Contributed equally.
Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA.
BMJ. 2021 Feb 17;372:n334. doi: 10.1136/bmj.n334.
To directly measure the fatal impact of coronavirus disease 2019 (covid-19) in an urban African population.
Prospective systematic postmortem surveillance study.
Zambia's largest tertiary care referral hospital.
Deceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death.
Postmortem nasopharyngeal swabs were tested via reverse transcriptase quantitative polymerase chain reaction (PCR) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Deaths were stratified by covis-19 status, location, age, sex, and underlying risk factors.
372 participants were enrolled between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%) according to the recommended cycle threshold value of <40 and in 70/364 (19.2%) when expanded to any level of PCR detection. The median age at death among people with a positive test for SARS-CoV-2 was 48 (interquartile range 36-72) years, and 69% (n=48) were male. Most deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death. Among the 19/70 people who died in hospital, six were tested before death. Among the 52/70 people with data on symptoms, 44/52 had typical symptoms of covid-19 (cough, fever, shortness of breath), of whom only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53) of people who died were aged under 60 years. The five most common comorbidities among people who died with covid-19 were tuberculosis (22; 31%), hypertension (19; 27%), HIV/AIDS (16; 23%), alcohol misuse (12; 17%), and diabetes (9; 13%).
Contrary to expectations, deaths with covid-19 were common in Lusaka. Most occurred in the community, where testing capacity is lacking. However, few people who died at facilities were tested, despite presenting with typical symptoms of covid-19. Therefore, cases of covid-19 were under-reported because testing was rarely done not because covid-19 was rare. If these data are generalizable, the impact of covid-19 in Africa has been vastly underestimated.
直接测量 2019 年冠状病毒病（covid-19）在非洲城市人群中的致命影响。
前瞻性系统尸检监测研究。
赞比亚最大的三级转诊医院。
在赞比亚卢萨卡的大学教学医院停尸房死亡 48 小时内登记的所有年龄的死者。
死后鼻咽拭子通过逆转录定量聚合酶链反应（PCR）检测严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）。根据 covis-19 状态、位置、年龄、性别和潜在危险因素对死亡进行分层。
2020 年 6 月至 9 月期间纳入 372 名参与者；364 名（97.8%）可获得 PCR 结果。根据推荐的循环阈值<40 的标准，SARS-CoV-2 在 58/364（15.9%）中检测到，在任何水平的 PCR 检测中，在 70/364（19.2%）中检测到。SARS-CoV-2 检测阳性者的中位死亡年龄为 48 岁（四分位间距 36-72 岁），69%（n=48）为男性。在 70 例 covid-19 死亡患者中，51 例（51/70；73%）死亡发生在社区；在死亡前没有接受过 SARS-CoV-2 检测。在 19 例死于医院的 19 例患者中，有 6 例在死亡前接受了检测。在 52 例有症状数据的患者中，44 例（44/52）有典型的 covid-19 症状（咳嗽、发热、呼吸急促），其中只有 5 例在死亡前接受了检测。在 7 名儿童中发现了 covid-19，其中只有 1 名在死亡前接受了检测。死于 covid-19 的比例随年龄增长而增加，但 76%（n=53）的死亡者年龄在 60 岁以下。死于 covid-19 的患者最常见的五种合并症是结核病（22 例；31%）、高血压（19 例；27%）、艾滋病毒/艾滋病（16 例；23%）、酒精滥用（12 例；17%）和糖尿病（9 例；13%）。
与预期相反，在卢萨卡，covid-19 死亡很常见。大多数发生在社区，那里缺乏检测能力。然而，尽管出现了典型的 covid-19 症状，但很少有在设施中死亡的人接受检测。因此，covid-19 病例报告不足，不是因为 covid-19 罕见，而是因为很少进行检测。如果这些数据具有普遍性，那么非洲 covid-19 的影响将被大大低估。
