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

It’s time to reckon. If throughout the world the Covid-19 pandemic has caused, directly and indirectly, almost three times more deaths than the official death toll, as reported on May 5 by the World Health Organization (WHO), Africa does not is an exception. Between 1^Ahem January 2020 and December 31, 2021, the number of Africans who died from Covid-19 would amount to 1.24 million, five and a half times more than the 229,197 deaths officially registered on January 4, 2022 by the African Centers office . Center for Control and Prevention (CDC).

Despite this, the countries of the continent, like the middle and low income countries of the rest of the world, they carry “only” 19% of this “hidden” burden, with the highest observed excess mortality concentrated in Southeast Asia, Eastern Europe, North America, and Latin America. Globally, 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 deaths officially registered in the same period, according to the WHO, whose figures confirm the spectacular reassessments announced in a study published in early March in the scientific journal the lancet.

To carry out these models, the UN agency compared the number of deaths that occurred in each country with those of previous years. Figures that, however, should be spoken with caution, explained the WHO during the presentation of the results. “The African estimates were presented without us being able to have all the necessary data, acknowledged William Msemburi, WHO analyst. Only five countries were able to provide consolidated data, 42 do not have enough and a few none. We are, therefore, faced with a real difficulty of modeling “, which could lead to fear of a greater number of these “hidden” deaths.

“The shortcomings revealed by the Covid-19 pandemic indicate that one of the crucial challenges of the coming years will be to strengthen health information systems, throughout the world, in order to better protect and prevent”, added Dr. Samira Asma, in charge of the archive at WHO.

South Africa pays the highest price

To explain the difference between the number of deaths announced daily by the Africa CDC and these complex mathematical models, one must first remember that excess mortality does not only count deaths directly attributable to SARS-CoV-2 -a curve in which it has had world public opinion. their eyes glued from the beginning of the crisis – but also those indirectly associated with it, all causes combined, “arising from the impact of the pandemic on health systems and society”explains the WHO.

On the continent, and in general for developing countries, the figures suggest that Africans have died both from Covid-19 itself and from its consequences. Because the pandemic has caused a great economic and social crisis: already fragile health systems shaken, giving up care, delays and resistance to anti-Covid vaccination, distancing populations from health centers whose financial and personnel resources are have massively reallocated to the response. , interrupted vaccination routine for other “big killer” diseases (AIDS, tuberculosis, malaria, measles), restricted 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 has increased by 37 million in 2021.

In terms of excess mortality, wide disparities are seen across the continent, with an average of 61 “excess” deaths per 100,000 population, according to WHO models, while the global average is 82. South Africa pays the highest price, with rates of 200 for South Africa, 164 for Eswatini, 156 for Botswana, 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 experienced higher excess mortality than Morocco (47), Algeria (79), and Libya (57) combined.

“In southern Africa, where the seasons are much more marked, we have seen phenomena of hospital saturation 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 constantly. » Excess mortality was less visible and less significant. From Senegal to Ethiopia, passing through the Ivory Coast or Nigeria, practically all the countries of the sub-Saharan band have figures below the continental average, with the exception of Cameroon (66), the Central African (64), Somalia (110) and the Republic of Democratic Republic of the Congo (65).

Most deaths at home

In this equation, however, it is difficult to determine precisely for each country the additional deaths directly attributable to the new coronavirus: a certain number of fatal cases of Covid-19 have been recorded. “omitted”As the study points out, in the absence of having tested people initial bet Where post-mortem or because national statistical systems are not robust enough.

A study made public at the end of March and carried out in Zambia on 1,118 people tested post-mortem had revealed the presence of the virus in 90% of cases during the epidemic peak, which does not mean, however, that all these people died of SARS-CoV-2. “Thanks to the numerous seroprevalence studies carried out on the continent, we know that the virus has circulated both there and elsewhere, recalls Arnaud Fontanet. But the Zambian case 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, although there are still few such studies in Africa. »

Another meta-analysis study, led by Andrew Levin and presented in 2021 at the British medical journal, had shown that the risk of dying (mortality rate) was twice as high in developing countries as in high-income countries, particularly due to difficulties in accessing health care. An effect compensated, even counteracted, by the youth of the African population. Of 1,300 million inhabitants, only 3.5% are over 65 years old.