A study of corpses in a Zambian morgue suggests that deaths from Covid-19 may have been routinely undercounted in the country, and by extension possibly elsewhere in Africa, challenging the view that the continent has avoided the worst effects of the pandemic.
According to official records, just over 90,000 people have died from Covid-19 in Africa, which equates to about 4 per cent of the global death toll in a continent that makes up 17 per cent of the world’s population.
Several explanations have been advanced for Covid’s apparently low impact, including the continent’s youthful population, its relative isolation and swift measures to contain the pandemic taken by health authorities.
However, research by Boston University School of Public Health, which has not yet been peer reviewed, offers an alternative thesis: that many Covid deaths have simply not been registered.
Researchers, who took nose and throat swabs from the bodies of recently deceased people at the University Teaching Hospital morgue in Lusaka, found a far higher incidence of Covid-19 than expected. Of 364 bodies tested, Covid-19 was detected in 70.
Lawrence Mwananyanda, who led the research, said it cast doubt on the view that Covid-19 had “somehow skipped” Africa. “If our data are generalisable, the impact of Covid-19 in Africa has been vastly underestimated,” the authors of the paper wrote.
While it was possible the first wave had been relatively well contained a second wave was proving more deadly. “In Lusaka now, everybody knows someone who has died of Covid or who is in the hospital with Covid,” he said.
Dr Mwananyanda estimated that Zambia’s official Covid-19 death toll of 723 might underestimate the true level by as much as tenfold, a pattern that he said could be replicated in many African countries where Covid-19 testing is limited and the cause — or even the fact — of death goes routinely unrecorded.
The World Health Organization last week said that a new variant of Covid-19 first detected in South Africa was causing a second wave of infections in much of the continent. In the four weeks to January 25, infections rose 50 per cent to 175,000 across the region compared with the previous four weeks, with deaths doubling in 10 countries, mainly in the south and north of the continent, it said.
As well as the new variant, which has been found in Botswana, Ghana, Kenya and Zambia, lockdowns had been relaxed in much of Africa and public fatigue at Covid-19 countermeasures, such as mask wearing and social distancing, had set in, said Dr Matshidiso Moeti, WHO regional director for Africa.
Many African nations were almost certainly undercounting the true number of Covid-19 deaths, Dr Moeti added.
Dr Faisal Shuaib, chief executive of Nigeria’s National Primary Health Care Development Agency, said the findings of the Zambia study rang true in Nigeria, Africa’s most populous country. “There are a lot of communities where autopsies are not carried out, so we don’t have complete data on causes of death,” he said. “So, yes, it is possible that we don’t know how many people are dying of Covid.”
However, Dr Shuaib cautioned that it was important to wait for the Zambia research to be rigorously peer reviewed before leaping to conclusions. Anecdotal evidence suggests that, outside South Africa, few African hospitals were overwhelmed with Covid-19 patients last year.
In the Zambia morgue study, conducted between June and September last year, the median age of death of those testing positive for Covid-19 was 48, much younger than in developed countries. Seven were children, including a baby only a few months old.
“Oral autopsies”, conducted by talking to relatives, found that many of the 70 deceased had exhibited Covid-like symptoms, including coughing and shortness of breath, in addition to testing positive on their postmortem swab tests. However, Dr Mwananyanda conceded it was impossible to be certain that Covid-19 was the cause of death.
Of the 70 patients, only 19 had been admitted to hospital. The remaining 51 had died in the community where Covid-19 testing was almost non-existent, he said.