Impression of COVID-19 in Africa ‘vastly underestimated’ warn researchers

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The effects of COVID-19 in Africa have been greatly underestimated, researchers warn in a study published today by the BMJ.

Outside of South Africa, this is the first study to provide systematic surveillance data capturing the effects of COVID-19 in Africa.

Their results are based on polymerase chain reaction (PCR) test results for 364 deceased of all ages in the morgue of the University Teaching Hospital in Lusaka, Zambia, who were enrolled within 48 hours of death between June and September 2020.

The results show that COVID-19 deaths accounted for 15 to 20% of all sampled deaths – much more than official reports suggest and contradict the popular belief that COVID-19 has largely skipped Africa and had little impact.

They also show that COVID-19 deaths occurred in a wider age range than reported elsewhere and were concentrated in those under 65, including an unexpectedly high number of child deaths.

The lack of data on COVID-19 in Africa has led to the popular belief that the virus largely skipped Africa and had little impact. However, this can be an example of the "lack of evidence" being widely misunderstood as "lack of evidence".

To fill this evidence gap, a team of international researchers set out to measure the lethal effects of COVID-19 on an urban African population.

The deaths were stratified by COVID-19 status, location, age, gender, and underlying risk factors.

Overall, the virus was found in 70 (19%) people. The mean age at death was 48 years and 70% were men.

Most of the deaths of people with COVID-19 (73%) occurred in the community, and none had been tested for the virus before death. Of the 19 people who died in the hospital, six were tested before death.

Of the 52 people with symptom data, 44 had typical symptoms of COVID-19 (cough, fever, shortness of breath), of which only five were tested before death.

COVID-19 has been identified in seven children, only one of whom had been tested before death.

The proportion of deaths from COVID-19 increased with age, but 76% of those who died were under 60 years of age.

The five most common underlying diseases (comorbidities) in people who died from COVID-19 were tuberculosis (31%), high blood pressure (27%), HIV / AIDS (23%), alcohol abuse (17%), and diabetes (13%).

Understanding the true magnitude of the impact COVID-19 is having on Africa is crucial, according to the researchers. There is not just one moral imperative that the world recognize suffering wherever it exists. If Africa is seen as less of a threat, this could give access to COVID-19 vaccines a lower priority.

This is an observational study that uses data from a city in an African country over a short period of three months. The researchers point out several limitations, such as: B. on the accuracy of medical map data and the ability to indirectly identify deaths due to COVID-19, e.g. B. by heart attack or stroke.

However, this was a well-designed study conducted by researchers with a high level of experience in post-mortem sampling and data collection to minimize the potential for false positives.

Hence, the authors say that contrary to expectations, COVID-19 deaths were frequent in Lusaka and the majority occurred in the community that lacks testing capacity.

Still, few who died in healthcare facilities were tested despite showing typical symptoms of COVID-19. Hence, COVID-19 cases were underreported because tests were rarely done, not because CV19 was rare, they explain.

If these data can be generalized, the impact of COVID-19 in Africa has been grossly underestimated.

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More information:
Covid-19 deaths in Africa: prospective systematic post-mortem surveillance study, BMJ (2021). DOI: 10.1136 / bmj.n334

Provided by
British Medical Journal

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