girls: Community based case-control study. Vaccine 2005, 23, 1251–1257. [Google Scholar] [CrossRef]
  134. Nemes, E.; Geldenhuys, H.; Rozot, V.; Rutkowski, K.T.; Ratangee, F.; Bilek, N.; Mabwe, S.; Makhethe, L.; Erasmus, M.; Toefy, A.; et al. Prevention of M. tuberculosis infection with H4:IC31 vaccine or BCG revaccination. N. Engl. J. Med. 2018, 379, 138–149. [Google Scholar] [CrossRef]
  135. Spencer, J.C.; Ganguly, R.; Waldman, R.H. Nonspecific protection of mice against influenza virus infection by local or systemic immunization with Bacille Calmette-Guerin. J. Infect. Dis. 1977, 136, 171–175. [Google Scholar] [CrossRef]
  136. Starr, S.E.; Visintine, A.M.; Tomeh, M.O.; Nahmias, A.J. Effects of immunostimulants on resistance of newborn mice to herpes simplex type 2 infection. Exp. Biol. Med. 1976, 152, 57–60. [Google Scholar] [CrossRef] [PubMed]
  137. Miller, A.; Reandelar, M.J.; Fasciglione, K.; Roumenova, V.; Li, Y.; Otazu, G.H. Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: An epidemiological study. medRxiv 2020. [Google Scholar] [CrossRef]
  138. Manjili, R.H.; Zarei, M.; Habibi, M.; Manjili, M.H. COVID-19 as an acute inflammatory disease. J. Immunol. 2020, 205, 12–19. [Google Scholar] [CrossRef]
  139. Yeo, W.S.; Ng, Q.X. Distinguishing between typical Kawasaki disease and multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2. Med. Hypotheses 2020, 144, 110263. [Google Scholar] [CrossRef]
  140. World Health Organization. Reported Estimates of BCG Coverage. Available online: (accessed on 8 April 2021).
  141. Hadley, C. Should auld acquaintance be forgot…The “hygiene hypothesis” is less about cleanliness, and more about the changes that humans have made to their lifestyle. EMBO Rep. 2004, 5, 1122–1124. [Google Scholar] [CrossRef] [PubMed]
  142. Chatterjee, B.; Karandikar, R.L.; Mande, S.C. Paradoxical case fatality rate dichotomy of Covid-19 among rich and poor nations points to the “hygiene hypothesis”. medRxiv 2020. [Google Scholar] [CrossRef]
  143. Chatterjee, B.; Karandikar, R.L.; Mande, S.C. The mortality due to COVID-19 in different nations is associated with the demographic character of nations and the prevalence of autoimmunity. medRxiv 2020. [Google Scholar] [CrossRef]
  144. Moore, M.; Gelfeld, B.; Okunogbe, A.; Paul, C. Identifying future disease hot spots: Infectious disease vulnerability index. Rand Health Q. 2016, 6. [Google Scholar] [CrossRef]
  145. Hotez, P.J.; Kamath, A. Neglected tropical diseases in sub-Saharan Africa: Review of their prevalence, distribution, and disease burden. PLoS Negl. Trop. Dis. 2009, 3, e412. [Google Scholar] [CrossRef] [PubMed]
  146. Rweyemamu, M.; Otim-Nape, W.; Serwadda, D. Foresight. Infectious Diseases: Preparing for the Future. Africa; Office of Science and Innovation: London, UK, 2006. [Google Scholar]
  147. Elton, L.; Thomason, M.J.; Tembo, J.; Velavan, T.P.; Pallerla, S.R.; Arruda, L.B.; Vairo, F.; Montaldo., C.; Ntoumi, F.; Hamid, M.M.A.; et al. Antimicrobial resistance preparedness in sub-Saharan African countries. Antimicrob. Resist. Infect. Control 2020, 9, 1–11. [Google Scholar] [CrossRef] [PubMed]
