DESPITE the recent increase in weekly COVID-19 deaths announced by government, the numbers could even be higher than what is made known, observers say.

Although the number of deaths in hospitals have reduced since the third wave began, from 262 in the second week of July down to 188 in the third week, the number of people dying in communities remains unknown.

Ministry of Health confirmed that the reported death figures are only “facility deaths” and do not include those from the communities. Real deaths are therefore assumed to be much higher than the reported figure, though it is difficult to say how many.

When asked during an interview, health permanent secretary Dr Kennedy Malama treated MakanDay Centre for Investigative Journalism to a coy response on the issue but said there is a cost attached to the tests.

“It’s not that these tests are free, government buys on behalf of the Zambian people, to be used, so even in our use of these we have to be prudent,” he said.

Listen to Dr Malama’s response in full

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On 25 June this year, Dr Malama confirmed during the daily updates that “recorded deaths are only those occurring in facilities.”

MakanDay has established that most deaths that occur in communities, where testing capacity is lacking are not captured, thereby the impact of the third wave of the virus is vastly underestimated.

Documents and interviews reveal the under-count of deaths that occur outside hospitals.

“If someone dies and you didn’t have time to do the test earlier, it is difficult to count them accurately without a postmortem,” explained, a well-placed medical source at Levy Mwanawasa General Hospital in Lusaka. Levy is one of the hospitals being used as a Covid-19 centre.

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A business manager of a company providing funeral and burial services situated outside the University Teaching Hospital (UTH) mortuary told MakanDay that in June this year, the death situation had gotten out of hand.

He said it was the first time he witnessed such an increase in the number of deaths in a day since he started operating his business in 2012.

“You know this thing (UTH mortuary) is quite big, now imagine where both fridges are full and you just start placing bodies on the floor,” he said. “It is only now that the situation has started to get better.”

In addition, he said at one point in June, they had almost run out of coffins and obtaining burial space was becoming a challenge.

“I went and got the book (in the mortuary), I counted the number of bodies that had come in between eight and 18:00hrs, I lost count,” he said.

He said on a normal day, UTH mortuary receives about 10 bodies brought in from the community. But during the third wave of the virus, the numbers would exceed 60.

A survey done by MakanDay on 10 funeral companies in Lusaka showed the average monthly rate of business increased tremendously. One of the proprietors said the number of funerals they conduct has doubled since May this year.

At the burial sites, many people were in the dark about their families' experience with COVID-19, mostly because they didn't know their relative, they had come to bury had contracted or died from the virus.

One of the mourners interviewed by MakanDay at Mutumbi cemetery in Lusaka said her relative had been suffering from a fever and cough and had lost her sense of smell days before – all signs of Covid.

But even before government’s public admission of the undercount, Lusaka Helps, an online Covid-19 support movement was already highlighting the issue.

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Image: Lusaka HELPS Facebook

“Well, in Zambia, not everyone who is sick goes to a health facility and not everyone who dies is tested for Covid. Many people will die outside of facilities, and unless there is testing of community deaths, these will not be captured in official figures,” the movement said in one of its Facebook postings.

The 2020 study done during the first wave which swabbed dead bodies brought to UTH found that as many as 15 percent were testing positive for Covid. The study report which appeared in the British Medical Journal in February this year, was developed to measure the fatal impact of coronavirus disease in an urban African population.

Government was not pleased with the findings. They retorted the study with the letter to the editor describing it as “an over-statement” as it was done “in one country, one city, and one hospital with a limited catchment area”.

But Dr Lawrence Mwananyanda, professor at Boston University in the US who conducted the study said there are many cases of people dying having Covid infection than what is being reported. He said the best way to know the actual number is to have all community deaths tested.

“Clearly there are more cases of deaths, of people dying having Covid infections,… it’s more than is reported by far and our publication here said it could be as ten times in fact higher,” said Dr Mwananyanda in an interview with MakanDay in Lusaka.

He further said when the study was done in June last year, underreporting of deaths was because very few tests were being done in the country, adding that nothing much has changed.

“We just don’t have the capacity to do proper surveillance and this is not only for Covid, this is across all diseases,” he said.

Listen to the interview


Although Zambia has made great strides in the collection of mortality data in recent years, significant challenges with death registration remain. According to the Zambia Statistics Agency (ZamStats), the death registration rate was only 20% in 2016. One reason for the low registration rate is the large proportion of out-of-facility deaths.