The COVID-19 pandemic has resulted in substantial mortality worldwide. However, to date, countries in the Middle East and Africa have reported considerably lower mortality rates than in Europe and the Americas. Motivated by reports of an overwhelmed health system, we estimate the likely under-ascertainment of COVID-19 mortality in Damascus, Syria. Using all-cause mortality data, we fit a mathematical model of COVID-19 transmission to reported mortality, estimating that 1.25% of COVID-19 deaths (sensitivity range 1.00% – 3.00%) have been reported as of 2 September 2020. By 2 September, we estimate that 4,380 (95% CI: 3,250 – 5,550) COVID-19 deaths in Damascus may have been missed, with 39.0% (95% CI: 32.5% – 45.0%) of the population in Damascus estimated to have been infected. Accounting for under-ascertainment corroborates reports of exceeded hospital bed capacity and is validated by community-uploaded obituary notifications, which confirm extensive unreported mortality in Damascus.
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We would like to thank a Wikipedia user—RamiPat (https://en.wikipedia.org/wiki/ User:RamiPat), who has updated the Syria COVID-19 wikipedia page daily, copying the reported deaths and cases from the Syrian MoH dashboard, which enabled us to identify the date of 1 death outside of Damascus that was not reported in the published daily COVID-19 reports. We would also like to thank Rim Turkmani and Mazen Gharibah from the Syria team at the Conflict Research Programme at London Schools of Economics. This work was supported by funding from The Wellcome Trust under a concordat agreement with the UK Foreign, Commonwealth and Development Office. We additionally acknowledge support from the UK Medical Research Council as well as Google for credits used during image processing of death notification data.
© 2021, The Author(s).