Unexpected low burden of coronavirus disease 2019 (COVID-19) in sub-Saharan Africa region despite disastrous predictions: reasons and perspectives.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the development of a highly contagious disease called coronavirus disease (COVID-19). Ten months after the onset of the pandemic, America and Europe remain the most affected regions. Initially, experts predicted that Africa, the poorest continent with the most vulnerable population and health system, would be greatly affected by the ongoing outbreak. However, 240days after the first confirmed case, Africa is among the least affected region, with lower than expected incident cases and mortality. In this review, we discuss possible explanations and reasons for this unexpected low burden of COVID-19 in Africa. We focus on the characteristics of the virus, specificities of the sub-Saharan African population and local environment.

Glycemic effects of quinine infusion in healthy volunteers.

BACKGROUND: We aimed to quantify the glycemic effects of quinine in healthy individuals. METHODS: We evaluated the glycemic profile in response to 4 h infusion of 500 ml of 0.9% saline versus 5% glucose solution with and without quinine at therapeutic dose (500 mg) in ten healthy volunteers (8 men) aged 28 ± 9 years. The order of the fourth explorations was randomly assigned. During these explorations, we measured blood glucose every 15 min for 4 h and compared the mean and glycemic fluctuations for each test. A resting ECG was performed before and after quinine infusion in each participant. RESULTS: The mean glycemic level during the 4-h infusion was 83 ± 5 mg/dl without quinine versus 74 ± 5 ​​mg/dl with quinine (p < 0.001) using saline solute versus 92 ± 7 mg/dl without quinine versus 82 ± 5 mg/dl with quinine (p < 0.001) when associated with the glucose solute. In isotonic dirty solute, quinine induces a cumulative glycemic decrease of 17.5% (p = 0.01) characterized by a nadir estimated at -26.5% at the 60th minute (65 ± 23 mg/dl), p <0.001 followed by a gradual increase until the 4th hour. There were no signs of hypoglycemia or significant prolongation of the QT interval at the ECG. Overall, quinine did not induce a significant change in blood glucose with glucose compared to saline. CONCLUSION: The intravenous infusion of quinine at a therapeutic dose induces a light drop in blood glucose with a significant nadir at the 60th minute in the healthy subject without hypoglycemia. This suggests the need for close monitoring in patients at risk of hypoglycemia such as those with severe malaria especially during the first hour of quinine infusion.