Scientists are baffled about why the death toll of COVID-19 is so much lower than expected in several African countries, including South Africa. Professor of Vaccinology at WITS University Shabir Madhi says South Africa has recorded over 644 000 cases of the virus, while just over 15 000 have died as a result of it. A total of 573 000 people have recovered from the virus in the country.

According to Madhi, South Africa’s COVID-19 death figures are “much lower than other countries that have high infection rates”.

A report by Bloomberg in June began questioning the accuracy of South Africa’s COVID-19 death toll.

“The official number of deaths linked to COVID-19 in South Africa doesn’t reflect the true scale of the crisis, with provinces that have been hit hardest by the outbreak showing a surge in fatalities, health experts say,” the report noted.

“The country recorded 10 994 excess deaths between May 6 and July 6, according to the South African Medical Research Council, which publishes weekly figures. The provinces with some of the highest confirmed infection rates – Gauteng and the Eastern Cape – experienced a particularly sharp increase. Compared with the predicted number of natural deaths from historical data in the week ending July 3, the Eastern Cape had 90% more and Gauteng 71% more.”

Keeping track of excess mortality is widely viewed as a way to estimate the full scale of COVID-19 fatalities. This includes those suspected to have the virus and died without testing, as well as people who died from other causes after being unable to receive treatment, as hospitals were swamped. Bloomberg found that neither of those categories are reflected in the official pandemic tally.

“Particularly in the Eastern Cape, we are getting a significant underreporting of mortality in villages and smaller towns,” said Ian Sanne, head of Right to Care, a non-profit organisation that provides treatment to people with HIV and associated diseases. “The risk is that we are missing quite a bit.”

South Africa’s number of cases had earned it the number seven spot in the world for most cases. As a result, government undertook a mass-testing regime just weeks after the first case was identified and tested millions since then. But as hospitals began buckling under the strain of treating those infected and resources were diverted to prioritise COVID-19 patients over others, Home Affairs offices also closed. This caused administrative backlogs, as well as a backlog of yet-to-be registered deaths.

South Africa also has the world’s largest HIV epidemic, as well as a high prevalence of other comorbidities such as tuberculosis and diabetes.

“I’m sure there is some underreporting of the deaths,” said Richard Lessells, an infectious disease specialist at the Kwazulu-Natal Research Innovation and Sequencing Platform, a Durban-based research institute also known as ‘Krisp’. “The discrepancy between the excess deaths and the reported Covid-19 deaths could be explained by this underreporting, or it could be a sign that the epidemic is having a knock-on effect on deaths due to other causes.”

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