Dissecting the low morbidity and mortality during the COVID-19 pandemic in Africa: a critical review of the facts and fallacies

Except for South Africa, Africa recorded very low cases of coronavirus disease-19 (COVID-19), and even lower deaths compared to other regions of the world. Several reasons were proposed to explain these low numbers. In this review, we appraise severe acute respiratory syndrome-2 (SARS-CoV-2) therapeutic targets and varying empirical evidence on the use of anti-COVID-19 herbal and bioactive agents in Africa and the role of geo-demographic factors associated with low morbidity and mortality in Africa. Many of the traditional medicinal plants Africans use in the fight against COVID-19 are thought to possess some intrinsic antiviral properties against SARS-CoV-2. Some others were used to treat COVID-19-related symptoms with positive testimonies, making it necessary for in-depth research of African traditional medicine. The adequate knowledge of medicinal plants, their activities, dosage and appropriate duration of use will further advance traditional medical care and help researchers to identify ideal promising drug candidates for accelerated drug development. COVID-19 in sub-Saharan Africa is extremely complex and involves numerous unknown variables as well as region-specific factors that have often been overlooked or underestimated. Traditional, complementary, and alternative medicine in the form of plant extracts and phytochemicals have significant inhibitory effects against SARS-CoV-2 as demonstrated by both in silico and in vitro models and thus could slow replication and transmission of the virus.