Early Transmission Dynamics of Novel Coronavirus (COVID-19) in Nigeria

Nigeria Centre for Disease Control, awareness creation and risk communication of Covid-19 pandemic amongst non-literate population in South-West Nigeria: Lessons for future health campaign

Risk communication of Covid-19 pandemic in Nigeria appeared to be urban-centered with the dominant use of social media, print communication and other controlled media. In such times of public health emergencies, non-literate population could be vulnerable as a result of their limited understanding of the nature of such health risk. Therefore, the study seeks to investigate the extent to which Nigeria Centre for Disease Control (NCDC) communicated the risk of Covid-19 disease to non-literate population in its public health campaign during the pandemic in South-West Nigeria. The study adopts risk communication theory which advances the approach communication should take during public health emergencies. Using descriptive cross-sectional mixed methods research design, a sample of 420 respondents were purposively selected from 6 towns in the rural areas of Lagos, Oyo and Osun states to examine the level of awareness on Covid-19 pandemic among non-literates. In addition, NCDC risk communication on Covid-19 for non-literate population were analyzed from 3 Jingles in Yoruba language as well as 9 flyers designed for Covid-19 disease from NCDC websites. Results showed that NCDC awareness creation on Covid-19 disease for non-literates in Southwest achieved significant success as a result of the medium used in creating awareness. Specifically, radio was highly rated among majority of the respondents (60.4%) followed by health workers (19.8%) as channels that created understandable message on Covid-19 safety protocols. Further findings on Jingles content revealed that all Covid-19 safety protocols were communicated in Yoruba language for Southwest populace. However, NCDC fall short in communicating Covid-19 risk effectively for non-literates in Southwest as jingles only buttressed the Covid-19 safety protocols and symptoms as well as the need to comply, without educating the masses on the dreadful nature of the disease and its dynamics. Though flyers designed by the NCDC communicated risk to an extent, nevertheless, graphics and symbols on Covid-19 disease were complimented by words in English language only, which could be difficult for non-literates to decipher. Based on the findings, the study recommends that public health agencies need to educate non-literate population about the nature of a disease more than creating awareness about the outbreak of a disease, and such education should be strategic, context-specific, and evidence-based.

Exploiting the Potential of Magnetic Nanoparticles for Rapid Diagnosis Tests (RDTs): Nanoparticle-Antibody Conjugates and Color Development Strategies

Magnetic nanoparticles (MNPs) have emerged as a promising material in disease diagnostics due to their potential to enhance detection sensitivity, facilitate concentration and purification of target substances in diverse samples, and enable favorable color-based detection. In this study, antibody-conjugated MNPs were successfully synthesized and validated through two appropriate methods: the measurement of MNPs' size and the use of phosphatase methods. Additionally, three methods were suggested and implemented for developing color in MNPs-based immunoassay, including the formation of MNP aggregations, utilization of MNPs' peroxidase-like activity, and synthesis of dually-conjugated MNPs with both enzyme and antibody. In particular, color development utilizing nanoparticle aggregations was demonstrated to result in a more yellowish color as virus concentration increased, while the peroxidase activity of MNPs exhibited a proportional increase in color intensity as the MNP concentration increased. This observation suggests the potential applicability of quantitative analysis using these methods. Furthermore, effective concentration and purification of target substances were demonstrated through the collection of MNPs using an external magnetic field, irrespective of factors such as antibody conjugation, dispersion medium, or virus binding. Finally, based on the key findings of this study, a design proposal for MNPs-based immunoassay is presented. Overall, MNPs-based immunoassays hold significant potential for advancing disease diagnostics.

Estimation of epidemiological parameters and ascertainment rate from early transmission of COVID-19 across Africa

Country reported case counts suggested a slow spread of SARS-CoV-2 in the initial phase of the COVID-19 pandemic in Africa. Owing to inadequate public awareness, unestablished monitoring practices, limited testing and stigmas, there might exist extensive under-ascertainment of the true number of cases, especially at the beginning of the novel epidemic. We developed a compartmentalized epidemiological model to track the early epidemics in 54 African countries. Data on the reported cumulative number of cases and daily confirmed cases were used to fit the model for the time period with no or little massive national interventions yet in each country. We estimated that the mean basic reproduction number is 2.02 (s.d. 0.7), with a range between 1.12 (Zambia) and 3.64 (Nigeria). The mean overall report rate was estimated to be 5.37% (s.d. 5.71%), with the highest 30.41% in Libya and the lowest 0.02% in São Tomé and Príncipe. An average of 5.46% (s.d. 6.4%) of all infected cases were severe cases and 66.74% (s.d. 17.28%) were asymptomatic ones. The estimated low reporting rates in Africa suggested a clear need for improved reporting and surveillance systems in these countries.

