As few as one-in-80 Covid-19 deaths are being reported in Syria, meaning the war torn country is likely to be far deeper into a worse outbreak than previously understood, new analysis suggests.
Comparing reported fatalities with data from death certificates and government records of all deaths, researchers estimate only 1.25 per cent of coronavirus deaths were being counted in the capital, Damascus.
The modelling led by scientists at London's Imperial College may suggest other countries thought to have been “spared” the virus have instead failed to record Covid-19 deaths.
“This estimate significantly alters our understanding of the Covid-19 epidemic in Damascus, which is at a much later stage than suggested by surveillance reports,” said Dr Oliver Watson, from the university's school of public health.
"This finding has dramatically changed my perception of how much of the Covid-19 pandemic may have occurred unobserved to date in many parts of the world.”
A lack of testing in many countries has hampered epidemiologists' efforts to understand how the coronavirus is spreading. Many countries have had to rely on figures for reported Covid-19 deaths, which are often a significant undercount. Other measures of death, such as regular counts of excess deaths are also often not available.
The researchers estimate that around 4,340 Covid deaths in Damascus had gone unreported by the start of September. The official death toll for the whole country is only 157, according to figures collected by John Hopkins University.
Given that Damascus is likely to have the best disease surveillance in Syria, the researchers said other regions of the country could have experienced similar or worse death rates.
The worldwide recorded death toll has reached well over 900,000 since the coronavirus emerged late in 2019. That figure is thought to be a significant undercount.
Countries in the Middle East and Africa have reported much lower mortality rates than the worst affected countries in Europe and the Americas.
“One hypothesis is that these countries have been ‘spared’, but another is that deaths have been under-ascertained”, because of for example a lack of testing, the authors said.
“However, the scale of under-ascertainment is difficult to assess with currently available data.”
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