Impact of Covid-19 Vastly Underestimated in Africa – Zambian Researchers

By Prince Kurupati

A group of Zambian researchers based at the Boston University School of Public Health recently conducted a research into the impacts of Covid-19 in Africa. The research was inspired by the need to ascertain if the widely held belief that Africa has largely been spared the worst effects of the corona virus pandemic is true or not. At the end of the study, the researchers came to the conclusion that “the impact of Covid-19 in Africa has been vastly underestimated.”

The group of researchers used the University Teaching Hospital morgue in Lusaka as the study setting. Conducting their study which ran from June to September, 2020, the researchers enrolled 372 corpses as research participants. Out of the 372, 364 were exposed to PCR testing most of whom posthumously. Of the 364 participants that were tested, 15.9% were positive to Covid-19. The study however, could not ascertain if Covid-19 was the cause of death for all of those who tested positive.

From the research, the researchers managed to conclude that “deaths with Covid-19 were common in Lusaka (Zambia). 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 underreported because testing was rarely done not because Covid-19 was rare. If these data are generalisable, the impact of Covid-19 in Africa has been vastly underestimated.”

The results of the study made the researchers to postulate that by extension, the same trend of undercounting and underestimating the impact of Covid-19 maybe true elsewhere in Africa. This, in essence, disproving official records which state that Covid-19 fatalities in Africa account for just 4% of the population in a continent that makes up 17 per cent of the world’s population.

Various myths and theories that were forwarded by different individuals on the continent were also tackled during the course of the research. Firstly, many individuals believe that Covid-19 is a pandemic that rakes havoc mostly in the middle and upper classes of society. Low density communities that live in densely populated areas are of the view that they have been largely spared by the pandemic. To justify this, many claim that if the pandemic had caused as much havoc as it did in the East and West, then hundreds of deaths would be recorded. This however, according to the research was disproved as it found out that “most deaths occurred in the community” but “the majority of people who died in the community… had not been tested for Covid-19 before death”. To compound the situation, out of the people who die in the communities, upon arriving at health institutions, “testing was rarely conducted” even though some would have died showing “a constellation of symptoms typical of Covid-19”.

In recent times, public fatigue at Covid-19 countermeasures such as mask wearing and social distancing has been on the rise. Many youths and young adults hold the belief that the elderly are at higher risk of contracting the virus and succumbing to the virus thus they leave themselves vulnerable. This, however, has been disproved by the research which states that “deaths with Covid-19 occurred quite evenly across the age spectrum, not just among elder people. Most deaths were in people aged 20-59 years. This pattern is distinct from that described in the US, the EU, and China; it is more typical of the death by age distribution and population age structures common in African countries.”

Furthermore, to highlight the impact that Covid-19 has had on the younger generations, the research concluded that “10% (7/10) of the deaths with Covid-19 were in children, including three infants. Among the younger children, gastrointestinal rather than respiratory complaints predominated, which may be a factor explaining why only one had been tested for Covid-19 before death. The preponderance of gastrointestinal symptoms among children has been described previously.”

However, while the research did disprove several commonly held beliefs, it did agree with the popular belief that Covid-19 affects more those living with comorbidities. The research “identified a high frequency of novel potential underlying risk factors that may be more specific to Africa. Notably, tuberculosis, malnutrition, and HIV/AIDS were very common in this setting.” Other high risk factors included chronic conditions such as “diabetes, cardiovascular disease, and emphysema”.

Overall, the research team led by Lawrence Mwanayanda came to the conclusion that Africa is no different to any other continent when it comes to the question of the impact of Covid-19. The assertion that Africa was spared the worst effects is thus not true. On this front, the research called for more systematic surveillance to be conducted by different African countries. Only when this is fulfilled can Africa have a more definitive answer to the question of the real impact of Covid-19 on the continent. The research encouraged African countries to take a leaf from South Africa when it comes to systematic surveillance as it has been a frontrunner.

The conclusions reached by the Boston University School of Public Health were supported by Dr Faisal Shuaib, chief executive of Nigeria’s National Primary Health Care Development Agency. Dr Shuaib said the findings of the study rang true in Nigeria, “There are a lot of communities where autopsies are not carried out, so we don’t have complete data on causes of death… So, yes, it is possible that we don’t know how many people are dying of Covid.” However, Dr Shuaib said that it was of critical significance for the research to be rigorously peer reviewed before its findings and recommendations are taken as the way forward.