The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model
The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model
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DOI：
10.1136/bmjgh-2020-002647
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发表时间：
2020-05-01
影响因子：
8.1
通讯作者：
Moeti, Matshidiso R.
中科院分区：
文献类型：
--
作者：
Cabore, Joseph Waogodo;Karamagi, Humphrey Cyprian;Moeti, Matshidiso R.
严重急性呼吸综合征冠状病毒-2 （SARS-CoV-2）的传播速度和影响前所未有。阻断其传播以防止广泛的社区传播至关重要，因为其影响超出了COVID-19病例和死亡人数，并影响到卫生系统提供其他基本服务的能力。为了强调这种情况的影响，本文提出的预测是使用马尔可夫链模型得出的，过渡状态和国家特定概率是根据当前可用的知识得出的。暴露风险和脆弱性指数用于使概率具体到国家。研究结果预测，在阿尔及利亚、南非和喀麦隆等面积较小的国家，暴露于这种病毒的风险很高。尼日利亚的感染人数最多，其次是阿尔及利亚和南非。毛里塔尼亚的病例最少，其次是塞舌尔和厄立特里亚。按人均计算，毛里求斯、塞舌尔和赤道几内亚受影响的人口比例最高，而尼日尔、毛里塔尼亚和乍得受影响的人口比例最低。在世界卫生组织在非洲的10亿人口中，22%（16%-26%）将在第一年受到感染，有37（29 - 44）万例有症状病例和15078（82 735-189 579）例死亡。估计将有460万人（360 - 550万人）因COVID-19住院，其中139 521人（81 876-167 044人）将是需要吸氧的重症病例，89 043人（52 253-106 599人）将是需要呼吸支持的危重病例。所需的缓解措施将严重影响卫生系统的能力，特别是二级和三级服务，而由于诊断能力薄弱和非特异性症状，许多病例可能在初级保健设施中未被发现。避免SARS-CoV-2广泛和持续的社区传播的影响是巨大的，很可能超过防止这种情况发生的任何成本。各国应推广有效防控措施，以最好地应对新冠肺炎疫情。
The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been unprecedented in its speed and effects. Interruption of its transmission to prevent widespread community transmission is critical because its effects go beyond the number of COVID-19 cases and deaths and affect the health system capacity to provide other essential services. Highlighting the implications of such a situation, the predictions presented here are derived using a Markov chain model, with the transition states and country specific probabilities derived based on currently available knowledge. A risk of exposure, and vulnerability index are used to make the probabilities country specific. The results predict a high risk of exposure in states of small size, together with Algeria, South Africa and Cameroon. Nigeria will have the largest number of infections, followed by Algeria and South Africa. Mauritania would have the fewest cases, followed by Seychelles and Eritrea. Per capita, Mauritius, Seychelles and Equatorial Guinea would have the highest proportion of their population affected, while Niger, Mauritania and Chad would have the lowest. Of the World Health Organization's 1 billion population in Africa, 22% (16%-26%) will be infected in the first year, with 37 (29 - 44) million symptomatic cases and 150 078 (82 735-189 579) deaths. There will be an estimated 4.6 (3.6-5.5) million COVID-19 hospitalisations, of which 139 521 (81 876-167 044) would be severe cases requiring oxygen, and 89 043 (52 253-106 599) critical cases requiring breathing support. The needed mitigation measures would significantly strain health system capacities, particularly for secondary and tertiary services, while many cases may pass undetected in primary care facilities due to weak diagnostic capacity and non-specific symptoms. The effect of avoiding widespread and sustained community transmission of SARS-CoV-2 is significant, and most likely outweighs any costs of preventing such a scenario. Effective containment measures should be promoted in all countries to best manage the COVID-19 pandemic.