While health surveillance is weak, he acknowledged, Sierra Leoneans has the latest, horrific experience of Ebola, which killed 4,000 people here in 2014-16. Since then, he said, citizens have been on alert for an infectious agent that could kill people in their communities. They would not continue to wrap up in events if that were the case, he said.
Dr. Salim Abdool Karim, who is in the African Centers for Disease Control and Prevention Covid task force and who was part of the research team that tracked excess deaths in South Africa, believes the death toll across the continent is likely to be consistent with his country. There is simply no reason why Gambians or Ethiopians would be less vulnerable to Covid than South Africans, he said.
But he also said it was clear that a large number of people did not show up at the hospital with difficulty breathing. The young population is clearly a key factor, he said, while some older people who die from strokes and other Covid-induced causes are not identified as coronavirus deaths. Many do not come to the hospital at all and their deaths are not recorded. But others do not get sick at speeds seen elsewhere, and it is a mystery that needs to be solved.
“It’s hugely relevant to things as basic as vaccine development and treatment,” said Dr. Prabhat Jha, who heads the Center for Global Health Research in Toronto and heads the work of analyzing causes of death in Sierra Leone.
Researchers working with Dr. Jha, uses new methods – such as looking for an increase in revenue from obituaries at radio stations in Sierra Leone’s cities over the last two years – to try to see if the deaths could have increased unnoticed, but he said it was clear that there had been no tide of desperately ill people.
Some organizations working on the Covid vaccination effort say the lower disease and death rates should be the driving force behind a rethinking of the policy. John Johnson, MSF’s vaccination adviser, said it made sense to vaccinate 70 percent of Africans a year ago, as it looked like vaccines could provide long-term immunity and make it possible to stop the Covid-19 transmission. But now that it is clear that protection is declining, collective immunity no longer seems to be achievable. And then an immunization strategy that focuses on protecting only the most vulnerable would undoubtedly be a better use of resources in a place like Sierra Leone.