A comparative analysis of infection and mortality in reassessing africa's COVID-19 dynamic using time-varying tests

It is commonly believed that Africa largely evaded the worst of the COVID-19 pandemic, with fewer cases than other continents. However, regional comparisons that ignore differences in testing intensity may misrepresent dynamics. Studying the spread and case-fatality relationship during COVID-19 across WHO regions requires explicitly adjusting for time-varying test volumes.

We build a weekly panel dataset spanning May 2020 to December 2021 for the WHO regions: Africa, Eastern Mediterranean, South-East Asia, the Americas, Western Pacific, and Europe. Data on tests, confirmed cases, and COVID-19-attributed deaths were sourced from Our World in Data. We apply a novel metric that corrects for fluctuating test volumes to quantify week-to-week acceleration in infections and in mortality. We then compare the frequency, magnitude, and timing of these acceleration episodes across regions.

Accounting for testing dynamics, we show that Africa exhibits multiple infection-acceleration episodes whose magnitude and frequency match those in other regions. Mortality accelerations in Africa closely follow infection surges, with an average lag of ten weeks. A positive correlation between infection acceleration in Africa and the Americas further indicates synchrony. These findings hold when using a larger secondary dataset of 140 countries.

Contrary to prevailing assumptions, Africa was not spared from the pandemic's severe dynamics. Infection surges were on par with those elsewhere and were followed by mortality accelerations. These results underscore that accounting for testing variability is essential to accurately assess pandemic progression, and they highlight the urgent need to strengthen surveillance and healthcare capacity across all regions.