African ICUs have the world’s highest Covid death rate. Why?

More than half the critically ill Covid-19 patients admitted to African ICUs from March to September had died in hospital by the 30-day mark. This is the highest Covid-19 ICU mortality on any continent, according to a study conducted in six countries, including SA.

The hospitals participating in the observational study, which is now under peer review, were from SA (11), Egypt (9), Ethiopia (7), Libya (7), Nigeria (2) and Ghana (2).

The higher death rate in African ICUs was found to be associated with scarce critical care resources and the severity of the illness, including organ failure, among the more than 1,000 patients admitted to these hospitals.

Increasing age was a risk for higher mortality, but comorbidities such as hypertension and diabetes were not; nor was HIV in the sample from the studied hospitals, the researchers observed.

First author, UCT anaesthesiologist Prof Bruce Biccard, said their data suggested limited resources contributed to the higher death rate on the continent: 55% compared to 31% in other regions.

Access to necessary critical care interventions in Africa were between seven- and 14-fold less than what was needed, the researchers noted.

Biccard, in the department of anaesthesia and perioperative medicine at Groote Schuur Hospital, said on Tuesday: “There are limited critical care resources so access to critical care is likely to be limited to sicker patients, with potentially poorer outcomes due to the severity of illness on presentation.

“The limited resources (including) both access to critical care interventions, for example dialysis, and the limited healthcare personnel available to provide care, means the care that can be given is compromised."

Access to necessary critical care interventions in Africa were between seven- and 14-fold less than what is needed.

Only 60% of the sites (21 out of 35 hospitals) could provide the critical care interventions of proning or dialysis and 83% could provide pulse oximetry.

The excess mortality was 18 to 29 deaths per 100 patients compared to other regions globally.

The Africa CDC reported on Tuesday that Covid-19 deaths in Africa reached 49,975, out of 1,757,665 total infections.

The study notes: “Previous estimates have suggested the number of critical care beds in Africa may be more than tenfold lower than Europe and North America, at an estimated 0.8 beds per 100,000 population.”

Only one out of every two adult patients (631 out of 1,153) referred to ICUs or high-care units, after suspected or known Covid-19 infection, were admitted to the participating hospitals, predominantly tertiary hospitals.

Biccard said: “We do not know the reasons for the admission of only one in two referred patients. I presume the majority are a result of insufficient critical care beds, though some will be because the patient is too well for critical care admission and some because the patient is too sick, that is, the critical care admission is considered futile.”

Hospitals had a median of two intensivists and a nurse-patient ratio of 1:2, the authors found.

On average AU member states had reported a lower case fatality rate at 2.4%, compared to the global fatality rate of 3.6% by November 19.

But the following 16 countries (actively sharing data) are reporting much higher death rates than the global case fatality rate, the Africa CDC reported: