Modeling COVID-19 Transmission in Africa: Country-wise Projections of Total and Severe Infections Under Different Lockdown Scenarios (preprint)

ObjectivesAs of August 24th 2020, there have been 1,084,904 confirmed cases of SARS-CoV-2 and 24,683 deaths across the African continent. Despite relatively lower numbers of cases initially, many African countries are now experiencing an exponential increase in case numbers. Estimates of the progression of disease and potential impact of different interventions are needed to inform policy making decisions. Herein, we model the possible trajectory of SARS-CoV-2 in 52 African countries under different intervention scenarios. DesignWe developed a compartmental model of SARS-CoV-2 transmission to estimate the COVID-19 case burden for all African countries while considering four scenarios: no intervention, moderate lockdown, hard lockdown, and hard lockdown with continued restrictions once lockdown is lifted. We further analyzed the potential impact of COVID-19 on vulnerable populations affected by HIV/AIDS and TB. ResultsIn the absence of an intervention, the most populous countries had the highest peaks in active projected number of infections with Nigeria having an estimated 645,081 severe infections. The scenario with a hard lockdown and continued post-lockdown interventions to reduce transmission was the most efficacious strategy for delaying the time to the peak and reducing the number of cases. In South Africa projected peak severe infections increase from 162,977 to 203,261, when vulnerable populations with HIV/AIDS and TB are included in the analysis. ConclusionThe COVID-19 pandemic is rapidly spreading across the African continent. Estimates of the potential impact of interventions and burden of disease are essential for policy makers to make evidence-based decisions on the distribution of limited resources and to balance the economic costs of interventions with the potential for saving lives. ARTICLE SUMMARY Strengths and limitations of this studyO_LIThough the rapid spread of SARS-CoV-2 through China, Europe and the United States has been well-studied, leading to a detailed understanding of its biology and epidemiology, the population and resources for combatting the spread of the disease in Africa greatly differ to those areas and require models specific to this context. C_LIO_LIFew models that provide estimates for policymakers, donors, and aid organizations focused on Africa to plan an effective response to the pandemic threat that optimizes the use of limited resources. C_LIO_LIThis is a compartmental model and as such has inherent weaknesses; including the possible overestimation of the number of infections as it is assumed people are well mixed, despite many social, physical and geographical barriers to mixing within countries. C_LIO_LIPeaks in transmission are likely to occur at different times in different regions, with multiple epicenters. C_LIO_LIThis model is not stochastic and case data are modeled from the first twenty or more cases, each behaving as an average case; in reality, there are no average cases; some individuals are likely to have many contacts, causing multiple infections, and others to have very few. C_LI

Risks to Children under-five in India from COVID-19 (preprint)

Objective: The novel coronavirus, COVID-19, has rapidly emerged to become a global pandemic and is known to cause a high risk to patients over the age of 70 and those with co-morbidities, such as hypertension and diabetes. Though children are at comparatively lower risk compared to adults, the Indian population has a large young demographic that is likely to be at higher risk due to exposure to pollution, malnutrition and poor access to medical care. We aimed to quantify the potential impact of COVID-19 on Indias child population. Methods: We combined district family household survey data with data from the COVID-19 outbreak in China to analyze the potential impact of COVID-19 on children under the age of 5, under three different scenarios; each of which assumed the prevalence of infection to be 0.5%, 1%, or 5%. Results: We find that in the lowest prevalence scenario, across the most populous 18 Indian states, asymptomatic, non-hospitalized symptomatic and hospitalized symptomatic cases could reach 87,200, 412,900 and 31,900, respectively. In a moderate prevalence scenario, these figures reach 174,500, 825,800, and 63,800, and in the worst case, high prevalence scenario these cases could climb as high as 872,200, 4,128,900 and 319,700. Conclusion: These estimates show COVID-19 has the potential to pose a substantial threat to Indias large population of children, particularly those suffering from malnutrition and exposure to indoor air pollution, who may have limited access to health services.