A STUDY by the Boston University School of Public Health has revealed that the COVID-19 pandemic in Lusaka has been highly underestimated with the COVID-19 deaths having been under-reported between June and September, 2020.

According to the report, dubbed: COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa, released in January, and co-authored by Dr Lawrence Mwananyanda and Dr Christopher Gill, it was found that the under-reporting of deaths in Zambia, Lusaka in particular, was due to the lack of community testing.

“Contrary to expectations, CV19+ deaths were common in Lusaka. The majority occurred in the community where testing capacity is lacking. Yet few who died at facilities were tested, despite presenting with typical symptoms of CV19. Therefore, CV19 cases were under-reported because testing was rarely done, not because CV19 was rare. If our data are generalisable, the impact of CV19 in Africa has been vastly underestimated,” the report disclosed.

“…Contradicting the prevailing narrative that CV19 has spared Africa, CV19 has had a severe impact in Zambia. How this was missed is largely explained by low testing rates, not by a low prevalence of CV19. Yet to avoid casting blame on Zambia, we note that the wealthiest countries on earth have struggled to test for and contain CV19. Can we be surprised that a resource-poor country would also struggle to respond effectively to the greatest global public health emergency since HIV/AIDS? Establishing systematic disease surveillance requires time and significant resources. Zambia had neither. The challenge of scarce resources is hardly unique to Zambia, and Zambia is hardly the poorest nation in Africa. If our data are generalisable, CV19’s impact across Africa has been substantially underestimated.”

It noted that from the results, COVID-19 accounted for almost 20 per cent of all deaths during the said period.

“From this systematic surveillance study in Lusaka, Zambia, we observed a surprisingly high prevalence of CV19 mortality. Conservatively, 15 per cent of all deceased individuals had CV19 during this period. If we assume that lower intensity PCR results (i.e., CT ≥40 to <45) reflect waning viral loads and are not false positives, then the CV19 prevalence approached 20 per cent of all deaths. Only a minority had been tested for CV19 antemortem,” the report read. Researchers, who took nose and throat swabs from the bodies of recently-deceased people at the University Teaching Hospital (UTH) mortuary in Lusaka, found a far higher prevalence of COVID-19 than expected with 70 out of 364 bodies testing positive for COVID-19 in the period under review. The report further revealed that of the 70 deaths that presented symptoms consistent with COVID-19, 66.7 per cent was COVID-19-based with 64 per cent of that being community deaths. “Most of the deceased presented with symptoms consistent with CV19 disease. We categorised 44/70 (66.7 per cent) deaths as ‘probable CV19’ based on the presence of fever and/or respiratory symptoms, of which 16/44 (36 per cent) were facility deaths and 28/44 (64 per cent) were community deaths. Among the 19 facility deaths (for whom PCR testing ante-mortem could have been done), symptoms suggestive of CV19 were present among 17/19 (89.5 per cent). The group of ‘probable CV19’ deaths included all six of the patients (5 adults and one child) who had been tested for CV19 antemortem. A further 7/70 (10.0 per cent), were considered ‘possible CV19’ given symptoms of sudden onset hemiparesis with or without preceding severe headaches, sudden onset left-sided chest pain, or sudden onset abdominal pain preceding death. All but one of these were community deaths. The single facility death presented with headache on a background of anaemia and chronic kidney disease,” it read. “A single case was deemed ‘probably not CV19.’ This was an individual transferred for management of burns, where there was no mention of CV19 compatible symptoms. This left 18/70 (25.7 per cent) where causality remained ‘uncertain’ due to insufficient clinical data. All of these were community deaths. Thus, for the 52 cases where data were sufficient to adjudicate causality, nearly all (51/52, 98.1 per cent) presented with symptoms suggestive of, or compatible with, the CV19 syndrome.” It further revealed that with most of the deaths having occurred in the community and outside of medical care, none of the COVID-19 deaths were tested before death, which shows how much the pandemic was under-estimated in Lusaka. “First, most deaths occurred in the community and outside of medical care. Among the majority that were community deaths, none had been tested for CV19 antemortem. This is undoubtedly a significant factor in underestimating the impact of CV19 in Lusaka. Second, testing was rarely conducted among the minority that were facility deaths, though nearly all had presented with a constellation of symptoms typical of CV19. We conclude that testing was neither widespread nor systematic,” disclosed the report. Zambia’s cumulative COVID-19 cases now stands at 55,042, with 780 being the total number of cumulative deaths as at February 1, 2021.