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

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...

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Published inBMJ 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
LanguageEnglish
Published England British Medical Journal Publishing Group 06.12.2022
BMJ Publishing Group LTD
BMJ Publishing Group
SeriesOriginal 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
Online AccessGet full text
ISSN2044-6055
2044-6055
DOI10.1136/bmjopen-2022-066763

Cover

Abstract 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.
AbstractList To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.OBJECTIVESTo determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.A systematic, postmortem prevalence study.DESIGNA systematic, postmortem prevalence study.A busy, inner-city morgue in Lusaka.SETTINGA busy, inner-city morgue in Lusaka.We 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.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.Not applicable-this was an observational study.INTERVENTIONSNot applicable-this was an observational study.Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.PRIMARY OUTCOMESPrevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.SECONDARY OUTCOMESShifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.From 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.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.COVID-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.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.
Objectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy, inner-city morgue in Lusaka.Participants We 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.Interventions Not applicable—this was an observational study.Primary outcomes Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time.Secondary outcomes Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates.Results From 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.Conclusions COVID-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.
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.
To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia. A systematic, postmortem prevalence study. A busy, inner-city morgue in Lusaka. We 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. Not applicable-this was an observational study. Prevalence of COVID-19 detections by PCR. Results were stratified by setting (facility vs community deaths), age, demographics and geography and time. Shifts in viral variants; causal inferences based on cycle threshold values and other features; antemortem testing rates. From 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. COVID-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.
Author Gill, Christopher J
Mwananyanda, Lawrence
Nakazwe, Ruth
Lungu, James
Mupila, Zachariah
Forman, Leah
Pemba, Lillian
Mubemba, Benjamin
Mwinga, Gift
Ngoma, Benard
Katowa, Ben
Lapidot, Rotem
Yankonde, Baron
Etter, Lauren
Bridges, Daniel
Simulundu, Edgar
Pieciak, Rachel C
Thea, Donald M
Chikoti, Chilufya
Chimoga, Charles
Nzara, Diana
MacLeod, William B
Pawlak, Natalie
Saasa, Ngonda
Kwenda, Geoffrey
Chirwa, Sarah
Mwenda, Mulenga
Matoba, Japhet
Muleya, Walter
AuthorAffiliation 12 Biomedical Sciences , University of Zambia University Teaching Hospital , Lusaka , Lusaka , Zambia
10 Biomedical Sciences , University of Zambia School of Veterinary Medicine , Lusaka , Lusaka , Zambia
1 Department of Global Health , Boston University School of Public Health , Boston , Massachusetts , USA
3 Program for Applied Technology in Health (PATH) , Lusaka , Zambia
6 Macha Research Trust , Choma , Southern Province , Zambia
5 Biostatistics and Epidemiology Data Analytics Center , Boston University School of Public Health , Boston , Massachusetts , USA
4 Avencion Limited , Lusaka , Zambia
11 Program for Applied Technology in Health , Lusaka , Zambia
8 Wildlife Sciences , The Copperbelt University , Kitwe , Copperbelt , Zambia
7 Pediatric Infectious Diseases , Boston Medical Center , Brookline , Massachusetts , USA
14 University of Zambia School of Veterinary Medicine , Lusaka , Zambia
9 Avencion , Lusaka , Zambia
13 Tufts University School of Medicine , Boston , Massachusetts , USA
2 Biome
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/36600354$$D View this record in MEDLINE/PubMed
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Keywords COVID-19
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Snippet ObjectivesTo determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.DesignA systematic, postmortem prevalence study.SettingA busy,...
To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia. A systematic, postmortem prevalence study. A busy, inner-city morgue in Lusaka....
To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.OBJECTIVESTo determine the prevalence of COVID-19 postmortem setting in Lusaka,...
Objectives To determine the prevalence of COVID-19 postmortem setting in Lusaka, Zambia.Design A systematic, postmortem prevalence study.Setting A busy,...
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StartPage e066763
SubjectTerms 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
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Title What is the prevalence of COVID-19 detection by PCR among deceased individuals in Lusaka, Zambia? A postmortem surveillance study
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Volume 12
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