In Africa, the “hidden” burden of excess mortality from Covid-19

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The grave of a man who died of Covid-19 in the Saint-Lazare cemetery in Dakar, August 4, 2021.

It’s time to pay. If worldwide the Covid-19 pandemic has directly and indirectly caused almost three times more deaths than the number of officially recorded deaths, as reported on May 5 by the World Health Organization (WHO), Africa is no exception. Between 1er In January 2020 and December 31, 2021, the number of Africans who died from Covid-19 would reach 1.24 million, five and a half times more than the 229,197 deaths officially listed by the African Centers office as of January 4, 2022. Control and Prevention Center (CDC).

Despite this, the continent’s countries, like those with low and middle incomes in the rest of the world, have carry “only” 19% of this “hidden” burden, with the greatest observed excess mortality being concentrated in Southeast Asia, Eastern Europe, North America and Latin America. Worldwide, SARS-CoV-2 and its multiple variants are responsible for the deaths of 13.3 to 16.6 million people. Far more than the officially recorded 5.5 million deaths over the same period, according to the WHO, whose figures confirm the spectacular reassessments announced in a study published in the scientific journal in early March. the lancet

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To run these models, the UN agency compared the number of deaths in each country with that of previous years. Figures that should be treated with caution, however, the WHO explained when presenting the results. “The African estimates were presented without all the necessary data, acknowledged William Msemburi, an analyst at the WHO. Only five countries were able to provide consolidated data, 42 do not have enough and some have none at all. We are therefore faced with a real difficulty in modeling”, which could spark fears of a greater number of these “hidden” deaths.

“The shortcomings exposed by the Covid-19 pandemic indicate that one of the critical challenges of the coming years will be to strengthen health information systems, around the world, to better protect and prevent.” added Dr. Samira Asma, who is responsible for the file at the WHO.

Southern Africa pays the heaviest price

To explain the difference between the daily deaths announced by the Africa CDC and these complex mathematical models, it must first be borne in mind that excess mortality does not only count deaths directly attributable to SARS-CoV-2 – the curve tracing the public opinion has had its eyes glued together since the beginning of the crisis – but also those indirectly affected by it, all causes together, “due to the impact of the pandemic on health systems and society”explains the WHO.

On the continent, and for developing countries in general, the figures suggest Africans have died as much from Covid-19 itself as from its effects. Because the pandemic has led to a major economic and social crisis: shaking already fragile health systems, renunciation of care, delays and resistance to anti-Covid vaccination, distancing populations from health centers whose financial resources and staff have been massively allocated response, interrupted vaccination routine for other “major deadly” diseases (AIDS, tuberculosis, malaria, measles), limited access to certain treatments and medicines, sudden impoverishment of households. According to the United Nations, the number of people living on less than $1.90 a day – the extreme poverty line – in sub-Saharan Africa will rise by 37 million by 2021.

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In terms of excess mortality, large differences are observed across the continent, with the average being 61 “excess” deaths per 100,000 population, according to WHO models, while the global average is 82. Southern Africa pays the highest price, with rates of 200 for South Africa, 164 for Eswatini, 156 for Bostwana, 151 for Namibia, 93 for Lesotho, 67 for Mozambique, 63 for Zimbabwe and 62 for Zambia. In the Maghreb, Tunisia (160) and Egypt (122) together had a higher excess mortality than Morocco (47), Algeria (79) and Libya (57) combined.

“In southern Africa, where the seasons are much clearer, we have seen hospital saturation phenomena during the winter waves,” deciphers Professor Arnaud Fontanet, epidemiologist at the Institut Pasteur in Paris, specialist in Covid-19 : “This was less the case in intertropical Africa, where the virus circulated more consistently. † Excess mortality was both less visible and less significant. From Senegal to Ethiopia, via the Ivory Coast or Nigeria, practically all countries of the sub-Saharan band have figures below the continental average, with the exception of Cameroon (66), Central Africa (64), Somalia (110) and the Democratic Republic of the Congo (65).

Most deaths at home

However, in this comparison, it is difficult to determine exactly the additional deaths directly attributable to the new coronavirus for each country: a certain number of fatal cases from Covid-19 have been identified. “missed”as the study points out, because they didn’t test the people ante True post mortem or because the national statistical systems are not robust enough.

A study made public at the end of March and conducted in Zambia among 1,118 people tested post mortem revealed the presence of the virus in 90% of cases during the epidemic peak, which does not mean, however, that these people all died from SARS-CoV-2. “Thanks to the many seroprevalence studies conducted on the continentwe know that the virus has been circulating there as much as elsewhere, remembers Arnaud Fontanet. But the case of Zambia is interesting because it also showed that 80% of Covid-19 deaths died at home. This is the missing piece of the puzzle to explain much of these hidden cases, even though there have been few such studies in Africa. †

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Another meta-analysis study, led by Andrew Levin and presented in 2021 in the British medical journal, had shown that the risk of death (death rate) was twice as high in developing countries as in high-income countries, mainly because of the difficulty of accessing health care. An effect offset, even offset, by the youth of the population in Africa. Of the 1.3 billion inhabitants, only 3.5% are older than 65 years.

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