Nearly 300,000 dead from Covid-19 in SA — and the threat is not over

The true burden of death in SA caused by Covid is approaching the 300,000 mark — three times the official figure of 97,000, experts say.

The daily number of deaths has been far lower during the pandemic's fourth wave but even so the official death toll is growing by more than 130 a day. With “excess deaths” included, the number is probably close to 400.

Debbie Bradshaw, a professor of biomathematics at the South African Medical Research Council (MRC), who has been part of the team calculating excess deaths, said: “The total number of excess deaths is approaching 300,000. It was 296,000 by February 5. We consider 85%-95% are Covid-19.”

The MRC team tracks excess deaths by comparing the weekly number of deaths from all causes with the number that would have been expected without the pandemic.

“Measuring the epidemic is extremely challenging as the number of cases that get reported is just the tip of the iceberg. It just depends on who gets tested,” said Bradshaw.

“We know there are many people who are asymptomatic or have mild symptoms and do not bother to test. In addition, the number of reported Covid-19 deaths is problematic: it only includes confirmed cases identified by a positive test that occur in hospitals.”

Deaths at home or in long-term care homes are less likely to be included in the reported deaths, and the paper-based system of recording deaths is hamstrung by time lags.

“So again, we get to see only the tip of an iceberg,” said Bradshaw. SA urgently needs an online death registration system “to ensure the information collected about cause of death  can be shared with the department of health in a timely manner for public health surveillance”.

At the peak of SA’s second wave, excess deaths topped 16,000 a week. During the third wave peak there were more than 10,000 excess deaths a week, while in the fourth wave the number peaked at about 3,500.

Referring to the lower number of deaths during the fourth wave, Wolfgang Preiser, a professor of virology at Stellenbosch University, said: “Hopefully, most will have a degree of immunity from vaccination and/or past infection.

"The new ‘rule’  is that one must encounter the virus thrice: two jabs plus booster, or two jabs and an infection before, in between or afterwards. Obviously afterwards is much safer than before the jabs.”

Preiser cautioned, however, that people are still dying from Omicron and this will be the case even when the coronavirus  eases to endemic status. The disease will be considered endemic when it isn’t eradicated but circulates at manageable levels.

“There will be some nonimmune people, especially those whose immune systems are weak (due to age or illness), who may still get severe disease or even die in an endemic situation,” said Preiser.

“How often this happens may change over time, depending on the frequency of reinfections, waning of immune responses, possible additional booster vaccinations, and many other factors that are difficult to foresee.”

Not all countries have followed the same trajectory as SA, which went into the Omicron wave with a high rate of previous infections.

In the US, for example, 2,200 people are dying every day from Covid. According to Reuters, this is higher than in Delta-driven waves, which peaked at seven-day averages of 2,078 deaths in September.

The World Health Organisation has also expressed  concern about the Omicron variant. 

Maria van Kerkhove, an epidemiologist with the organisation, said: “We have increasing information that it is less severe but it is still a dangerous virus. We are seeing the full spectrum from asymptomatic cases all the way through to severe disease and death.”

She said underlying conditions, advanced age, and being unvaccinated are all major risk factors for a severe form of Covid even with the Omicron variant.

It is “very efficiently transmitted” she said, and this places “a significant burden on health-care systems” because even though most won’t need hospitalisation, an exponential increase in numbers means the number of those at risk and who get sick also rises.