Covid19 Deaths on the rise: Point to Health worker vulnerability

Dr Richard Ayah

The Ministry of Health in the daily Covid19 update statement reported 16 deaths over the last 24 hours. This is a joint 5th highest daily total, after 1st, 12th, 19th and 21st August (23,18,19,16 deaths respectively). A total of 858 persons have now been reported officially to have died of Covid19.

Covid19 Crude Case Fatality Rate and Case Detection Rate (March – October 2020):Source adapted from MOH

4,888 covid19 tests were performed in the last 24 hours and 497 reported as positive, case detection rate of 10.2%. The average case detection rate in October 2020, is now 6.52% above that of September (4.63%), but below August (9.30%) and July (10.21%). Given the trends since 13th October, the average case detection rate for October is likely to continue to rise. What are the implications of this? The 7-day running average number of tests currently being done is about 4,500, and if the detection rate continues to rise then it implies more testing needs to be done to reflect the true Covid19 situation.

Perhaps of greater significance is the number of deaths being reported. Undoubtedly there are many deaths that are covid19 related that have not been reported, either because of stigma or because a test was not available at the time of death. So the total number of deaths reported to date is likely to be an underestimate. That the tip of the Covid19 pyramid is growing larger (only 7% of Covid19 cases have symptoms), indicates a large pyramid below. With inadequate testing it means that health worker are being exposed more and that health facilities may become overwhelmed as health workers either quarantine after exposure or fall ill.

Of interest is that in months of July and August which was reported as the ‘peak’ the proportion of covid19 positive cases was more that the proportion of tests done in that month. This is not the case in October so far, the proportion of covid19 positive cases is almost the same as the number of tests done.

Monthly Proportion of Covid19 positive cases and Monthly Tests

When the two bits of data are put together – rising number of covid19 deaths and proportion of tests the same as the proportion of positive cases, it suggests that there are many more cases not being picked up and that the current testing strategy is not helping health workers to plan for care or their own protection.

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Dr Richard Ayah

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