What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study

Gill, Christopher J.; Mwananyanda, Lawrence; Macleod, W. Bentley; Kwenda, Geoffrey; Pieciak, Rachel; Etter, Lauren; Bridges, Daniel J.; Chikoti, Chilufya; Chirwa, Sarah; Chimoga, Charles; Forman, Leah S; Katowa, Ben; Lapidot, Rotem; Lungu, James; Matoba, Japhet; Mwinga, Gift; Mubemba, Benjamin; Mupila, Zachariah; Muleya, Walter; Mwenda, Mulenga; Ngoma, Benard; Nakazwe, Ruth; Nzara, Diana; Pawlak, Natalie; Pemba, Lillian; Saasa, Ngonda; Simulundu, Edgar; Yankonde, Baron; Thea, Donald M

doi:10.1136/bmjopen-2022-066763

Cited by 15 publications

(19 citation statements)

References 39 publications

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“…Our initial investigations have shown that CMRs from the WHO and The Economist are moderately correlated with reported COVID-19 deaths while there is no correlation for CMRs produced from IHME estimates. Since under-reporting of COVID-19 deaths is a common problem in countries with low GHS scores, with postmortem surveillance studies in Africa indicating that deaths are undercounted by a factor of 10,90 91 the potential greater reliance on reported COVID-19 deaths by WHO and The Economist may partially explain the different estimates in countries with low GHS scores. Besides varying reliance on reported deaths, all three modelling groups also use different sets of covariates to produce estimates in locations without data.…”

Section: Discussionmentioning

confidence: 99%

“…In the interim, countries may consider improving their surveillance by employing survey methods such as postmortem surveillance studies. One such surveillance study in Zambia found that actual COVID-19 deaths are 10 times greater than reported deaths 90. These methods may assist in constructing more robust measures of COVID-19 impact and therefore assist future studies in providing more robust evaluations of the contributions of pandemic preparedness capacities.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

Ledesma¹,

Isaac²,

Dowell³

et al. 2023

BMJ Glob Health

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BackgroundPrevious studies have observed that countries with the strongest levels of pandemic preparedness capacities experience the greatest levels of COVID-19 burden. However, these analyses have been limited by cross-country differentials in surveillance system quality and demographics. Here, we address limitations of previous comparisons by exploring country-level relationships between pandemic preparedness measures and comparative mortality ratios (CMRs), a form of indirect age standardisation, of excess COVID-19 mortality.MethodsWe indirectly age standardised excess COVID-19 mortality, from the Institute for Health Metrics and Evaluation modelling database, by comparing observed total excess mortality to an expected age-specific COVID-19 mortality rate from a reference country to derive CMRs. We then linked CMRs with data on country-level measures of pandemic preparedness from the Global Health Security (GHS) Index. These data were used as input into multivariable linear regression analyses that included income as a covariate and adjusted for multiple comparisons. We conducted a sensitivity analysis using excess mortality estimates from WHO and The Economist.ResultsThe GHS Index was negatively associated with excess COVID-19 CMRs (table 2; β= −0.21, 95% CI= −0.35 to −0.08). Greater capacities related to prevention (β= −0.11, 95% CI= −0.22 to −0.00), detection (β= −0.09, 95% CI= −0.19 to −0.00), response (β = −0.19, 95% CI= −0.36 to −0.01), international commitments (β= −0.17, 95% CI= −0.33 to −0.01) and risk environments (β= −0.30, 95% CI= −0.46 to −0.15) were each associated with lower CMRs. Results were not replicated using excess mortality models that rely more heavily on reported COVID-19 deaths (eg, WHO and The Economist).ConclusionThe first direct comparison of COVID-19 excess mortality rates across countries accounting for under-reporting and age structure confirms that greater levels of preparedness were associated with lower excess COVID-19 mortality. Additional research is needed to confirm these relationships as more robust national-level data on COVID-19 impact become available.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

Ledesma¹,

Isaac²,

Dowell³

et al. 2023

BMJ Glob Health

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“…At least one study consecutively tested all decedents brought to a university hospital morgue in Lusaka, Zambia, without regard to symptoms of COVID-19 and found a positivity rate of 15.9% from June to September 2020 12 and 32.0% from January to June 2021. 13 In this setting, unlike in San Francisco, COVID-19 testing before death was rare in the community. Most data on COVID-19 positivity among decedents originate from cases investigated for the cause of death with a high index of suspicion for COVID-19 due to symptoms or death in an area of high COVID-19 morbidity and mortality.…”

