Early in 2020, experts warned of the devastating toll that COVID-19 would have on African countries. By the close of 2021, however, Africa remained one of the least affected regions in the world, leading commentators to speculate about a so-called “Africa paradox”. This review evaluates current research and data to establish the burden of COVID-19 infections and mortality in the African region. Despite claims that African countries were spared from COVID-19 infection, there is now considerable serological evidence confirming that people in African countries ultimately experienced levels of SARS-CoV2 infection comparable to or more than people in other global regions. Additionally, multiple measures demonstrate substantial impacts of COVID-19 on mortality in specific African countries where mortality and/or seroprevalence data are available. The gaps between recorded cases and seroprevalence are large and increased over the course of the pandemic. Researchers also observe significant gaps between recorded COVID-19 deaths and other measures of mortality, attributable to weak civil and vital registration systems, limited health care resources, and higher mortality at younger ages. Our findings reinforce the need for more equitable global distribution of health care resources and expanded disease and mortality surveillance across the continent.

中文翻译：

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数百万人失踪：揭开非洲地区 Covid-19 病例和死亡的负担

2020 年初，专家警告说，COVID-19 将对非洲国家造成毁灭性的损失。然而，到 2021 年底，非洲仍然是世界上受影响最小的地区之一，这导致评论人士猜测所谓的“非洲悖论”。本综述评估了当前的研究和数据，以确定非洲地区 COVID-19 感染和死亡率的负担。尽管声称非洲国家没有受到 COVID-19 感染，但现在有大量血清学证据证实，非洲国家人民最终经历的 SARS-CoV2 感染水平与全球其他地区的人民相当或更高。此外，多项措施表明，在可获得死亡率和/或血清流行率数据的特定非洲国家，COVID-19 对死亡率有重大影响。记录病例和血清流行率之间的差距很大，并且在大流行期间不断扩大。研究人员还观察到，记录的 COVID-19 死亡人数与其他死亡率指标之间存在显着差距，原因是民事和人口动态登记系统薄弱、医疗保健资源有限以及年轻死亡率较高。我们的研究结果强调需要在全球范围内更公平地分配医疗保健资源，并扩大整个非洲大陆的疾病和死亡率监测。