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

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Tomb of a dead man du Covid-19 in the Saint-Lazare cemetery in Dakar, August 4, 2021.

It’s time for accounts. While the Covid-19 pandemic has caused nearly three times as many deaths worldwide, directly and indirectly, as officially reported, the World Health Organization (WHO) reported on May 5. ). ), Africa is no exception. Between 1er January 2020 and December 31, 2021, the number of Africans who died of Covid-19 would be 1.24 million, five and a half times more than the 229,197 official deaths listed on January 4, 2022 by the African Bureau of Disease Control and Prevention (CDC) of the African Union.

Despite this, the countries of the continent, like those with low and medium incomes in the rest of the world, “Only” carry 19% of this “hidden” burden, with the largest excesses of mortality found in Southeast Asia, Eastern Europe, North America and Latin America. In the world, SARS-CoV-2 and its multiple variants are responsible for the deaths of 13.3 to 16.6 million people. Much more than the 5.5 million official deaths in the same period, according to the WHO, whose figures confirm the spectacular revaluations announced in a study published in early March in the scientific journal The Lancet.

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To carry out these models, the UN agency compared the number of deaths in each country with those in previous years. The figures, however, need to be discussed with caution, the WHO explained in the presentation of the results. “Les estimations africaines were presented without all the necessary data, a renowned William Msebburi, WHO analyst. Only five countries were able to provide consolidated data, 42 did not have enough and a few did not. We are facing a real modeling difficulty “, which could lead to a greater fear of a larger number of these “hidden” deaths.

“The shortcomings of the Covid-19 pandemic indicate that one of the crucial issues for the coming years will be to strengthen health information systems around the world in order to better protect and prevent them.” added Dr. Samira Asma, WHO’s case manager.

Southern Africa pays the heaviest tribute

To explain the difference between the names of deaths announced daily by CDC Africa and these complex mathematical modeling, it must first be remembered that supermortality counts not only deaths directly attributable to SARS-CoV-2 – a curve on which world opinion has eyes riveted since the beginning of the crisis – but also those that are indirectly associated, all causes combined, “Resulting from the impact of the pandemic on health systems and society”explains the WHO.

On the mainland, and usually for developing countries, the numbers suggest that Africans have died as much from Covid-19 itself as from its consequences. Because the pandemic has led to a major economic and social crisis: the already fragile health system shaken, the abandonment of care, delays and resistance to Covid vaccination, the removal of people from health centers whose financial resources and staff have been massively reassigned to the response, discontinued vaccination routine for other “major killer” diseases (AIDS, tuberculosis, malaria, measles), restricted access to certain treatments and medications, sudden impoverishment of homes. 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 has increased by 37 million in 2021.

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In terms of excess mortality, there are large disparities across the continent, with an average of 61 “surplus” deaths per 100,000 population, according to WHO models, while the global average is 82. L Southern Africa pays the heaviest tribute, 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) both had higher mortality rates than Morocco (47), Algeria (79) and Libya (57) combined.

“In southern Africa, where the seasons are much busier, we have seen the saturation of hospitals during the winter waves,” decrypts Professor Arnaud Fontanet, epidemiologist at the Pasteur Institute in Paris, specialist in Covid-19 : “This has been the case in intertropical Africa, where the virus has spread more consistently.” » La surmortalité was at the time less visible and less important. From Senegal to Ethiopia, Côte d’Ivoire or Nigeria, virtually all countries in the sub-Saharan strip have lower figures than the mainland average, with the exception of Cameroon (66), Central Africa. (64), Somalia (110) and the Democratic Republic of the Congo (65).

A majority of deaths at home

In this equation, however, it is difficult to determine for each country the number of deaths directly attributable to the new coronavirus: a number of fatal cases of Covid-19 have been reported. “Missed”as the study points out, for failing to test people ante egg post mortem or because the national statistical systems are not robust enough.

A study released in late March and conducted in Zambia on 1,118 people tested post mortem had revealed the presence of the virus in 90% of cases during the epidemic peak period, which does not mean, however, that these people all died of SARS-CoV-2. “Thanks to the many seroprevalence studies conducted on the continent, the virus is known to have circulated there as much as elsewhere, recalls Arnaud Fontanet. But the case of Zambia is interesting because it has also shown that 80% of the deaths in Covid-19 have died at home. This is the missing piece of the puzzle to explain much of these hidden cases, although there have been few such studies in Africa yet. »

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Another meta-analysis study, led by Andrew Levin and presented in 2021 in British Medical Journal, had shown that the risk of death (lethality rate) was twice as high in developing countries as in high-income countries, especially because of difficulties in accessing care. An effect offset, if not counterbalanced, by the youth of the population in Africa. Of the 1.3 billion people, only 3.5% are over the age of 65.

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