Namibia's Worst Month: An Analysis of COVID-19 Deaths in July, 2021

July, 2021, was the worst month, to date, for COVID-19 and related deaths in Namibia, when a total reported number of 1,523 people (out of 3,350 or, 45%) succumbed to the disease. However, the story of the worst month of COVID-19 and related deaths did not start on the 1st and end on the 31st of July because the COVID-19 pandemic is a continuous event that commenced more than a year ago, in March, 2020, when the first two (2) cases of COVID-19 in Namibia were reported to the Ministry of Health and Social Services (MOHSS).

    Since then, more than 120,000 Namibians tested positive for COVID-19, and, sadly, more than 3,350 people have died. Namibia currently has more than 3,500 active cases. Many Namibians lost family members, siblings, friends, colleagues, superiors, in some cases both parents, to COVID-19. 

    By the 5th of July, 2021, international news outlets reported that Namibia had the highest infection rate on the African continent, and then, in the world, which was surprising given the country's low population density. With an estimated population of 2,5 million people in a medium-sized country, Namibia's population density is a fraction lower than Mongolia and Western Sahara, two (2) of the world's least densely populated countries. The news came as a shock to many. 

    By the 10th of July, 2021, the COVID-19 daily death toll increased, alarmingly, and by the 15th of July, 2021, more than 720 people had passed away (on average, 48 people per day). 

    A dark cloud hung over the country, the daily news was bleak. On social media and Whatsapp groups, grieving families, spouses, and friends shared death notices, memories, and photos of loved ones. Every day brought a fresh onslaught of grief as the devastation and reality of the COVID-19 pandemic sank in. Community mental health suffered severely, and being a small population by global standards, many Namibians knew many other Namibians. It was, truly, a frightening, miserable time in the country's short history, and far from over.

What is “percent positive”? 

The percent positive is the percentage of all COVID-19 tests that are positive. In mathematical terms: (n of positive tests / n of total tests performed) x 100. The answer is called the “positivity rate” and helps determine the spread of COVID-19 infections in a community, and whether testing is sufficient or not. 

    Testing for COVID-19 is a critical tool to identify infected community members. Infected community members are required to isolate, away from healthy, uninfected members in order to reduce the infection rate of COVID-19, or the percent positive. 

    The higher the percent positive, the higher the number of community members infected with COVID-19, the faster the disease spreads in a community, and the more likely that COVID-19 and related deaths will occur. 

    The World Health Organisation (WHO) established a percent positive of 5% as a threshold for COVID-19 infections, and has continuously urged countries to keep infections below 5%, or to ease social restrictions and lockdowns only when the percent positive drops lower than 5% and remains lower than 5% for two (2) consecutive weeks, or fourteen (14) consecutive days. 

    As early as January, 2021, alarm bells were ringing about the COVID-19 infection rate in Namibia, which, at 17% after the December summer holidays, was far higher than the WHO threshold of 5%. The situation deteriorated rapidly thereafter, so that by the 20th of June, 2021, the COVID-19 infection rate had shot up to 39%, and, worse, by the 4th of July, had reached an astonishing 46%, meaning almost 50% of tests performed were positive.

The COVID-19 Death Toll in July, 2021

The World Health Organisation (WHO) defines deaths due to COVID-19 as deaths “resulting from a clinically compatible illness, in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma).” 

    In addition, a death due to COVID-19 “may not be attributed to another disease (e.g. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19.” 

    The WHO also recognises a “causal sequence leading to death” whereby COVID-19 causes pneumonia and fatal respiratory distress, in a chain of events that result in COVID-19 related deaths. Similarly, people with existing chronic conditions or compromised immune systems, suffering from non-communicable diseases such as coronary artery disease, diabetes, or disabilities, are at higher risk, than the general population, of death due to COVID-19.

    Table 1: The number of COVID-19 and related deaths reported per day, per region, in Namibia, for July, 2021

Source: Ministry of Health and Social Services (MOHSS) of Namibia

    The data in Table 1 were obtained from daily reports and updates provided by the Ministry of Health and Social Services (MOHSS) of Namibia, from 1 July to 31 July, 2021. During the course of July, 2021, all fourteen (14) regions in Namibia reported COVID-19 and related deaths. The total number of reported deaths were 1,523 for the period 1 July to 31 July, 2021. The following regions reported deaths in excess of a hundred (< 100):

1. Khomas: n = 277
2. Oshana: n = 192
3. Erongo: n = 156
4. Omaheke: n = 142
5. Kavango East: n = 131
6. Omusati: n = 114
7. Otjozondjupa: n = 111
8. Hardap: n = 106 

    In quantity, the aforementioned regions represent 57% out of the fourteen (14) regions in Namibia. The total number of COVID-19 and related deaths in these regions, for the period under review, were 1,229 or 81% of the total number of reported deaths (n = 1,523), in July, 2021. The following regions reported the lowest number of deaths, in July, 2021: 