  148. Eisele, T.P. Mass drug administration can be a valuable addition to the malaria elimination toolbox. Malar. J. 2019, 18, 1–5. [Google Scholar] [CrossRef] [PubMed]
  149. Romani, L.; Marks, M.; Sokana, O.; Nasi, T.; Kamoriki, B.; Wand, H.; Whitfeld, M.J.; Engelman, D.; Solomon, A.; Steer, A.C.; et al. Feasibility and safety of mass drug coadministration with azithromycin and ivermectin for the control of neglected tropical diseases: A single-arm intervention trial. Lancet Glob. Health 2018, 6, e1132–e1138. [Google Scholar] [CrossRef]
  150. Macfarlane, C.; Dean, L.; Thomson, R.; Garner, P. Community drug distributors for mass drug administration in neglected tropical disease programmes: Systematic review and analysis of policy documents. J. Glob. Health 2019, 9, 020414. [Google Scholar] [CrossRef]
  151. Echeverría-Esnal, D.; Martin-Ontiyuelo, C.; Navarrete-Rouco, M.E.; Cuscó, M.D.-A.; Ferrández, O.; Horcajada, J.P.; Grau, S. Azithromycin in the treatment of COVID-19: A review. Expert Rev. Anti-Infect. Ther. 2020, 19, 147–163. [Google Scholar] [CrossRef]
  152. Wamae, C.N. Mass drug administration and worms experience in Africa: Envisage repurposing ivermectin for SARS-COV-2. Am. J. Trop. Med. Hyg. 2020, 103, 10–11. [Google Scholar] [CrossRef] [PubMed]
  153. Hellwig, M.D.; Maia, A. A COVID-19 prophylaxis? Lower incidence associated with prophylactic administration of ivermectin. Int. J. Antimicrob. Agents 2020, 57, 106248. [Google Scholar] [CrossRef] [PubMed]
  154. Caly, L.; Druce, J.D.; Catton, M.G.; Jans, D.A.; Wagstaff, K.M. The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro. Antivir. Res. 2020, 178, 104787. [Google Scholar] [CrossRef] [PubMed]
  155. National Institutes of Health (NIH). COVID-19 Treatment Guidelines: Ivermectin. 2021. Available online: (accessed on 8 April 2021).
  156. World Health Organization. World Malaria Report 2019; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
  157. Olesen, O.F.; Parker, M.I. Health research in Africa: Getting priorities right. Trop. Med. Int. Health 2012, 17, 1048–1052. [Google Scholar] [CrossRef] [PubMed]
  158. Long, C.A.; Zavala, F. Immune responses in malaria. Cold Spring Harb. Perspect. Med. 2017, 7, a025577. [Google Scholar] [CrossRef]
  159. Artavanis-Tsakonas, K.; Tongren, J.E.; Riley, E.M. The war between the malaria parasite and the immune system: Immunity, immunoregulation and immunopathology. Clin. Exp. Immunol. 2003, 133, 145–152. [Google Scholar] [CrossRef]
  160. Centers for Disease Control and Prevention (CDC). Where Malaria Occurs. 2020. Available online: (accessed on 8 April 2021).
  161. Oyebode, O.; Kandala, N.-B.; Chilton, P.J.; Lilford, R.J. Use of traditional medicine in middle-income countries: A WHO-SAGE study. Health Policy Plan. 2016, 31, 984–991. [Google Scholar] [CrossRef]
  162. Mahomoodally, M.F. Traditional medicines in Africa: An appraisal of ten potent African medicinal plants. Evid. Based Complement. Altern. Med. 2013, 2013, 617459. [Google Scholar] [CrossRef]
