Understanding the epidemiology of infectious diseases often depends largely on the local resources available to carry out surveillance tasks. It is very easy to fall into the trap of believing that the lack of information about a particular country or region means that diseases do not have an impact on these places.
The seemingly low rates of COVID-19 on the African continent are an example.
Much of what we believe we know about the impact of COVID-19 globally is based on aggregate data presented through portals like the Johns Hopkins COVID-19. website. From this, it could easily be concluded that the pandemic hit the United States harder than anywhere else in the world and that Africa has been largely saved.
But COVID-19 extends where the concentration of people allows it. What sets the US apart from most African countries is that the United States has more resources disease surveillance in the world, including the United States Centers for Disease Control and Prevention.
The existence and reliability of data can vary depending on local capacity, experience, resources and political will. In Africa, the highest concentration of cases appears being in South Africa – relatively high-income country with excellent capacity and resources for testing and surveillance.
We have been measuring the fatal impact of COVID-19 in the capital of Zambia, Lusaka. It has shown us the difficulty of systematic monitoring. Still, the global health community has largely dealt with the low rates of most of Africa a mystery. The most likely explanation is that the resources needed for surveillance are inadequate and therefore we do not see a complete picture of what is really going on.
We have been collecting data on for over four years infant deaths as part of a project to study other diseases. When the COVID-19 pandemic broke out, we were able to modify our surveillance work to include this new virus and determine what proportion of individuals of all ages in Lusaka tested positive by postmortem sampling. This is a work funded by the Gates Foundation and we have shared our findings with the Zambian Ministry of Health.
These data they are representative and generalizable because we are sampling the teaching staff of the Teaching Hospital, which collects almost all the deaths that occur in the city in all age groups. Although we did not have the resources to test all deaths (30 to 40 deaths per day is quite typical), we showed a random subset of these.
What we observed from June to September 2020 was that approximately one in five dead individuals tested positive for SARS-CoV-2 in our molecular laboratory in Lusaka. The rates we saw were about ten times higher than those officially reported at the time.
Since that initial report, we have continued to monitor deaths from COVID-19 at the same funeral home. The situation has clearly worsened. By June 2021 we were detecting SARS-CoV-2 in approximately 25% of deaths. But in June itself, the rate rose to a staggering 87% of deaths.
We are currently in the process of analyzing excess mortality, comparing the year COVID-19 with the seasonal mortality fund rate of the previous three years. This will help us better measure the impact of COVID-19.
Lack of vigilance
Our team is based in the teaching body of the University Teaching Hospital. We try to sign up every three to five death this happens, approaching the family or relatives to obtain informed consent. Our consent rates have been very high (approximately 90%).
We then obtain clinical information about the events leading to the deadly disease and obtain a nasal swab sample to test it. We use test kits from U.S. Centers for Disease Control, which are considered a global gold standard.
If we included the detection of SARS-CoV-2 at any level of signal strength in the PCR trial, we found it in 19% of all deaths between June and September 2020. About three-quarters of these deaths occurred outside of medical care. Of these, none had been tested for the virus before death. Of the deaths that occurred at a hospital, only a third had been tested before death.
This indicates that the apparently low rate of COVID-19 reported elsewhere was explained by the lack of systematic surveillance. COVID-19 seemed uncommon only because tests were rarely performed. Of the 70 deaths from COVID-19 we detected from 342 deaths, only six had been tested for COVID-19 before dying. And yet, almost everyone had had symptoms suggestive of COVID-19: cough, fever, shortness of breath.
In Zambia there are not enough funds and capacity to conduct comprehensive surveillance. Classified Zambia 117th out of 128 countries in terms of economic competitiveness in 2007.
The main concern is whether these results they are exclusive to Zambia. We doubt it. COVID-19 seems more likely to have a severe impact in many (possibly most) parts of Africa, but this is simply not documented.
As we have seen in the United States — which has largely reopened its society after vaccinating more than 180 million citizens — the only way out of this human calamity is vaccines.
Not more a few percent of Zambia’s population has received any vaccine against COVID. And while the goal is to vaccinate the population, Zambia’s access to vaccines is very limited. Hopefully the COVAX initiative can change this situation.
As long as Africa’s “low COVID-19 rate” continues to be seen as a puzzling enigma rather than a sign of inadequate surveillance, African countries will be behind the bus to get these life-saving products. In all likelihood, this is a catastrophe that is occurring on a continental scale, but which is simply not reported and therefore not appreciated.
To solve a problem like COVID-19, it is clear that it is essential to have accurate information about the true state of the situation.
Citation: Latest data from Lusaka morgue analysis show an increase in deaths from COVID-19 (2021, July 12) recovered on July 12, 2021 at https://medicalxpress.com/news/2021- 07-latest-lusaka-morgue-analysis-spike.html
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