Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: insights from Madagascar.
Reconciling model predictions with low reported cases of COVID-19 in Sub-Saharan Africa: insights from Madagascar.
复制标题
DOI：
10.1080/16549716.2020.1816044
复制
发表时间：
2020-12-31
影响因子：
2.6
通讯作者：
Rakotonirina J
中科院分区：
文献类型：
--
作者：
Evans MV;Garchitorena A;Rakotonanahary RJL;Drake JM;Andriamihaja B;Rajaonarifara E;Ngonghala CN;Roche B;Bonds MH;Rakotonirina J
COVID-19在全球范围内造成了严重破坏，特别是撒哈拉以南非洲（SSA），模型显示大多数人口将受到感染。传统观点认为，非洲大陆将承受更大的COVID-19负担，原因与其他传染病相同：生态、社会经济条件、缺乏水和卫生基础设施以及卫生系统薄弱。然而，迄今为止，与标准模型的预测和世界其他地区的经验相比，撒哈拉以南非洲报告的发病率和死亡率较低。有三种主要的解释，每种解释对最终的流行病负担都有不同的影响：（1）低病例检出率，（2）流行病学的差异（例如低R 0），（3）政策干预。病例数量少导致一些撒南非洲国家政府放松了这些政策干预。这是否会导致病例死灰复燃？为了理解如何解释马达加斯加低于预期的COVID-19病例数据，我们使用一个简单的年龄结构模型来探索这些解释中的每一个，并预测与之相关的疫情影响。我们表明，截至2020年7月的COVID-19病例发病率可以用首例输入病例较晚出现、非药物干预措施（NPI）较早实施和病例发现率较低等因素的组合来解释。然后，我们在马达加斯加COVID-19疫情至2020年8月的背景下重新评估这些发现。这一分析强调，马达加斯加与撒哈拉以南非洲其他国家沿着，仍然面临着日益严重的健康危机的风险。如果继续执行非营利组织倡议，可能会挽救多达50 000人的生命。即使有NPI，没有疫苗和新疗法，COVID-19也可能感染多达30%的人口，使其成为马达加斯加来年最大的公共卫生威胁，因此临床试验和不断改善医疗保健的重要性。
COVID-19 has wreaked havoc globally with particular concerns for sub-Saharan Africa (SSA), where models suggest that the majority of the population will become infected. Conventional wisdom suggests that the continent will bear a higher burden of COVID-19 for the same reasons it suffers from other infectious diseases: ecology, socio-economic conditions, lack of water and sanitation infrastructure, and weak health systems. However, so far SSA has reported lower incidence and fatalities compared to the predictions of standard models and the experience of other regions of the world. There are three leading explanations, each with different implications for the final epidemic burden: (1) low case detection, (2) differences in epidemiology (e.g. low R 0), and (3) policy interventions. The low number of cases have led some SSA governments to relaxing these policy interventions. Will this result in a resurgence of cases? To understand how to interpret the lower-than-expected COVID-19 case data in Madagascar, we use a simple age-structured model to explore each of these explanations and predict the epidemic impact associated with them. We show that the incidence of COVID-19 cases as of July 2020 can be explained by any combination of the late introduction of first imported cases, early implementation of non-pharmaceutical interventions (NPIs), and low case detection rates. We then re-evaluate these findings in the context of the COVID-19 epidemic in Madagascar through August 2020. This analysis reinforces that Madagascar, along with other countries in SSA, remains at risk of a growing health crisis. If NPIs remain enforced, up to 50,000 lives may be saved. Even with NPIs, without vaccines and new therapies, COVID-19 could infect up to 30% of the population, making it the largest public health threat in Madagascar for the coming year, hence the importance of clinical trials and continually improving access to healthcare.
影响因子：
8.1
作者：
Kitutu FE;Mayora C;Johansson EW;Peterson S;Wamani H;Bigdeli M;Shroff ZC
通讯作者：
Shroff ZC