Africa’s low COVID-19 mortality rate: A paradox?

Lawal, Yakubu

doi:10.1016/j.ijid.2020.10.038

Cited by 126 publications

(140 citation statements)

References 2 publications

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“…Actually, the low intensity and lethality of the national epidemics in most African countries suggest hypothetical protective interactions of the high burden of tuberculosis (and/or BCG coverage) and tropical parasitic diseases, along with the lack of health-care infrastructure capable of clinically detecting and confirming COVID-19 cases, the implementation of social distancing and hygiene, international air traffic flows, the climate, the relatively young and rural population, the genetic polymorphism of the angiotensin-converting enzyme 2 receptor, cross-immunity and the use of antimalarial drugs [ [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] ]. However, the detection of a new variant of the SARS-CoV-2 in South Africa (variant 501Y·V2) in middle December 2020 with preliminary studies suggesting that the variant is associated with a higher viral load, which may suggest potential for increased transmissibility, might challenge the low transmissibility, low lethality trend observed so far in most African Countries [ 81 ].…”

Section: Evidence Of the Syndemic Nature Of The Sars-cov-2 Pandemicmentioning

confidence: 99%

The SARS-CoV-2 pandemic: A syndemic perspective

et al. 2021

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The SARS-CoV-2 pandemic has affected communities, populations, and countries throughout the world. As the SARS-CoV-2 pandemic developed, the extent to which the disease interacted with already existing endemic, non-communicable and infectious diseases became evident, hence deeply influencing health outcomes. Additionally, a synergistic effect has been demonstrated also with socio-economic, cultural, and contextual determinants of health which seem to contribute to poorer health and accumulating social disadvantages. In this essay, using as a starting point the syndemic theory that translates the cumulative and intertwined factors between different epidemics, we argue that the SARS-CoV-2 is a one health issue of a syndemic nature and that the failure to acknowledge this contributes to weakened policy-making processes and public health responses and ineffective health policies and programs.

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Section: Evidence Of the Syndemic Nature Of The Sars-cov-2 Pandemicmentioning

confidence: 99%

The SARS-CoV-2 pandemic: A syndemic perspective

et al. 2021

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“… 1 A puzzling question is why covid-19 seems to have largely skipped Africa. 2 3 4 Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should be favored wherever population densities are high, but the Institute of Health Metrics and Evaluation recently listed covid-19 as the 45th most common cause of death in Africa, despite it being the 12th leading cause globally. 5 No obvious reason exists why covid-19 would not spread as efficiently in Nairobi, Accra, or Lagos as it has in New York City, London, or Mumbai.…”

Section: Introductionmentioning

confidence: 99%

“…The global coronavirus disease 2019 (covid-19) pandemic has had a devastating effect on the health of millions of people, with ongoing and/or accelerated transmission in nearly all regions of the world 1. A puzzling question is why covid-19 seems to have largely skipped Africa 234. Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) should be favored wherever population densities are high, but the Institute of Health Metrics and Evaluation recently listed covid-19 as the 45th most common cause of death in Africa, despite it being the 12th leading cause globally 5.…”

Section: Introductionmentioning

confidence: 99%

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

Mwananyanda

Gill

MacLeod

et al. 2021

BMJ

165

164

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Objective To directly measure the fatal impact of coronavirus disease 2019 (covid-19) in an urban African population. Design Prospective systematic postmortem surveillance study. Setting Zambia’s largest tertiary care referral hospital. Participants Deceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death. Main outcome measure Postmortem nasopharyngeal swabs were tested via reverse transcriptase quantitative polymerase chain reaction (PCR) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Deaths were stratified by covis-19 status, location, age, sex, and underlying risk factors. Results 372 participants were enrolled between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%) according to the recommended cycle threshold value of <40 and in 70/364 (19.2%) when expanded to any level of PCR detection. The median age at death among people with a positive test for SARS-CoV-2 was 48 (interquartile range 36-72) years, and 69% (n=48) were male. Most deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death. Among the 19/70 people who died in hospital, six were tested before death. Among the 52/70 people with data on symptoms, 44/52 had typical symptoms of covid-19 (cough, fever, shortness of breath), of whom only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53) of people who died were aged under 60 years. The five most common comorbidities among people who died with covid-19 were tuberculosis (22; 31%), hypertension (19; 27%), HIV/AIDS (16; 23%), alcohol misuse (12; 17%), and diabetes (9; 13%). Conclusions Contrary to expectations, deaths with covid-19 were common in Lusaka. Most occurred in the community, where testing capacity is lacking. However, few people who died at facilities were tested, despite presenting with typical symptoms of covid-19. Therefore, cases of covid-19 were under-reported because testing was rarely done not because covid-19 was rare. If these data are generalizable, the impact of covid-19 in Africa has been vastly underestimated.

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“…1 A puzzling question is why CV19 appears to have largely skipped Africa? [2][3][4] transmission should be favored wherever population densities are high, yet the institute of Health Metrics and Evaluation (IHME) recently listed CV19 as the 45 th most common cause of death in Africa, despite being the 12 th leading cause globally. 5 There is no obvious reason why CV19 would not spread as efficiently in Nairobi, Accra, or Lagos as it has in New York City, London, or Mumbai.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa

Mwananyanda

Gill

MacLeod

et al. 2020

Preprint

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ObjectivesLimited SARS CoV 2 testing in many African countries has constrained availability of data on the impact of COVID-19 (CV19). To address this gap, we conducted a systematic post-mortem surveillance study to directly measure the fatal impact of CV19 in an urban African population.DesignWe enrolled deceased individuals at the University Teaching Hospital (UTH) Morgue in Lusaka, Zambia. We obtained nasopharyngeal swabs for testing via reverse-transcriptase quantitative PCR (RT-qPCR) against the SARS-2 Coronavirus. We stratified deaths by CV19 status, by location, age, sex, and underlying risk factors.SettingUTH is Zambia’s largest tertiary care referral hospital and its morgue registers ∼80% of Lusaka’s deaths.ParticipantsParticipants of all ages were enrolled if within 48 hours of death and if the next of kin or representative provided written informed consent.ResultsWe enrolled 372 participants between June and September 2020, and had PCR results for 364 (99.5%). CV19 was detected in 70/364 (19.2%). The median age for CV19+ deaths was 48 years (IQR 36-72 years) and 70% were male. Most CV19+ deaths (51/70, 72.8%) occurred in the community; none had been tested for CV19 antemortem. Among the 19/70 facility deaths, six were tested antemortem. Among the 52/70 CV19 deaths with symptoms data, 44/52 had typical symptoms of CV19 (cough, fever, shortness of breath), of whom only five were tested antemortem. We identified CV19 among seven children; only one had been tested antemortem. The proportion of CV19+ deaths increased with age, but 75.7% of CV19+ deaths were aged <60 years. The five most common co-morbidities among CV19+ deaths were: tuberculosis (31.4%); hypertension (27.1%); HIV/AIDS (22.9%); alcohol use (17.1%); and diabetes (12.9%).ConclusionsContrary to expectations, CV19+ deaths were common in Lusaka. The majority occurred in the community where testing capacity is lacking. Yet few who died at facilities were tested, despite presenting with typical symptoms of CV19. Therefore, CV19 cases were under reported because testing was rarely done, not because CV19 was rare. If our data are generalizable, the impact of CV19 in Africa has been vastly underestimated.

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Africa’s low COVID-19 mortality rate: A paradox?

Cited by 126 publications

References 2 publications

The SARS-CoV-2 pandemic: A syndemic perspective

The SARS-CoV-2 pandemic: A syndemic perspective

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

COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa

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