  163. World Health Organisation. WHO Global Report on Traditional and Complementary Medicine 2019; World Health Organization: Geneva, Switzerland, 2019. [Google Scholar]
  164. World Health Organization. Expert Panel Endorses Protocol for COVID-19 Herbal Medicine Clinical Trials. 2020. Available online: (accessed on 9 April 2021).
  165. Akindele, A.J.; Agunbiade, F.O.; Sofidiya, M.O.; Awodele, O.; Sowemimo, A.; Ade-Ademilua, O.; Akinleye, M.O.; Ishola, I.O.; Orabueze, I.; Salu, O.B.; et al. COVID-19 pandemic: A case for phytomedicines. Nat. Prod. Commun. 2020, 15. [Google Scholar] [CrossRef]
  166. Available online: (accessed on 9 April 2021).
  167. Pairo-Castineira, E.; Clohisey, S.; Klaric, L.; Bretherick, A.D.; Rawlik, K.; Pasko, D.; Walker, S.; Parkinson, N.; Fourman, M.H.; Russell, C.D.; et al. Genetic mechanisms of critical illness in COVID-19. Nat. Cell Biol. 2020, 591, 92–98. [Google Scholar] [CrossRef]
  168. Zeberg, H.; Pääbo, S. The major genetic risk factor for severe COVID-19 is inherited from Neanderthals. Nat. Cell Biol. 2020, 587, 610–612. [Google Scholar] [CrossRef]
  169. Zhao, Y.; Zhao, Z.; Wang, Y.; Zhou, Y.; Ma, Y.; Zuo, W. Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2. Am. J. Respir. Crit. Care Med. 2020, 202, 756–759. [Google Scholar] [CrossRef]
  170. Ellinghaus, D.; Degenhardt, F.; Bujanda, L.; Buti, M.; Albillos, A.; Invernizzi, P.; Fernández, J.; Prati, D.; Baselli, G.; Asselta, R.; et al. The severe Covid-19 GWAS group genomewide association study of severe Covid-19 with respiratory failure. N. Engl. J. Med. 2020, 383, 1522–1534. [Google Scholar] [CrossRef] [PubMed]
  171. Mwangi, J. Blood group distribution in an urban population of patient targeted blood donors. East. Afr. Med. J. 1999, 76. [Google Scholar]
  172. Cheng, Y.; Mohammed, S.; Okoh, A.; Lee, K.; Raczek, C.; Krushna, A.; Cohen, A.J.; Nagarakanti, S. Association of Blood type on clinical outcomes in Black/African Americans hospitalized for COVID-19 infection. Blood 2020, 136, 14. [Google Scholar] [CrossRef]
  173. Rettner, R. What’s the Rarest Blood Type? Live Science. 2019. Available online: (accessed on 9 April 2021).
  174. Millett, G.A.; Jones, A.T.; Benkeser, D.; Baral, S.; Mercer, L.; Beyrer, C.; Honermann, B.; Lankiewicz, E.; Mena, L.; Crowley, J.S.; et al. Assessing differential impacts of COVID-19 on black communities. Ann. Epidemiol. 2020, 47, 37–44. [Google Scholar] [CrossRef]
  175. Tishkoff, S.A.; Reed, F.A.; Friedlaender, F.R.; Ehret, C.; Ranciaro, A.; Froment, A.; Hirbo, J.B.; Awomoyi, A.A.; Bodo, J.-M.; Doumbo, O.; et al. The genetic structure and history of Africans and African Americans. Science 2009, 324, 1035–1044. [Google Scholar] [CrossRef] [PubMed]
  176. Bryc, K.; Auton, A.; Nelson, M.R.; Oksenberg, J.R.; Hauser, S.L.; Williams, S.; Froment, A.; Bodo, J.-M.; Wambebe, C.; Tishkoff, S.A.; et al. Genome-wide patterns of population structure and admixture in west Africans and African Americans. Proc. Natl. Acad. Sci. USA 2009, 107, 786–791. [Google Scholar] [CrossRef]
