Résumé
Background 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. Methods 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.Results Accounting for testing dynamics, we show that Africa exhibits multiple infectionacceleration 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. Conclusions 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.The relatively low number of reported COVID-19 cases and deaths in Africa has prompted debates about whether the continent was spared the worst of the pandemic, a phenomenon described by some as the African "puzzle" 1,2 or "paradox" 3 . Early media reports and research articles speculated that Africa's younger population, lower population density in rural areas, and prior experience with infectious diseases and their pharmaceutical treatments might have mitigated the severe impacts observed in other regions.However, emerging evidence from seroprevalence studies indicates that far more individuals in Africa were exposed to SARS-CoV-2 than is reflected in official surveillance data, especially during the pandemic's first 2 years. For example, the ratio of seroprevalence to confirmed cases has been estimated to be as high as 100:1 4 . This gap between seroprevalence estimates and reported cases grew as the pandemic continued 5 , suggesting substantial under-reporting in surveillance data. For example, while 6 mention low testing rates as a likely source of under-reporting in their discussion of the