Still, as a rare attempt to research Africa’s death toll with clinical data, the BU team’s work has had a significant impact, outside experts say. Before his first paper, says Watson, who has worked on several studies related to Covid-19 in a low-income environment, there was a “fairly equal balance” within academia among those who believed there was “something fundamentally different about it.” the hand was in Africa that meant there weren’t that many deaths” and those who emphasized a lack of data.
The Zambia study, he says, played an important role in “shifting the story” towards the latter idea. Ugandan Kirenga says the study resonates with his observations of likely undercounting there. But Roma Chilengi, special covid-19 adviser to Zambian President Hakainde Hichilema, who also heads the organization that collects Zambia’s official surveillance data, says he still believes the pandemic in his country is not so deadly. has been as expected: at first he feared that “sweeping like wildfire,” he told me, have not materialized. Still, Chilengi broadly agrees with the BU team’s conclusions. “As an exploratory observation, there is no doubt that we had a lot of people who died of covid but were not diagnosed,” he says.
Survivors – and algorithms – agree
In addition to the UTH cadavers, a growing body of non-clinical studies have also added weight to the claim that a majority of African deaths have been missed. A paper published last May in The Lancet that followed nearly 6,800 confirmed or suspected Covid-19 patients referred to intensive care facilities in 10 African countries found that less than half were hospitalized and 48% of those who died within a month. According to the authors of the paper, this represents an additional in-hospital mortality of 11 to 23 deaths per 100 patients compared to the global average — a figure they associate with understaffing and the frequent absence of life-saving interventions such as oxygenation and dialysis.
Although Zambia was not included in the study, the locals told me that treatment gaps were acute there as well. Sky Banda, a 58-year-old resident of Kaunda Square, a compound named after Zambia’s first president, says many community members who fell ill during the height of the pandemic viewed hospitalization as a “ticket straight to the morgue.” Most chose home-based herbal treatments instead.
Onechi Lwenje, a 36-year-old filmmaker who spent a week in the UTH’s covid-19 ward in early 2021 during Zambia’s second wave, says staff were so overwhelmed that some patients would die and go undetected for hours. “Most people who went into that department never got out,” he says.
While death records from Africa remain patchy, attempts to approximate excess mortality through statistical workarounds also support the theory of substantial undercounting. A machine learning model developed by The Economist, based on more than 100 indicators correlating with additional deaths in countries where that data is available, suggests that Africa has seen 1.1 million to 3 million additional deaths since the start of the pandemic. A model from the University of Washington’s Institute of Health Metrics and Evaluation, included in a paper published by The Lancet in March, estimates the number to be 2.1 million as of December 2021 for sub-Saharan Africa alone, with a central estimate for Zambia of 81,000-20 times the official toll of 3,967.