Article Text

The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model
  1. Joseph Waogodo Cabore1,
  2. Humphrey Cyprian Karamagi2,
  3. Hillary Kipruto3,
  4. James Avoka Asamani3,
  5. Benson Droti4,
  6. Aminata Binetou Wahebine Seydi2,
  7. Regina Titi-Ofei2,
  8. Benido Impouma5,
  9. Michel Yao5,
  10. Zabulon Yoti5,
  11. Felicitas Zawaira6,
  12. Prosper Tumusiime4,
  13. Ambrose Talisuna5,
  14. Francis Chisaka Kasolo7,
  15. Matshidiso R Moeti8
  1. 1 Director of Programme Management, World Health Organization Regional Office for Africa, Brazzaville, Congo
  2. 2 Data Analytics and Knowledge Management, World Health Organization Regional Office for Africa, Brazzaville, Congo
  3. 3 Universal Health Coverage - Life Course, World Health Organization Regional Office for Africa, Harare, Zimbabwe
  4. 4 Universal Health Coverage - Life Course, World Health Organization Regional Office for Africa, Brazzaville, Congo
  5. 5 Health Emergencies Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
  6. 6 Assistant Regional Director, World Health Organization Regional Office for Africa, Brazzaville, Congo
  7. 7 Country Support, World Health Organization Regional Office for Africa, Brazzaville, Congo
  8. 8 Regional Director, World Health Organization Regional Office for Africa, Brazzaville, Congo
  1. Correspondence to Dr Humphrey Cyprian Karamagi; karamagih{at}gmail.com

Abstract

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.

  • mathematical modelling
  • epidemiology
  • health systems
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Twitter @karamagih

  • Contributors This analysis is a result of multidisciplinary, cross team effort comprising experts of the World Health Organization Regional Office for Africa with skills in epidemiology, statistics, public health, emergency response and health systems. MRM conceived the study and JWC coordinated its execution and internal review. HCK led the technical team and the health systems related analytics. JAA and HK led the statistical analytics. BD led the data consolidation, together with AS and RT-O. BI, MY and ZY led the emergency response inputs, while PT and HCK led the health systems inputs. AT, FZ and FCK led the epidemiology information and carried out the overall technical review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area, or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon request. Data used in the study are from publicly available and verified databases from the United Nations agencies depending on the indicator. The tool consolidating and analysing these data is publicly available with all countries of the World Health Organization African Region and upon request.

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