1. Kavango West: n = 8
2. Kunene: n = 41
3. //Karas: n = 43
4. Zambezi: n = 54
5. Ohangwena: n = 62
6. Oshikoto: n = 86   

    The lowest numbers of deaths are significant because they are indicative of community infection rates, or the percent positive, in those regions. For example, the low number of deaths in the Kavango West region, compared to the high number of deaths in the Khomas region, for the same period, infers that the COVID-19 infection rate in Kavango West was significantly lower than in the Khomas region. Similarly, the number of deaths in the Khomas region, compared to other regions, infers that COVID-19 infections in the Khomas region are significantly more than in any other region, a so-called ''hot spot'' for the disease. The following regions reported the highest number of COVID-19 and related deaths in a single day: 

1. Oshana: n = 44 (16 July, 2021)
2. Omaheke: n = 34 (14 July, 2021)
3. Khomas: n = 33 (11 July, 2021)
4. Oshana: n = 33 (14 July, 2021)
5. Khomas: n = 29 (7 July, 2021)

    The aforementioned dates clearly cluster around the national peak of reported COVID-19 and related deaths, i.e., between the 5th and the 20th of July, 2021, in Oshana, Omaheke, and Khomas, which infers that human behaviour such as not getting tested, not wearing masks, not sanitising or washing hands, nor maintaining social distances, not isolating when feeling ill or infected, is responsible for increased COVID-19 infection and consequently, deaths. In July, 2021, the five (5) regional “hot spots” for COVID-19 infection, in chronological, descending order, were: 

1. Khomas 
2. Oshana 
3. Erongo 
4. Omaheke 
5. Kavango East 

    Graph 1: The total number of COVID-19 and related deaths per region in Namibia, in July, 2021

    Another indicator of high or low infection rates, positivity percentages, were the average deaths reported per day, in July, 2021. The national average of COVID-19 and related deaths per day was 48 in July, 2021, but, on regional levels, the averages indicated the probability of daily deaths reported. The probability (P(A)), of the average number of reported COVID-19 and related deaths, in each region: 

1. Erongo: P(A) = 5 deaths per day (high)
2. Hardap: P(A) = 3 deaths per day
3. Kavango East: P(A) = 4 deaths per day
4. Kavango West: P(A) = 0 deaths per day
5. //Karas: P(A) = 1 death per day
6. Khomas: P(A) = 9 deaths per day (high)
7. Kunene: P(A) = 1 death per day
8. Ohangwena: P(A) = 2 deaths per day
9. Omaheke: P(A) = 4.5 deaths per day
10. Omusati: P(A) = 4 deaths per day
11. Oshana: P(A) = 6 deaths per day (high)
12. Oshikoto: P(A) = 3 deaths per day 
13. Otjozondjupa: P(A) = 3.5 deaths per day
14. Zambezi: P(A) = 2 deaths per day 

    Graph 2: The total number of COVID-19 and related deaths per day, per region, in Namibia, in July, 2021, with linear forecast prediction for August, 2021

    Graph 2 shows a marked increase in reported COVID-19 and related deaths from the 5th of July onward, a peak between the 5th and the 20th of July, that tapers off towards the end of July, 2021. 

Conclusion

This study showed that high COVID-19 infection rates resulted in an increase in the number of COVID-19 and related deaths in Namibia, in July, 2021, with on average 48 people dying, per day, when the positivity rate reached 46%. This shows a positive relationship between the COVID-19 positivity rate and COVID-19 and related deaths. In other words, an increase in one variable, the percent positive (or infection rate), resulted in an increased death toll (or mortality rate). 

    COVID-19 infection is detected in a community and its members through testing. Testing is used to identify infected community members who require isolation until they are no longer vectors for the disease, or infectious. It is also used to determine the infection rate, percent positive, of COVID-19 in a community. 

    Human behaviour and access to credible, reliable information drive COVID-19 infection rates in Namibia. Namibia's health protocols to curb the spread of COVID-19 stipulate that masks be worn in public, social distances are maintained, crowds and crowded places are avoided, hands are washed or sanitised after touching surfaces, and to accept any vaccine offered to avoid hospitalisation, serious illness, and death. 

    If health protocols are complied with and positively enforced, Namibia will most certainly avoid another tragedy such as July, 2021. 

References and Sources 

1. Collins, T., 2021. Ministers Die as Namibia faces World's Highest COVID-19 Infection Rate. The Telegraph, London, United Kingdom: https://www.telegraph.co.uk/global-health/science-and-disease/ministers-die-namibia-faces-worlds-highest-covid-19-infection/ 
2. Granville, S. 2021. Covid in Namibia: ''Fifteen of my relatives have died''. BBC News: https://www.bbc.com/news/world-africa-57748119 
3. (daily) Update by Dr. Kalumbi Shangula, Minister of Health and Social Services on COVID-19 in Namibia, Ministry of Health and Social Services (MOHSS)
4. Dowdy, D. and D' Souza G., 2020. COVID-19 Testing: Understanding the ''Percent Positive''. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA: https://www.jhsph.edu/covid-19/articles/covid-19-testing-understanding-the-percent-positive.html 
5. World Health Organisation, 2021. International Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death: Based on ICD (International Classification of Diseases), World Health Organisation, Geneva, Switzerland: https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-19.pdf 

This study was undertaken and written by Anya Namaqua Links: anyalinks@gmail.com. Photo from The Namibian newspaper. No portion of this article may be reproduced without the express written permission from the writer. Acknowledgement is required for quotations and referencing.