The coronavirus disease 2019 (COVID-19) pandemic has spread to all 55 countries in Africa. The prevalence is highly heterogeneous, and the majority of cases are asymptomatic. Several factors are thought to explain heterogeneity of COVID-19 in Africa, including the level of containment measures, demographic aspects, climate and environmental factors, host genetics and immune factors. Here, we discuss the prevalence of COVID-19 in Africa, the status of serological studies, COVID-19 and comorbidities, as well as the spread of SARS-CoV-2 variants and the status of vaccine roll-outs in Africa.