Comparative impact assessment of COVID-19 policy interventions in five South Asian countries using reported and estimated unreported death counts during 2020-2021.
Comparative impact assessment of COVID-19 policy interventions in five South Asian countries using reported and estimated unreported death counts during 2020-2021.
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DOI：
10.1371/journal.pgph.0002063
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发表时间：
2023
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关于南亚COVID死亡数据的质量，一直存在激烈的讨论和争论。根据世卫组织的数据，在2020-2021年报告的550万例COVID-19死亡病例中，57万例（10%）来自全球南方的五个中低收入国家：印度、巴基斯坦、孟加拉国、斯里兰卡和尼泊尔。然而，多项超额死亡估计显示，COVID-19的实际死亡人数明显高于报告的死亡人数。例如，IHME和世卫组织都预测2020-2021年的总死亡人数约为1490万，其中450万至550万人归因于这五个国家。我们透过反事实的透镜，聚焦于这五个国家（占全球23. 5%的人口）于二零二零年及二零二一年的COVID-19表现，并询问，倘一个低收入国家采纳另一个类似国家的疫情政策，其死亡率会受到多大程度的影响？我们使用Mishra等人（2021）开发的贝叶斯半机械模型，通过排列这些国家在类似时间段内随时间变化的生殖数（Rt），比较报告和估计的总死亡人数。我们的分析显示，于2021年上半年，印度的死亡率（按报告死亡人数计算）可分别降至每百万人96人及102人，而若印度分别采纳尼泊尔及巴基斯坦的政策，则实际每百万人报告死亡人数为170人。就死亡总数而言，如果印度采取孟加拉国和巴基斯坦的政策，每百万人中本可避免481人和466人死亡。另一方面，2021年下半年，印度每百万人报告的COVID-19死亡人数较低（每百万人48人死亡），每百万人估计总死亡人数较低（每百万人80人死亡），而巴基斯坦以外的中低收入国家若遵循印度的策略，其报告死亡率将较低。报告的总死亡人数与估计的总死亡人数之间的差距突出表明，整个次大陆的死亡人数报告不足的程度和程度各不相同，模型估计数取决于死亡数据的准确性。我们的分析表明，及时的公共卫生干预和疫苗对于降低死亡率非常重要，并且需要为中低收入国家的死亡登记系统提供更好的覆盖基础设施。
There has been raging discussion and debate around the quality of COVID death data in South Asia. According to WHO, of the 5.5 million reported COVID-19 deaths from 2020-2021, 0.57 million (10%) were contributed by five low and middle income countries (LMIC) countries in the Global South: India, Pakistan, Bangladesh, Sri Lanka and Nepal. However, a number of excess death estimates show that the actual death toll from COVID-19 is significantly higher than the reported number of deaths. For example, the IHME and WHO both project around 14.9 million total deaths, of which 4.5–5.5 million were attributed to these five countries in 2020-2021. We focus our gaze on the COVID-19 performance of these five countries where 23.5% of the world population lives in 2020 and 2021, via a counterfactual lens and ask, to what extent the mortality of one LMIC would have been affected if it adopted the pandemic policies of another, similar country? We use a Bayesian semi-mechanistic model developed by Mishra et al. (2021) to compare both the reported and estimated total death tolls by permuting the time-varying reproduction number (Rt) across these countries over a similar time period. Our analysis shows that, in the first half of 2021, mortality in India in terms of reported deaths could have been reduced to 96 and 102 deaths per million compared to actual 170 reported deaths per million had it adopted the policies of Nepal and Pakistan respectively. In terms of total deaths, India could have averted 481 and 466 deaths per million had it adopted the policies of Bangladesh and Pakistan. On the other hand, India had a lower number of reported COVID-19 deaths per million (48 deaths per million) and a lower estimated total deaths per million (80 deaths per million) in the second half of 2021, and LMICs other than Pakistan would have lower reported mortality had they followed India’s strategy. The gap between the reported and estimated total deaths highlights the varying level and extent of under-reporting of deaths across the subcontinent, and that model estimates are contingent on accuracy of the death data. Our analysis shows the importance of timely public health intervention and vaccines for lowering mortality and the need for better coverage infrastructure for the death registration system in LMICs.