Impact analysis of COVID-19 on Nigerian workers' productivity using multiple correspondence analysis

As the COVID-19 pandemic became a global health concern, many business activities have had to adjust to the protocols required to keep people safe, thereby altering the work structures of many professionals. With data gathered from 466 respondents in Nigeria, of which approximately 70% are from the South-West, this study shows how the factors associated with the health crisis have affected work productivity during this period. The snowball survey research design techniques with the two-way interaction model were employed. Multiple Correspondence Analysis was used to analyse and understand multiple and pairwise qualitative factors that influence productivity. The first part of the analysis identified boredom, remuneration, internet availability, fear of COVID-19 and depressing news of COVID-19 as the factors that had significant impacts on workers' productivity. The second part of the analysis shows how the categories of the five significant factors were either associated or not with productivity. An analysis of each of these factors showed that fear of the disease was associated with slight productivity but access to internet facilities and remuneration were strongly associated with improved work productivity, while boredom and depressing news about COVID-19 were associated with non-productivity during this period. Further evidence also showed that training and new skills acquisition might improve workers' productivity much more. We, therefore, recommend dynamic skills acquisition, training, and investment in tools and services that will enhance flexibility with the changing work structure that comes because of global crises.

Studying and Simulating the Fractional COVID-19 Model Using an Efficient Spectral Collocation Approach

We give a theoretical and numerical analysis of a coronavirus (COVID-19) infection model in this research. A mathematical model of this system is provided, based on a collection of fractional differential equations (in the Caputo sense). Initially, a rough approximation formula was created for the fractional derivative of tp. Here, the third-kind Chebyshev approximations of the spectral collocation method (SCM) were used. To identify the unknown coefficients of the approximate solution, the proposed problem was transformed into a system of algebraic equations, which was then transformed into a restricted optimization problem. To evaluate the effectiveness and accuracy of the suggested scheme, the residual error function was computed. The objective of this research was to halt the global spread of a disease. A susceptible person may be moved immediately into the confined class after being initially quarantined or an exposed person may be transferred to one of the infected classes. The researchers adopted this strategy and considered both asymptomatic and symptomatic infected patients. Results acquired with the achieved results were contrasted with those obtained using the generalized Runge-Kutta method.

Risk Factors for COVID-19 Infection among Healthcare Workers in North-East Nigeria

Healthcare workers (HCWs) face an unprecedented higher risk of COVID-19 infection due to their work and exposure. In this study, we aim to examine the associated risk factors for COVID-19 infection among HCWs in North-East Nigeria. We used data collected retrospectively among a cohort of clinical and non-clinical HCWs in six healthcare facilities in Adamawa State, Nigeria. We estimated the marginal probability of COVID-19 infection among HWCs using alternating logistic regression via the generalized estimating equations (GEE) approach. Among the 318 HCWs, 178 (55.97%) were males, mean (±SD) age was 36.81 (±8.98), 237 (74.76%) were clinical, and 80 (25.24) were non-clinical staff. The overall prevalence of COVID-19 was 16.67% among HCWs. After adjusting for other variables in the model, our results showed that clinical staff had a 5-fold higher risk of COVID-19 infection than non-clinical staff (aOR = 5.07, 95% CI: 1.32–19.52). Moreover, significant exposure risk factors for COVID-19 infection for HCWs increase with age, time spent attending to patients, caring for COVID-19 patients, and having worked with COVID-19 samples, while the risk decreases with the use of an N95 mask. Our findings suggested that the burden of COVID-19 infection is higher for clinical staff than non-clinical staff, and increasing age contributed to the increased risk.

What We Can Learn from the Exported Cases in Detecting Disease Outbreaks - A Case Study of the COVID-19 Epidemic

Purpose

Early warning in the travel origins is crucial to prevent disease spreading. When travel origins have delays in reporting disease outbreaks, the exported cases could be used to estimate the epidemic.

Methods

We developed a Bayesian model to jointly estimate the epidemic prevalence and detection delay using the exported cases and their arrival and detection dates. We used simulation studies to discuss potential biases generated by the exported cases. We proposed a hypothesis testing framework to determine the epidemic severity.

Results

We applied the method to the early phase of the COVID-19 epidemic of Wuhan, United States, Italy, and Iran and found that the indicators estimated from the exported cases were consistent with the domestic data under certain scenarios. The exported cases could generate various biases if not modeled properly. We presented the required number of exported cases for determining different severity levels of the outbreak.

