Covid-19 demography in France and South Africa: A comparative study of morbidity and mortality in 2020-2022

Background Covid-19 epidemics raged around the world in years 2020-2022. The dynamics of the epidemics and their mortality varied by country depending on prevention, treatments, vaccination and health status of the population.Objective The study compares Covid-19 morbidity and mortality in South-Africa and in France, two countries with similar population size and with reliable reporting systems, in order to better understand the dynamics and impacts of the epidemics and the effects of health policies and programs.Data and methods Data on cases, deaths, hospitalizations, vaccinations were drawn from national statistics. Published data on cases and deaths were corrected for undercount.Results Results show a different epidemiology in the two countries in the first three years of the epidemic (2020-2022). Incidence was higher in South Africa, and some 44% more people were infected by December 2022 than in France. Mortality and case-fatality were also higher in South Africa despite a favourable age structure. The age pattern of mortality showed higher values in South Africa among the young adults. Young women appeared somewhat disadvantaged in South Africa. Lastly, vaccination appeared to have had no effect on incidence, but a large effect on case-fatality in France.Conclusions Despite about the same population size and the same crude death rate at baseline, South Africa exhibited more cases and more deaths from Covid-19 over the 2020-2022 period. Prevention strategies (lockdown and vaccination) appear to have had large impacts on morbidity and mortality.