Counting the burials: African nations scramble to track COVID-19

ADDIS ABABA: Long after the funding for his project was frozen, Bilal Endris has kept a lonely watch over cemeteries in Ethiopia's capital by slipping cash to gravediggers to alert his team to any sudden spikes in burials. In a nation where fewer than 2% of deaths are registered, an increase in burials may be one of the first signs that a killer disease is on the loose. The program was set up to monitor deaths related to HIV/AIDS a decade ago. Now doctor Bilal monitors for a spike in fatalities linked to COVID-19.

He has yet to see one, but projects like his are being set up in other African countries where many deaths go unrecorded, making it hard to assess the scale of a disease. In some cases, nations are dusting off programs set up during Ebola outbreaks. Bilal himself has secured additional funding to restore the program to all 73 of Addis Ababa's cemeteries from just 10 now. Only eight countries in Africa - Algeria, Cape Verde, Djibouti, Egypt, Mauritius, Namibia, Seychelles, and South Africa - record more than 75% of deaths, according to the United Nations.

In other regions, where official data is readily available, researchers have used the number of deaths from all causes that exceed the average for the time of year to help gauge the number linked to the coronavirus pandemic. "In Ethiopia and everywhere across Africa ... we go blind." Bilal told Reuters. "I wanted to turn the health care system into one based on evidence." In the capital Addis Ababa, less than 20% of deaths occur in hospitals, Bilal said, so monitoring deaths requires talking to community leaders and burial grounds.

In Nigeria, Africa's most populous nation, media reports citing gravediggers alerted authorities to an undetected COVID-19 outbreak in the northern city of Kano in April, when deaths surged from a daily average of 11 to 43. Bilal's project began tracking burials at all graveyards in Addis Ababa a decade ago.

But in 2018, the U.S. Centers for Disease Control and Prevention (CDC) froze its funding, as the country had started using other methods to track HIV mortality, according to a CDC spokeswoman.

Bilal scaled back his surveillance to 10 cemeteries and began working for free, paying sources with a tiny grant from Addis Ababa University - until May.