Conclusions

The exported case data is a good addition to the domestic data but also has its drawbacks. Utilizing the diagnosis resources from all countries, we advocate that countries work collaboratively to strengthen the global infectious disease surveillance system.

First wave COVID-19 pandemic in Senegal: Epidemiological and clinical characteristics

Background

The novel coronavirus disease 2019 (COVID-19) pandemic has spread from China to the rest of the world. Africa seems less impacted with lower number of cases and deaths than other continents. Senegal recorded its first case on March 2, 2020. We present here data collected from March 2 to October 31, 2020 in Senegal.

Methods

Socio-demographic, epidemiological, clinical and virological information were collected on suspected cases. To determine factors associated with diagnosed infection, symptomatic disease and death, multivariable binary logistic regression and log binomial models were used. Epidemiological parameters such as the reproduction number and growth rate were estimated.

Results

67,608 suspected cases were tested by the IPD laboratories (13,031 positive and 54,577 negative). All age categories were associated with SARS-CoV-2 infection, but also patients having diabetes or hypertension or other cardiovascular diseases. With diagnosed infection, patients over 65 years and those with hypertension and cardiovascular disease and diabetes were highly associated with death. Patients with co-morbidities were associated with symptomatic disease, but only the under 15 years were not associated with. Among infected, 27.67% were asymptomatic (40.9% when contacts were systematically tested; 12.11% when only symptomatic or high-risk contacts were tested). Less than 15 years-old were mostly asymptomatic (63.2%). Dakar accounted for 81.4% of confirmed cases. The estimated mean serial interval was 5.57 (± 5.14) days. The average reproduction number was estimated at 1.161 (95%CI: 1.159–1.162), the growth rate was 0.031 (95%CI: 0.028–0.034) per day.

Conclusions

Our findings indicated that factors associated with symptomatic COVID-19 and death are advanced age (over 65 years-old) and comorbidities such as diabetes and hypertension and cardiovascular disease.

Human Respiratory Infections in Nigeria: Influenza and the Emergence of SARS-CoV-2 Pandemic

The increasing outbreak of zoonotic diseases presents challenging times for nations and calls for a renewed effort to disrupt the chain of events that precede it. Nigeria's response to the 2006 bird flu provided a platform for outbreak response, yet it was not its first experience with Influenza. This study describes the impact of SARS-CoV-2 on Influenza surveillance and, conversely, while the 1918 Influenza pandemic remains the most devastating (500,000 deaths in 18 million population) in Nigeria, the emergence of SARS CoV-2 presented renewed opportunities for the development of vaccines with novel technology, co-infection studies outcome, and challenges globally. Although the public health Intervention and strategies left some positive outcomes for other viruses, Nigeria and Africa's preparation against the next pandemic may involve prioritizing a combination of technology, socioeconomic growth, and active surveillance in the spirit of One Health.

Travel-Related Monkeypox Outbreaks in the Era of COVID-19 Pandemic: Are We Prepared?

Several neglected infectious pathogens, such as the monkeypox virus (MPXV), have re-emerged in the last few decades, becoming a global health burden. Despite the incipient vaccine against MPXV infection, the global incidence of travel-related outbreaks continues to rise. About 472 confirmed cases have been reported in 27 countries as of 31 May 2022, the largest recorded number of cases outside Africa since the disease was discovered in the early 1970s.

An Efficient Numerical Simulation for the Fractional COVID-19 Model Using the GRK4M Together with the Fractional FDM

In this research, we studied a mathematical model formulated with six fractional differential equations to characterize a COVID-19 outbreak. For the past two years, the disease transmission has been increasing all over the world. We included the considerations of people with infections who were both asymptomatic and symptomatic as well as the fact that an individual who has been exposed is either quarantined or moved to one of the diseased classes, with the chance that a susceptible individual could also migrate to the quarantined class. The suggested model is solved numerically by implementing the generalized Runge–Kutta method of the fourth order (GRK4M). We discuss the stability analysis of the GRK4M as a general study. The acquired findings are compared with those obtained using the fractional finite difference method (FDM), where we used the Grünwald–Letnikov approach to discretize the fractional differentiation operator. The FDM is mostly reliant on correctly converting the suggested model into a system of algebraic equations. By applying the proposed methods, the numerical results reveal that these methods are straightforward to apply and computationally very effective at presenting a numerical simulation of the behavior of all components of the model under study.

