The days when COVID-19 was only a distant threat to West African countries are over. It is now evident that the virus is here to stay and must be addressed with practical responses that take into account the West African settings. Although, the infection curve is not exponential, community transmission is beginning to gain grounds in the region, with countries such as Cote d’Ivoire, Ghana, Guinea, Nigeria, and Senegal at the forefront with the most cases (fig 1). The lack of testing capacity in many countries suggests that the estimated number of cases are most likely understated. Currently, there are three factors that give the region an advantage in the fight against the novel disease. First, is its youthful population. The average age of Africans is below 20 years, and available data suggests that the risk of serious medical complications and death is lower among younger people. Furthermore, warm weather in the region could potentially reduce the spread of the virus, although this fact is remains unproven. Lastly, as a result of the Ebola epidemic in West Africa, it could analysts have argued that the region has some experience confronting infectious diseases. While these factors might allow the region to avoid the worst of the pandemic, it also faces grave challenges that could overwhelm these advantages. They include high levels of poverty; densely packed urban areas; and weak health systems and insecurity. This paper reviews the current healthcare conditions in west Africa and its preparedness in combating COVID-19. It interrogates both states and regional level responses to the virus and analyses the risk factors and emerging issues the region as the pandemic continues to spread. Inevitably, the pandemic will widen inequalities across the region, worsen already existing fragilities, restrict employment and investment prospects, and possibly aggravate existing unrest in conflict prone regions. Therefore, it is recommended, that both state governments and regional body pay adequate attention, to the evolving pandemic whilst responding in a practical and timely manner.