  177. Cooper, R.; Rotimi, C.; Ataman, S.; McGee, D.; Osotimehin, B.; Kadiri, S.; Muna, W.; Kingue, S.; Fraser, H.; Forrester, T.; et al. The prevalence of hypertension in seven populations of west African origin. Am. J. Public Health 1997, 87, 160–168. [Google Scholar] [CrossRef] [PubMed]
  178. Carnethon, M.; Pu, J.; Howard, G.; Albert, M.A.; Anderson, C.A.; Bertoni, A.G.; Mujahid, M.S.; Palaniappan, L.; Taylor, H.A.; Willis, M.; et al. Cardiovascular health in African Americans: A scientific statement from the American heart association. Circulation 2017, 136, e393–e423. [Google Scholar] [CrossRef] [PubMed]
  179. United Nations Development Programme (UNDP). Income Gini Coefficient. 2020. Available online: (accessed on 9 April 2021).
  180. Yaya, S.; Yeboah, H.; Charles, C.H.; Otu, A.; LaBonte, R. Ethnic and racial disparities in COVID-19-related deaths: Counting the trees, hiding the forest. BMJ Glob. Health 2020, 5, e002913. [Google Scholar] [CrossRef]
  181. Sze, S.; Pan, D.; Nevill, C.R.; Gray, L.; Martin, C.A.; Nazareth, J.; Minhas, J.; Divall, P.; Khunti, K.; Abrams, K.R.; et al. Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis. EClinicalMedicine 2020, 29-30, 100630. [Google Scholar] [CrossRef] [PubMed]
  182. Andrews, G.R. Racial Inequality in Brazil and the United States: A statistical comparison. J. Soc. Hist. 1992, 26, 229–263. [Google Scholar] [CrossRef]
  183. Hamilton, C.V.; Huntley, L.; Alexander, N.; Guimardes, A.S.A.; James, W. Beyond Racism: Race and Inequality in Brazil, South Africa, and the United States; Lynne Rienner Publishers: Boulder, CO, USA, 2001. [Google Scholar]
  184. Finch, W.H.; Finch, M.E.H. Poverty and Covid-19: Rates of incidence and deaths in the United States during the first 10 weeks of the pandemic. Front. Sociol. 2020, 5, 47. [Google Scholar] [CrossRef]
  185. Viens, A.M.; Eyawo, O. COVID-19: The rude awakening for the political elite in low- and middle-income countries. BMJ Glob. Health 2020, 5, e002807. [Google Scholar] [CrossRef] [PubMed]
  186. Nwosu, C.O.; Oyenubi, A. Income-related health inequalities associated with the coronavirus pandemic in south Africa: A decomposition analysis. Int. J. Equity Health 2021, 20, 1–12. [Google Scholar] [CrossRef]
  187. Musa, H.H.; Musa, T.H.; Musa, I.H.; Musa, I.H.; Ranciaro, A.; Campbell, M.C. Addressing Africa’s pandemic puzzle: Perspectives on COVID-19 transmission and mortality in sub-Saharan Africa. Int. J. Infect. Dis. 2020, 102, 483–488. [Google Scholar] [CrossRef]
  188. Kuehn, B.M. Africa succeeded against COVID-19′s first wave, but the second wave brings new challenges. JAMA 2021, 325, 327. [Google Scholar] [CrossRef] [PubMed]
  189. World Health Organization. Africa Faces Steepest COVID-19 Surge Yet. 2021. Available online: (accessed on 29 June 2021).
  190. Callaway, E. Delta coronavirus variant: Scientists brace for impact. Nat. Cell Biol. 2021, 595, 17–18. [Google Scholar] [CrossRef]
