Why are COVID-19 effects less severe in Sub-Saharan Africa? Moving more and sitting less may be a primary reason

[Extract] The world is entering a new phase of the coronavirus disease 2019 (COVID-19) health crisis with the lifting of social and physical distancing as well as lockdown restrictions to control the pandemic. Scientific evidence obtained during the COVID-19 pandemic to this point have brought clear themes to the forefront. One important theme pertains to who is at a higher risk for poorer outcomes if infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clearly, individuals with risk factors for chronic disease and one or more chronic disease diagnoses are at significantly higher risk for poor outcomes with SARS-CoV-2 infection.1,2 Moreover, unhealthy lifestyle behaviors (i.e., physical inactivity, poor nutrition, smoking and excess body mass) are the leading cause for the high incidence and prevalence of chronic disease the world was facing well before the COVID-19 pandemic.3 In fact, physical inactivity and chronic diseases were both characterized as pandemics prior to COVID-19.1,4,5 In this context, decades of unhealthy lifestyle behaviors, both independently and through the association with chronic disease risk factors, primed the pump for poor COVID-19 outcomes.1,6, 7, 8 Another emerging theme is the disproportionate burden of poor outcomes in underserved communities and underrepresented individuals.9, 10, 11 A higher prevalence of unhealthy lifestyle characteristics and chronic disease certainly contributes to this disparity.12, 13, 14 From an international perspective related to health inequalities, a common conclusion is that the burden of disease is usually highest in the lowest-income countries, especially countries in sub-Saharan Africa. This pattern is most starkly seen for a wide range of infectious diseases,15 though rates of non-communicable diseases are already substantial and are rising in the region.16,17 As such, since the early days of the pandemic, there has been grave concern for the disastrous impact the COVID-19 pandemic would have in sub-Saharan Africa.