Article ; Online: Covid-19 deaths in Africa: prospective systematic postmortem surveillance study.
2021 Volume 372, Page(s) n334
Abstract: ... African population.: Design: Prospective systematic postmortem surveillance study.: Setting ... deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV ... of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53 ...
| 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. |
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| MeSH term(s) | Adult ; Age Distribution ; Age Factors ; Aged ; Autopsy ; COVID-19/diagnosis ; COVID-19/mortality ; COVID-19/virology ; COVID-19 Nucleic Acid Testing/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Nasopharynx/virology ; Prospective Studies ; Risk Factors ; SARS-CoV-2/genetics ; SARS-CoV-2/isolation & purification ; Sex Factors ; Urban Population/statistics & numerical data ; Zambia/epidemiology | |||||
| Language | English | |||||
| Publishing date | 2021-02-17 | |||||
| Publishing country | England | |||||
| Document type | Journal Article ; Research Support, Non-U.S. Gov't | |||||
| ZDB-ID | 1362901-3 | |||||
| ISSN | 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151 | |||||
| ISSN (online) | 1756-1833 | |||||
| ISSN | 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151 | |||||
| DOI | 10.1136/bmj.n334 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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