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

• Published in: BMJ open Vol. 12; no. 12; p. e066763
• Main Authors: Gill, Christopher J, Mwananyanda, Lawrence, MacLeod, William B, Kwenda, Geoffrey, Pieciak, Rachel C, Etter, Lauren, Bridges, Daniel, Chikoti, Chilufya, Chirwa, Sarah, Chimoga, Charles, Forman, Leah, 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
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 06.12.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Autopsies; Causality; Child; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 diagnostic tests; COVID-19 Testing; Epidemiology; Global Health; Health surveillance; Humans; Pandemics; Pediatrics; Polymerase Chain Reaction; Prevalence; PUBLIC HEALTH; Respiratory syncytial virus; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Teaching hospitals; Whooping cough; Zambia - epidemiology; Zambia; Africa; Lusaka Zambia; COVID-19; PUBLIC HEALTH; Epidemiology
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-066763

ObjectivesTo determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.DesignA systematic, postmortem prevalence study.SettingA busy, inner-city morgue in Lusaka.ParticipantsWe sampled a random subset of all decedents who transited the University Teaching Hospital morgue. We sampled the posterior nasopharynx of decedents using quantitative PCR. Prevalence was weighted to account for age-specific enrolment strategies.InterventionsNot applicable—this was an observational study.Primary outcomesPrevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.Secondary outcomesShifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.ResultsFrom 1118 decedents enrolled between January and June 2021, COVID-19 was detected among 32.0% (358/1116). Roughly four COVID-19+ community deaths occurred for every facility death. Antemortem testing occurred for 52.6% (302/574) of facility deaths but only 1.8% (10/544) of community deaths and overall, only ~10% of COVID-19+ deaths were identified in life. During peak transmission periods, COVID-19 was detected in ~90% of all deaths. We observed three waves of transmission that peaked in July 2020, January 2021 and ~June 2021: the AE.1 lineage and the Beta and Delta variants, respectively. PCR signals were strongest among those whose deaths were deemed ‘probably due to COVID-19’, and weakest among children, with an age-dependent increase in PCR signal intensity.ConclusionsCOVID-19 was common among deceased individuals in Lusaka. Antemortem testing was rarely done, and almost never for community deaths. Suspicion that COVID-19 was the cause of deaths was highest for those with a respiratory syndrome and lowest for individuals <19 years.