This article argues that the key issue with the COVID-19 pandemic in sub-Saharan Africa is not, as they would have it, that the population is young and that there are therefore not that many susceptible people. That is, in any case, a highly dubious assumption. With high rates of TB, untreated HIV, diabetes, hypertension and malnourishment in many parts of the continent, it may be the case that large numbers of younger people are exposed to risk. South Africa’s rapid and extreme lockdown was not implemented because of a concern for wealthy older people in the middle-class suburbs. It was imposed due to the terrifying prospect of the disease tearing through informal settlements already ravaged by disease and poverty.
The key issue is rather that the social distancing measures that can be effective in highly regulated built environments of the Global North don’t work in conditions of urban overcrowding and poor infrastructure. It is impossible to “shelter in place” when there is no adequate sanitation, governmental authority is weak, and the media environment is awash with misinformation. Those factors make a China-style lockdown impossible whether the population is mostly young or whether it contains a large proportion of over-75s.
We need to go beyond the notion that “one size fits all” solutions are not enough. We’ve known that for a month already. If one size doesn’t fit all, what are the other “sizes”?