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Covid-19 deaths in Africa: prospective systematic postmortem surveillance study.
Mwananyanda, Lawrence; Gill, Christopher J; MacLeod, William; Kwenda, Geoffrey; Pieciak, Rachel; Mupila, Zachariah; Lapidot, Rotem; Mupeta, Francis; Forman, Leah; Ziko, Luunga; Etter, Lauren; Thea, Donald.
  • Mwananyanda L; Contributed equally.
  • Gill CJ; Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
  • MacLeod W; Right To Care - Zambia.
  • Kwenda G; Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
  • Pieciak R; Contributed equally.
  • Mupila Z; Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
  • Lapidot R; Department of Biomedical Sciences, University of Zambia, Lusaka, Zambia.
  • Mupeta F; Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
  • Forman L; ZPRIME Molecular Laboratory, University Teaching Hospital, Lusaka, Zambia.
  • Ziko L; Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
  • Etter L; Division of Internal Medicine, Infectious Diseases Section, University Teaching Hospital, Lusaka, Zambia.
  • Thea D; Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA.
BMJ ; 372: n334, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1088219
ABSTRACT

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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Systematic review/Meta Analysis Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: SARS-CoV-2 / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study / Systematic review/Meta Analysis Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Africa Language: English Journal: BMJ Journal subject: Medicine Year: 2021 Document Type: Article