Excess COVID-19 mortality among critically ill patients in Africa

In their multicentre, prospective, observational cohort study of 3140 critically ill patients (60·6% male, mean age 55·6 years [SD 16·1]) enrolled from 64 hospitals in ten African countries reported in The Lancet, the African COVID-19 Critical Care Outcomes Study (ACCCOS) Investigators4 show that, despite having low COVID-19 mortality rates, Africa has the highest global mortality rate in patients with COVID-19 who are critically ill: 48·2% (95% CI 46·4–50·0; 1483 of 3077 patients) against a global average of 31·5% (27·5–35·5). In addition to the previously reported drivers of mortality (eg, the patient's disease severity at presentation and having comorbidities such as HIV/AIDS, diabetes, and chronic liver disease), the ACCCOS Investigators found that having HIV/AIDS (odds ratio 1·91) and delayed access to high-care units and intensive care units (2·14) were drivers of mortality. [...]the authors also recognise some limitations, including that the study was done in tertiary hospitals. [...]23 (36%) of 64 hospitals were in South Africa and Egypt, which are better resourced countries compared with some other African countries; mortality is probably higher in lower-income African countries.