Alternative epidemic indicators for COVID-19 in three settings with incomplete death registration systems

Abstract

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media–conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide.

The Missing Millions: Uncovering the Burden of Covid‐19 Cases and Deaths in the African Region

“…IFRs for other African countries, including Ethiopia, Mozambique, and South Africa, exceeded 0.5 percent, well above population benchmarks for high-income countries from other studies using the same methodology (Levin et al 2020). Additionally, recent work focusing on the highly characterized epidemic in Lusaka, Zambia, and conducted to match the IFR study by Brazeau et al (2022), found that the impact of the first pandemic wave in Lusaka during 2020 was highly consistent with COVID-19 epidemics elsewhere, leaving little room for any so-called "Africa paradox" (Sheppard et al 2023).…”

“…Observed death was significantly higher in the third quarter of 2020 for ages 35-49, 50-64, and 65+ and for both men and women. Additional work bringing together data from burial site worker reports, satellite imagery of cemeteries, social media-conducted surveys of infection, and representative serological studies from three major cities-Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan)-during 2020, researchers show substantial impacts of the pandemic coupled with high variability across contexts in the percentage of COVID-19 deaths that were reported (McCabe et al 2023). In Aden, Yemen, satellite imagery surveillance of all cemeteries from July 2016 to September 2020 suggests that an additional 2,120 excess deaths occurred from April 1, 2020, to September 19, 2020.…”

“…In the same study, researchers also uncovered a large unobserved epidemic in Khartoum, Sudan using household mortality survey and seroprevalence data, which suggested that only about 3 to 6 percent of COVID-19 deaths were reported. Finally, the postmortem surveillance studies conducted at the University of Zambia in Lusaka demonstrate substantial and sustained impacts of COVID-19 on mortality (Gill et al 2022;Mudenda et al 2021;Mwananyanda et al 2021;Sheppard et al 2023).…”