  191. Fullman, N.; Yearwood, J.; Abay, S.M.; Abbafati, C.; Abd-Allah, F.; Abdela, J.; Abdelalim, A.; Abebe, Z.; Abebo, T.A.; Aboyans, V.; et al. Measuring performance on the healthcare access and quality index for 195 countries and territories and selected subnational locations: A systematic analysis from the Global burden of disease study 2016. Lancet 2018, 391, 2236–2271. [Google Scholar] [CrossRef]
  192. Dente, M.G.; Resti, C.V.; Declich, S.; Putoto, G. The reported few cases and deaths of Covid-19 epidemic in Africa are still data too questionable to reassure about the future of this continent. Front. Public Health 2021, 9, 613484. [Google Scholar] [CrossRef]
  193. Headey, D.; Heidkamp, R.; Osendarp, S.; Ruel, M.; Scott, N.; Black, R.; Shekar, M.; Bouis, H.; Flory, A.; Haddad, L.; et al. Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality. Lancet 2020, 396, 519–521. [Google Scholar] [CrossRef]
  194. Jewell, B.L.; Mudimu, E.; Stover, J.; Brink, D.T.; Phillips, A.N.; Smith, J.A.; Martin-Hughes, R.; Teng, Y.; Glaubius, R.; Mahiane, S.G.; et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: Results from multiple mathematical models. Lancet HIV 2020, 7, e629–e640. [Google Scholar] [CrossRef]
  195. Goalkeepers Report. COVID-19 A Global Perspective. 2020. Available online: (accessed on 14 April 2021).
  196. World Health Organization Immunization, Vaccines and Biologicals Website. More than 117 Million Children at Risk of Missing Out on Measles Vaccines, as COVID-19 Surges. 2020. Available online: (accessed on 14 April 2021).
  197. World Health Organization. Coronavirus Disease (COVID-19): Herd Immunity, Lockdowns and COVID-19. 2020. Available online: (accessed on 9 April 2021).
  198. World Health Organization Regional Office for Africa. HIV/AIDS. 2021. Available online: (accessed on 9 April 2021).
  199. Sankoh, O.; Dickson, K.E.; Faniran, S.; Lahai, J.I.; Forna, F.; Liyosi, E.; Kamara, M.K.; Jabbi, S.-M.B.-B.; Johnny, A.B.; Conteh-Khali, N.; et al. Births and deaths must be registered in Africa. Lancet Glob. Health 2020, 8, e33–e34. [Google Scholar] [CrossRef]
  200. Bedford, J.; Farrar, J.; Ihekweazu, C.; Kang, G.; Koopmans, M.; Nkengasong, J. A new twenty-first century science for effective epidemic response. Nat. Cell Biol. 2019, 575, 130–136. [Google Scholar] [CrossRef]
  201. Africa Union CDC. COVID-19 Vaccination. 2021. Available online: (accessed on 11 August 2021).
  202. Halperin, D.T.; Hodgins, S.; Bailey, R.C.; Klausner, J.D.; Jackson, H.; Wamai, R.; Ladapo, J.A.; Over, M.; Baral, S.; Escandón, K.; et al. Revisiting COVID-19 Policies: 10 Evidence-Based Recommendations for Where to Go from Here. Available online: (accessed on 6 July 2021).
  203. Njenga, M.K.; Dawa, J.; Nanyingi, M.; Gachohi, J.; Ngere, I.; Letko, M.; Otieno, C.F.; Gunn, B.M.; Osoro, E. Why is there low morbidity and mortality of COVID-19 in Africa? Am. J. Trop. Med. Hyg. 2020, 103, 564–569. [Google Scholar] [CrossRef] [PubMed]
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Corruption Crime Politics The Courts