Section: Discussionmentioning

confidence: 95%

“…However, testing was prioritized for populations with high COVID-19 mortality, such as older persons, persons dying in nursing facilities, adults in aggregate living, and racial/ethnic groups experiencing COVID-19 disparities. At least one study consecutively tested all decedents brought to a university hospital morgue in Lusaka, Zambia, without regard to symptoms of COVID-19 and found a positivity rate of 15.9% from June to September 2020 12 and 32.0% from January to June 2021 13 . In this setting, unlike in San Francisco, COVID-19 testing before death was rare in the community.…”

Section: Discussionmentioning

confidence: 99%

A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco

Miyashiro,

McFarland

2023

Am J Forensic Med Pathol

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The Health Officer of the City and County of San Francisco, California, issued the order that all decedents were required to have a documented COVID-19 test effective from June 2020 to June 2021. The justification for the requirement was that complete data on COVID-19 status at the time of death were needed to help protect first responders and funeral home workers, identify missed cases, and characterize the places of death for otherwise unknown COVID-19 cases. To fill the gap in COVID-19 testing for all decedents, particularly among persons dying outside of hospitals, a specialized Decedent Testing Unit was created along with an increased capacity of the Office of the Chief Medical Examiner. From July 1, 2020, to June 30, 2021, the Decedent Testing Unit and Office of the Chief Medical Examiner provided postmortem testing results for 2776 decedents. Of these, 80 tested positive for COVID-19 for a positivity rate of 2.97%. The largest number of COVID-19–positive specimens were collected from persons who died at home (n = 37, 46.3%), followed by those who died in hospice (n = 20, 25.0%), other places outside of homes or facilities (n = 8, 10.0%), and in skilled nursing or long-term care facilities (n = 7, 8.8%). Follow-up of California death records found that 17 of these 80 cases (21.3%) had COVID-19 listed as one of the causes of death, 22 (27.5%) mentioned COVID-19 under “other conditions,” and 41 (51.3%) made no mention of COVID-19. In the context of providing the COVID-19 status of decedents not otherwise known to have infection, our data help gauge the likelihood of missing deaths due to or with COVID-19 and inform future public health decisions on whether to require universal postmortem testing with COVID-19 resurgences or with new deadly epidemics.

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“…9 In the post-public health emergency phase of the pandemic, testing rates have dwindled down to less than 10 tests/100K/day and 100 tests/100K/day on average for LMICs and HICs respectively (as of September 2023). 9 Low testing rates severely underestimate COVID-19 cases, 10 which not only complicate antiviral demand forecasts but also create additional barriers to the effective distribution and use of antivirals.…”

Section: Introductionmentioning

confidence: 99%

Estimating the potential impact and diagnostic requirements for SARS-CoV-2 test-and-treat programs

Han

Hannay

Carmona

et al. 2022

Preprint

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Oral antivirals can potentially reduce the burden of COVID-19. However, low SARS-CoV-2 clinical testing rates in many low- and middle-income countries (LMICs) (mean <10 tests/100,000 people/day, July 2022) makes the development of effective test-and-treat programs challenging. Here, we used an agent-based model to investigate how testing rates and strategies could affect development of test-and-treat programs in three representative LMICs. We find that at <10 tests/100,000 people/day, test-and-treat programs are unlikely to have any impact on the public health burden of COVID-19. At low effective transmission rates (R_t≤1.2), increasing to 100 tests/100,000 people/day and allowing uncapped distribution of antivirals to LMICs (estimate = 26,000,000-90,000,000 courses/year for all LMICs), could avert up to 65% of severe cases, particularly in countries with older populations. For higher R_t, significant reductions in severe cases are only possible by substantially increasing testing rates or restricting clinical testing to those with higher risk of severe disease.

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What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study

Cited by 15 publications

References 39 publications

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

Evaluation of the Global Health Security Index as a predictor of COVID-19 excess mortality standardised for under-reporting and age structure

A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco

Estimating the potential impact and diagnostic requirements for SARS-CoV-2 test-and-treat programs

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