Threescore and ten: estimating COVID-19 deaths in Africa

“The days of our years are threescore and ten”. Psalm 90, verse 10.

SUMMARY. Deaths in the developing world from COVID-19 are expected to be comparatively “light”, gainsaying all those who have expressed special fears for Africa or for indigenous peoples. COVID-19 is a ‘grim reaper’ disease most strongly affecting countries that have managed to keep their aged populations alive, often with multiple comorbidities. This is not the case in Africa.

As a first estimate, we find that sub-Saharan Africa should have about 65% of the total deaths of the USA, unless factors associated with lack of development turn out to be more significant than anticipated. This will probably work out to about 130,000 deaths in the first instance.

The relative benefits and costs of heavy lockdown are different in Africa, and this may affect the decisions of governments. It is also possible that losing focus on greater killers like AIDS and malaria may have a higher cost in African lives than COVID-19.

Threescore and ten

Although the Bible claims that 70 years old is the natural life expectancy of humans, all the nations that have so far had significant death tolls over 5000 have (with the exception of Iran) an average life expectancy of over 80 years. As this includes infant mortality, the average adult can expect to live significantly longer in these countries. Many of these elderly people have morbidities such as heart problems, cancer and diabetes, and these can combine with COVID-19 with fatal results.

The highest death rates from COVID-19 are in the ‘Big Five’ Belgium, the United Kingdom, Italy, Spain and France. The USA because of its large population currently has the most deaths, around 100,000 or 280 per million. We expect this eventually to double as new confirmed cases are still about 25,000 per day and the epidemic still has a good way to run.

Population pyramid

The two major factors affecting COVID-19 death rates are very well established as age and the presence of comorbidities. In many countries, In China, 81% of deceased were over 60 years of age, while In New York, less than 1% were without an underlying condition such as a lung disorder or disorder of a major organ, cancer or immunodeficiency.

Table 1. COVID-19 deaths by age group, USA, to 4 May, and population by age group, sub-Saharan Africa and USA

	COVID deaths	Population, millions 2020
Age	USA	Africa	USA
85+ years old	22543	1.1	6.6
75-85 years old	18621	8.2	15.4
65-75 years old	14447	23.6	30.5
55-65 years old	8312	44.3	42.8
45-55 years old	3338	71.3	40.5
35-45 years old	1186	110.4	43.7
25-35 years old	463	157.5	45.4
15-25 years old	76	217.7	41.9
0-15 years old	12	460.3	40.0
Total	68998	1038.6	327.2

Sources: [1], [2], www.statista.com, [6]

As Table 1 shows, although the USA has less than a third of the population of Sub-Saharan Africa, it has almost double the population aged over 70 and six times the number over 85. Most of the Covid-19 deaths occur in the over 70 age group. Comorbidities of older people are nowhere near as common in Africa as in the USA, since diabetes and heart problems are much less common, and when comorbidities do occur, they are much more often fatal, so the surviving older people tend to be healthier.

On the other hand, there are countervailing factors in Africa that may increase mortality:

· AIDS and other infections are more common in Africa, which might act as a comorbidity factor, though they are more prevalent in young people.

· The availability of ventilators is very much lower in Africa, though as half the people on ventilators die, these may actually not help to lower mortality much. The general absence of a treatment means that higher-quality medical services do not offer the big advantage they do for other diseases.

· Crowding in slums, and the lack of clean water for handwashing, will probably cause the virus to spread faster and may lead to a larger number of first-round cases. So far however, this has not been such an obvious concern in India.

Estimating deaths

As a first approximation, we might assume the positives and negatives will cancel out and COVID-19 death rates in each age group will be about the same in the USA and Africa. Table 1 implies that the number of deaths in the whole of sub-Saharan Africa will only be 65% of the number of deaths in the USA.

So far, the number of confirmed cases in SSA is just over 115,000 and deaths are 3500. The recovery rate is comparatively high. The pandemic is at an early stage – so how far can it be expected to go?

COVID-19 deaths in the USA are 100,000 at present and probably will amount to about 200,000 in total during the current wave, though [3] regards this as a best-case estimate. On this basis we can expect 130,000 deaths from COVID-19 in SSA. By comparison more than 1 million people die from AIDS annually in SSA, and 400,000 from malaria.

The extra mortality from COVID-19 will therefore provide a very unpleasant addition to the infectious disease burden, but not a catastrophic one as in the Western countries that are unused to any significant death toll. Disruptions to programmes for the bigger killers AIDS and malaria may well be as significant as COVID itself. [4,5]

Other estimates by Kings College range from 300,000 to 3 million, which are considerably higher. However, this group have consistently produced overestimates of the numbers of deaths.

Conclusions

Because the proportions of elderly in Africa are so many fewer and their health is probably better than their Western counterparts, it seems likely that the death rates from COVID-19 will not be so shocking as in Western countries. Our first estimate is for about 65% of the death toll of the USA, something like 130,000 deaths. This will be a substantial extra health burden in a region already suffering from greater numbers of deaths from AIDS, malaria and other infectious diseases.

The much greater social costs of imposing lockdowns in Africa, which cannot easily be softened by government assistance or foreign aid, will have to be weighed against the relatively lower proportion of deaths by governments seeking to impose broad-brush quarantine or isolation measures.