Covid-19 deaths in Africa: prospective systematic postmortem surveillance study

Area of Science:

• Epidemiology
• Infectious Diseases
• Public Health

Background:

• Coronavirus disease 2019 (COVID-19) has had a significant global impact.
• Accurate assessment of COVID-19's mortality burden in African populations is crucial.
• Limited data exists on the true extent of fatal COVID-19 cases in urban African settings.

Purpose of the Study:

• To directly measure the fatal impact of COVID-19 in an urban African population.
• To determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in postmortem individuals.
• To identify risk factors and demographic patterns associated with COVID-19 deaths.

Main Methods:

• A prospective systematic postmortem surveillance study was conducted at Zambia's largest tertiary care referral hospital.
• Postmortem nasopharyngeal swabs were tested for SARS-CoV-2 using reverse transcriptase quantitative polymerase chain reaction (PCR).
• Deaths were stratified by COVID-19 status, location, age, sex, and underlying risk factors.

Main Results:

• SARS-CoV-2 was detected in 15.9% (58/364) of participants using standard PCR thresholds, and 19.2% (70/364) with broader detection.
• The median age of COVID-19 decedents was 48 years, with 69% being male.
• Most COVID-19 deaths (73%) occurred in the community, and only 5 out of 52 symptomatic individuals were tested before death.

Conclusions:

• Contrary to expectations, COVID-19 deaths were common in Lusaka, predominantly in the community with inadequate testing.
• Under-reporting of COVID-19 cases is likely due to insufficient testing rather than rarity of the disease.
• The impact of COVID-19 in Africa may be vastly underestimated if these findings are generalizable.