The official number of deaths linked to Covid-19 in South Africa doesn’t reflect the true scale of the crisis, with provinces that have been hit hardest by the outbreak showing a surge in fatalities, health experts say.
The country recorded 10,994 excess deaths between May 6 and July 6, according to the South African Medical Research Council, which publishes weekly figures. The provinces with some of the highest confirmed infection rates — Gauteng and the Eastern Cape — are experiencing a particularly sharp increase. Compared with the predicted number of natural deaths from historical data in the week ending July 3, the Eastern Cape had 90% more and Gauteng 71% more, the latest report showed.
Tracking excess mortality is widely seen as way to gauge the full scale of fatalities from Covid-19. It includes those suspected of having the coronavirus who died without having been tested, as well as people who died of other causes after being unable to seek treatment because hospitals were swamped. Neither of those categories would be reflected in the official pandemic tally.
“Particularly in the Eastern Cape, we are getting a significant underreporting of mortality in villages and smaller towns,” said Ian Sanne, head of Right to Care, a non-profit organization that provides treatment to people with HIV and associated diseases. “The risk is that we are missing quite a bit.”
South Africa’s outbreak ranks as the world’s fifth-worst, with 350,879 confirmed cases. The government adopted a mass-testing regime weeks after the first infection was identified and has tested more than 2.4 million people, a response that sets it apart from all other African nations. Authorities have said they’re confident they’re grasping the true scale of the epidemic and release detailed Covid-19 reports daily.
Yet hospitals say they’re buckling under the strain, and the closure of Home Affairs offices during the first stage of a lockdown has led to administrative backlogs and unregistered deaths. South Africa also has the world’s largest HIV epidemic and a high prevalence of diabetes and tuberculosis, which are major causes of death.
Even though the Health Ministry added more than 100,000 confirmed cases in little more than a week this month, the Covid-19 mortality rate is relatively low. As of Saturday, there were 4,948 deaths in South Africa attributed to the virus, far fewer than the 38,888 deaths in Mexico, which has roughly the same number of infections.
“I’m sure there is some underreporting of the deaths,” said Richard Lessells, an infectious disease specialist at the Kwazulu-Natal Research Innovation and Sequencing Platform, a Durban-based research institute known as Krisp. “The discrepancy between the excess deaths and the reported Covid-19 deaths could be explained by this underreporting, or it could be a sign that the epidemic is having a knock-on effect on deaths due to other causes.”
Anban Pillay, a deputy director general in the Department of Health, criticized such assessments.
“We disagree completely with this analysis,” he said. “This is a theoretical argument.”