Insufficient critical-care resources, high comorbidities such as HIV/AIDS, diabetes, chronic liver and kidney disease and well as severity of organ dysfunction upon admission suggest that African countries may have the highest global death rate among critically ill Covid-19 patients.
Chairperson of the School of Medicine at UP Professor Robin Green said Africans at higher risk of more severe disease and death when Covid-19 positive.
Green said this suggests that the African population is desperately in need of better ICU resources and medications, but especially prevention through vaccination.
“The current vaccine roll-out in Africa is hopelessly ineffective. We would appeal to all humanitarian and health agencies to make vaccines for Africa a priority,” said Green.
Until now, little had been known about how Covid-19 was affecting critically ill patients in Africa, as there have been no reported clinical outcomes data from Africa or any patient management data in low-resource settings.
To address this evidence gap, the African Covid-19 Critical Care Outcomes Study (ACCCOS) aimed to identify which human and hospital resources, underlying conditions and critical-care interventions might be associated with mortality or survival in adults (aged 18 or older) admitted to intensive-care or high-care units in Africa.
The study – published in The Lancet – focused on 64 hospitals in 10 countries namely: Egypt, Ethiopia, Ghana, Kenya, Libya, Malawi, Mozambique, Niger, Nigeria and South Africa.
According to the study, between May and December 2020, about half (or 3 752 of 6 779) of patients with suspected or confirmed Covid-19 infection referred to critical care were admitted. Of those, 3 140 patients participated in the study.
The study states that all those patient received standard care and were followed up for at least 30 days unless they died or were discharged.
According to the researchers, modelling was used to identify risk factors associated with death.
“After 30 days, almost half (48% – 1 483/3 077) of the critically ill patients had died. The analysis estimates that death rates in these patients were 11% (in best-case scenarios) to 23% (in worst-case scenarios) higher than the global average of 31.5%,” reads the study. Leading to the conclusion that the mortality rate is higher in African countries than reported from studies done in Asia, Europe, North America and South America because of existing illnesses prevalent in people living in Africa.
University of Cape Town’s Professor Bruce Biccard (and research co-leader) said the study is the first to give a comprehensive picture of what is happening to people who are severely ill with Covid-19 in Africa.
Biccard said the findings show that poor access to potential life-saving interventions such as dialysis, proning – turning patients onto their stomachs to improve breathing, and blood oxygen monitoring could be factors in the deaths of these patients.
“These could also partly explain why one in eight patients had therapy withdrawn or limited. Sadly, it indicates that our ability to provide sufficient care is compromised by a shortage of critical-care beds and limited resources within intensive-care units,” said Biccard.
He added that he hopes these findings can help prioritise resources and guide the management of severely ill patients – and ultimately save lives – in resource-limited settings around the world.
Clinical and Academic Head of the Critical Care Department at UP Professor Fathima Paruk said the unique findings such as the high death rate, being male not being associated with a higher risk of death, ICU bed shortages, underuse of resources or a paucity of certain ICU resources, highlight the importance and need for our own data.
She said the findings provide much-needed evidence in terms of guiding clinical management and in terms of the pressing need to ensure the appropriate provision, allocation and use of resources, so that we can save more lives in resource-limited settings.
She added that this high death rate among severely ill Covid-19 patients in Africa further strengthens the case for prevention through vaccination.