Scrutinizing the spread of COVID-19 in Madagascar

Cross-sectional cycle threshold values reflect epidemic dynamics of COVID-19 in Madagascar

As the national reference laboratory for febrile illness in Madagascar, we processed samples from the first epidemic wave of COVID-19, between March and September 2020. We fit generalized additive models to cycle threshold (C_t) value data from our RT-qPCR platform, demonstrating a peak in high viral load, low-C_t value infections temporally coincident with peak epidemic growth rates estimated in real time from publicly-reported incidence data and retrospectively from our own laboratory testing data across three administrative regions. We additionally demonstrate a statistically significant effect of duration of time since infection onset on C_t value, suggesting that C_t value can be used as a biomarker of the stage at which an individual is sampled in the course of an infection trajectory. As an extension, the population-level C_t distribution at a given timepoint can be used to estimate population-level epidemiological dynamics. We illustrate this concept by adopting a recently-developed, nested modeling approach, embedding a within-host viral kinetics model within a population-level Susceptible-Exposed-Infectious-Recovered (SEIR) framework, to mechanistically estimate epidemic growth rates from cross-sectional C_t distributions across three regions in Madagascar. We find that C_t-derived epidemic growth estimates slightly precede those derived from incidence data across the first epidemic wave, suggesting delays in surveillance and case reporting. Our findings indicate that public reporting of C_t values could offer an important resource for epidemiological inference in low surveillance settings, enabling forecasts of impending incidence peaks in regions with limited case reporting.

Spatio-temporal characteristics and control strategies in the early period of COVID-19 spread: a case study of the mainland China

COVID-19 has caused huge impacts on human health and the economic operation of the world. Analyzing and summarizing the early propagation law can help reduce the losses caused by public health emergencies in the future. Early data on the spread of COVID-19 in 30 provinces (autonomous regions and municipalities) of mainland China except for Hubei, Hong Kong, Macao, and Taiwan were selected in this study. Spatio-temporal analysis, inflection point analysis, and correlation analysis are used to explore the spatio-temporal characteristics in the early COVID-19 spread. The results suggested that (1) the total confirmed cases have risen in an "S"-shaped curve over time, and the daily new cases have first increased and finally decreased; (2) the spatial distributions of both total and daily new cases show a trend of more in the east and less in the west, with a "multi-center agglomeration distribution" around Hubei Province and some major cities; (3) the spatial agglomeration of total confirmed cases has been increasing over time, while that of the daily new cases shows much more obvious in the mid-stage; and (4) timely release of the first-level public health emergency response can accelerate the emergence of the epidemic inflection point. The above analysis results have a specific reference value for the government's policy-making and measures to face public health emergencies.

Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar

There are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district-community, primary care centers, hospital-including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats.