Epidemiological characteristics of sudden unexpected deaths during 3 COVID-19 waves in Tshwane, South Africa.

The underreported cases of suspected COVID-19 deaths are owed to the lack of molecular tests done on autopsies. In South Africa, there was a backlog in reporting the cause of death data which resulted in a high number of excess deaths. The study was done on individuals who died unexpectedly as “sudden deaths” and “found deaths”, death occurred within 24 hours of the onset of symptoms in an individual with a history of possible exposure to SARS-CoV-2. The objective was to define the prevalence and epidemiological characteristics of cases admitted to a government mortuary through 3 COVID-19 waves of infections between 2021-2022. The highest number, 21.74% (10/46) of positive SARS-CoV-2 cases, were detected in December 2021 when the Omicron variant first circulated in South Africa. The odds (OR) of testing positive for SARS-CoV-2 were higher [OR=1.27;95% CI (0.36-4.48), p= (0.96)] in children in 2021 and significantly greater [OR=7.23;95% CI (1.37-38.22), p= (0.038)] in children in 2022. There was an 8.69% (4/46) positivity rate in children (11-15 years) which increased the risk of infection. This study suggests an increase in SARS-CoV-2 positive cases of unexpected deaths during the Omicron wave, suggesting an underreporting in children and adults in Africa.