City Under Siege: Staggering New York Crime Wave Roils Politics, Challenges Left

Views: 26

The NYPD’s new anti-gun units hit the streets last week and not a moment too soon. New York City is in the midst of a staggering crime wave.

Over the past weekend, 29 people were shot in 24 separate incidents, the Daily News reported. According to the latest NYPD statistics, major felonies in the city increased 58% in February 2022, in year over year comparisons to February 2021. Murders rose 10%. Felony assaults rose 22%. Rapes increased 35%. Robberies increased 56%. Hate crimes—largely against Jews and Asian-Americans—surged 189%. Crimes in the transit systems—mainly the subways—were up 73%.

New York is a city under siege. Every day brings a new horror story. A child is assaulted in Times Square. A young woman is stabbed to death in her Chinatown apartment. A senior citizen is hacked to death by a wheelchair-bound transgender two-time convicted murderer. A madman smears feces on a woman’s face in a subway station, is released on bail, and arrested again after hurling a dumbbell through a window. A woman is shoved in front of a subway train and killed. Another woman is attacked with a hammer. A teen is shot to death in front of a Brooklyn high school. A baby is shot in the face in the Bronx. A teenage cashier at a Burger King in Manhattan is shot and killed during a robbery. Two police officers are killed by gunfire in Harlem.

At Judicial Watch, we warned for years that New York was slipping toward a crisis of crime and disorder. The reasons were not difficult to discern. Progressive policy makers were denigrating and defunding the police at every opportunity, dismantling successful policing units, decriminalizing quality-of-life crimes, emptying  jails, and launching a disastrous program of bail reform.

Under Mayor Bill de Blasio, New York abandoned the successful policing strategy of enforcing quality-of-life laws. This was the “Broken Windows” theory of policing, a key factor in crime reduction during the mayoral tenure of Rudy Giuliani.

“Broken Windows” is a metaphor for urban decline. The building with an unrepaired broken window soon leads to the other windows being broken and more disorderly conduct. A neighborhood where minor offenses go unchallenged soon becomes a breeding ground for more serious criminal activity and, ultimately, violence,” write Giuliani police commissioner William Bratton and George Kelling, the father of Broken Windows theory.

New York decriminalized quality-of-life crimes under de Blasio. Public urination, public drinking, littering, and subway turnstile jumping were no longer illegal. Incidents of harassment, menacing, petty theft, public urination and public intoxication began to increase. That distant tremor in the urban air was the sound of windows breaking.

Meanwhile, progressives rammed through the state legislature in Albany a reform package that eliminated bail for a wide range of offenses—from assault, arson and child abuse to manslaughter, robbery and riot—and removed judicial discretion in holding suspects. The reform legislation took effect January 2020. Many more offenders walked. Some of them were poor first-time offenders on minor crimes who simply could not afford bail and deserved to walk; others were violent personalities or career criminals who did not. Crime rates jumped.

The public backlash was swift. In November 2021, New York elected a new mayor, a former police officer who had campaigned on a platform of public safety, Eric Adams. The new mayor’s plans include a refreshed version of the successful but controversial NYPD anti-crime unit, which was disbanded in 2020 in the midst of social justice protests. The new six-person anti-gun units, launched last week, will aggressively tackle gun crime in New York. About 170 police officers have been deployed so far, focusing on high crime areas, with 300 more to follow.

Adams also is advocating for reform of radical bail laws, tougher gun possession charges for youthful offenders, and a crackdown on transit crime with an increased police presence in the subways .

Initially stunned by the Adams electoral victory, New York’s powerful progressive factions have begun to push back hard on the new mayor. Adams’ appeal to Democratic leaders in Albany for bail reform—largely focused on giving judges more discretion to hold potentially violent offenders—was quickly shot down. Progressive politicians in New York argue that there is not a proven connection between the new bail laws and increased crime; conservatives disagree.

Adams, meanwhile, gained an important ally in the bail reform fight: New York Governor Kathy Hochul. The former lieutenant governor took over after Andrew Cuomo resigned. Last week, she sent the state legislature a “confidential” ten-point public safety plan that backed the Adams proposal to give judges more discretion in setting bail. The plan quickly leaked, infuriating the Left. Perhaps not coincidentally, Hochul will be asking the voters for a full term as governor in November.

Back in New York City, the new NYPD anti-gun teams acted quickly, making a first arrest just two hours into the first patrol—an alleged member of the Bloods crime gang with a loaded 9mm handgun. By the end of the first week, the anti-gun units had arrested thirty more suspects and taken ten illegal guns off the streets.


Verified by MonsterInsights