Transmission Dynamics of COVID-19 in Ghana and the Impact of Public Health Interventions

This study characterized COVID-19 transmission in Ghana in 2020 and 2021 by estimating the time-varying reproduction number (Rt) and exploring its association with various public health interventions at the national and regional levels. Ghana experienced four pandemic waves, with epidemic peaks in July 2020 and January, August, and December 2021. The epidemic peak was the highest nationwide in December 2021 with Rt ≥ 2. Throughout 2020 and 2021, per-capita cumulative case count by region increased with population size. Mobility data suggested a negative correlation between Rt and staying home during the first 90 days of the pandemic. The relaxation of movement restrictions and religious gatherings was not associated with increased Rt in the regions with fewer case burdens. Rt decreased from > 1 when schools reopened in January 2021 to < 1 after vaccination rollout in March 2021. Findings indicated most public health interventions were associated with Rt reduction at the national and regional levels.

Compliance with COVID-19-preventive behaviours among employees returning to work in the post-epidemic period

Background

The COVID-19 pandemic has underscored the importance of behaviours such as social distancing in controlling pandemics. Currently, the epidemic is under control in China and production has resumed in various industries. This study investigates the behavioural compliance and related factors for COVID-19 prevention among employees returning to the workplace and provide strategic recommendations for improving individual-level preventive behaviour to prevent a new outbreak.

Methods

A cross-sectional study design was used. Data were gathered from returning employees in China using an online questionnaire survey, from March to May, 2020. The questionnaire covered participants’ COVID-19-related knowledge, compliance with recommended preventive behaviours, and levels of depression and anxiety. Univariate and multi-factor methods were used to analyse the data and identify factors influencing behaviour compliance.

Results

Of the 1300 participants completing the full survey, more than half were male (71.92%) and 61% were aged between 31 and 50 years. Six hundred and ninety-eight (53.7%) participants showed high compliance, while 602 (46.3%) showed low compliance. In models adjusted for demographic and socio-economic factors, high education level (odds ratio [OR] = 0.23, 95% confidence interval [CI]: 0.07–0.70), office staff (OR = 0.51, 95% CI: 0.33–0.78), higher knowledge of COVID-19 (OR = 0.74, 95% CI: 0.67–0.81), and quarantining (OR = 0.74, 95% CI: 0.57–0.96) predicted better compliance with preventive behaviours (P <  0.05), while high anxiety levels (OR = 1.55, 95% CI: 1.10–2.18) predicted lower compliance with preventive behaviours (P <  0.05).

Conclusion

For employees returning to work during the post-COVID-19-epidemic period, compliance with recommended preventive behaviours requires improvement. Consequently, comprehensive intervention measures, including the provision of health education and psychological counselling, as well as the continuance of a strict isolation policy, could enhance such compliance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12709-9.

Reviewing Health Security Capacities in Nigeria Using the Updated WHO Joint External Evaluation and WHO Benchmarks Tool: Experience from a Country-Led Self-Assessment Exercise

Across the world, the level of pandemic preparedness varies and no country is fully prepared to respond to all public health events. The International Health Regulations 2005 require state parties to develop core capacities to prevent, detect, and respond to public health events of international concern. In addition to annual self-assessment, these capacities are peer reviewed once every 5 years through the voluntary Joint External Evaluation (JEE). In this article, we share Nigeria's experience of conducting a country-led midterm self-assessment using a slightly modified application of the second edition of the World Health Organization (WHO) JEE and the new WHO benchmarks tool. Despite more stringent scoring criteria in the revised JEE tool, average scoring showed modest capacity improvements in 2019 compared with 2017. Of the 19 technical areas assessed, 11 improved, 5 did not change, and 3 had lower scores. No technical area attained the highest-level scoring of 5. Understanding the level of, and gaps in, pandemic preparedness enables state parties to develop plans to improve health security; the outcome of the assessment included the development of a 12-month operational plan. Countries need to intentionally invest in preparedness by using existing frameworks (eg, JEE) to better understand the status of their preparedness. This will ensure ownership of developed plans with shared responsibilities by all key stakeholders across all levels of government.

nSpatially refined time-varying reproduction numbers of SARS-CoV-2 in Arkansas and Kentucky and their relationship to population size and public health policy, March – November, 2020

