Khartoum deaths highlight Africa’s hidden Covid toll

Over 16,000 coronavirus deaths in Sudan’s capital Khartoum have gone unreported, according to research by Imperial College London, in results that shine a light on the hidden toll of the pandemic in Africa.  

Research from the university’s Covid-19 Response Team and partners found that 38% of Khartoum’s population had been infected by November 20 and estimated that just 2% of Covid-19 deaths have been reported, with total deaths thought to number 16,090. High levels of immunity found after the end of the first wave can be explained by under reporting of deaths, the researchers concluded.  

The research offers a stark view of the pandemic that is not captured in the continent’s official numbers, and challenges the widespread view that African countries have escaped the worst of the virus. 

While coronavirus is reported to have impacted Africa less than other continents, vast numbers of cases may have gone unreported. Africa has officially recorded over 2 million cases and almost 50,000 deaths, with 16,052 cases and 1,197 confirmed deaths registered in Sudan by November 23, according to data from Johns Hopkins University compiled by the BBC. Imperial College researchers suggest that a lack of testing capacity and registration systems may partly account for the undercount.  

“Whilst the pandemic has strained health systems to near-capacity in many high-income countries the absence of comparable epidemics in many African countries is notably perplexing. Under-reporting (or under ascertainment) of Covid-19 deaths is a likely candidate for explaining these patterns, however, it is difficult to measure with vital registration systems and limited testing capacity in many countries.”  

Dr Oliver Watson, of Imperial College’s School of Public Health, says the results demonstrate the urgency of alternative data sources for understanding Covid-19’s true global spread. 

“It is increasingly apparent and saddening the extent to which Covid-19 has been able to spread largely unobserved in some parts of the world. As in our previous study in Damascus, Syria, official Covid-19 mortality figures only show a fraction of the burden Covid-19 has placed on Khartoum. This analysis again demonstrates the need for alternative data sources if we wish to understand the spread of Covid-19 globally. We hope our findings reinforce the continued protection of high risk individuals as Khartoum heads into a second wave.” 

Interventions remain crucial 

Researchers say that action can be taken to lessen the impact of a second wave. If transmission is maintained at current levels and mortality under ascertainment remains at 3%, the researchers predict that a second wave will peak in Khartoum before 2021 and will be similar in size to the first wave. The second wave is predicted to be larger than the first wave if mortality under ascertainment is 5%.  

However, the research showed that interventions were effective during the first wave and led to a reduction in the reproduction number from 3.5 to 1 by April 20. The ending of stringent suppression measures in July resulted in transmission increasing, with the rate rising above 1 during September. The researchers say that historic mortality investigations can help to predict the trajectory of the second wave and inform how long shielding should be maintained.