Purpose

Methods

Results

Conclusions

Current State of COVID-19 Pandemic in Africa: Lessons for Today and the Future

This study is a cross-sectional, observational analysis of the COVID-19 pandemic in Africa, to understand the progression of the disease across the continent. Published data on COVID-19 from 20 January 2020 to 21 June 2021 were obtained and analyzed. Case fatality ratios, as well as case growth rates and other indices were computed. On 21 June 2021, a total of 178,210,532 confirmed cases and 3,865,978 deaths had been recorded worldwide. While the Americas recorded the highest number of cases, Southern Africa recorded the majority of African cases. Fatality rate since from 20 February 2020 to 21 June 2021 was highest in the Americas (2.63%) and low in the South Eastern Asia region (1.39%), globally increasing from 2.17% at the end of January to 6.36% in May 2020 and decreasing to a range between 2.14% to 2.30% since January 2021. In Africa, the infection rate per 100,000 persons was up to 3090.18, while deaths per 100,000 and case fatality ratio were as high as 119.64 and 5.72%, respectively, among the 20 most-affected countries. The testing rate per million population was highest in Botswana (512,547.08). Fatality appears to be increasing in some regions of Africa. The rate of infection and fatality in Africa could still likely take an upward turn. Strict control measures are required, considering the continent's weak healthcare systems.

Early reports of epidemiological parameters of the COVID-19 pandemic

Background

The emergence of a new pathogen requires a rapid assessment of its transmissibility, to inform appropriate public health interventions.

Methods

The peer-reviewed literature published between 1 January and 30 April 2020 on COVID-19 in PubMed was searched. Estimates of the incubation period, serial interval and reproduction number for COVID-19 were obtained and compared.

Results

A total of 86 studies met the inclusion criteria. Of these, 33 estimated the mean incubation period (4–7 days) and 15 included estimates of the serial interval (mean 4–8 days; median length 4–5 days). Fifty-two studies estimated the reproduction number. Although reproduction number estimates ranged from 0.3 to 14.8, in 33 studies (63%), they fell between 2 and 3.

Discussion

Studies calculating the incubation period and effective reproduction number were published from the beginning of the pandemic until the end of the study period (30 April 2020); however, most of the studies calculating the serial interval were published in April 2020. The calculated incubation period was similar over the study period and in different settings, whereas estimates of the serial interval and effective reproduction number were setting-specific. Estimates of the serial interval were shorter at the end of the study period as increasing evidence of pre-symptomatic transmission was documented and as jurisdictions enacted outbreak control measures. Estimates of the effective reproduction number varied with the setting and the underlying model assumptions. Early analysis of epidemic parameters provides vital information to inform the outbreak response.

Early Spatiotemporal Patterns and Population Characteristics of the COVID-19 Pandemic in Southeast Asia

This observational study aims to investigate the early disease patterns of coronavirus disease 2019 (COVID-19) in Southeast Asia, consequently providing historical experience for further interventions. Data were extracted from official websites of the WHO and health authorities of relevant countries. A total of 1346 confirmed cases of COVID-19, with 217 recoveries and 18 deaths, were reported in Southeast Asia as of 16 March 2020. The basic reproductive number (R0) of COVID-19 in the region was estimated as 2.51 (95% CI:2.31 to 2.73), and there were significant geographical variations at the subregional level. Early transmission dynamics were examined with an exponential regression model: y = 0.30e0.13x (p < 0.01, R2 = 0.96), which could help predict short-term incidence. Country-level disease burden was positively correlated with Human Development Index (r = 0.86, p < 0.01). A potential early shift in spatial diffusion patterns and a spatiotemporal cluster occurring in Malaysia and Singapore were detected. Demographic analyses of 925 confirmed cases indicated a median age of 44 years and a sex ratio (male/female) of 1.25. Age may play a significant role in both susceptibilities and outcomes. The COVID-19 situation in Southeast Asia is challenging and unevenly geographically distributed. Hence, enhanced real-time surveillance and more efficient resource allocation are urgently needed.

Estimation of novel coronavirus (COVID-19) reproduction number and case fatality rate: A systematic review and meta-analysis

BACKGROUND AND AIMS

Realizing the transmission potential and the magnitude of the coronavirus disease 2019 (COVID-19) aids public health monitoring, strategies, and preparation. Two fundamental parameters, the basic reproduction number (R 0) and case fatality rate (CFR) of COVID-19, help in this understanding process. The objective of this study was to estimate the R 0 and CFR of COVID-19 and assess whether the parameters vary in different regions of the world.

METHODS

We carried out a systematic review to find the reported estimates of the R 0 and the CFR in articles from international databases between January 1 and August 31, 2020. Random-effect models and Forest plots were implemented to evaluate the mean effect size of R 0 and the CFR. Furthermore, R 0 and CFR of the studies were quantified based on geographic location, the tests/thousand population, and the median population age of the countries where the studies were conducted. To assess statistical heterogeneity among the selected articles, the I 2 statistic and the Cochran's Q test were used.

RESULTS

Forty-five studies involving R 0 and 34 studies involving CFR were included. The pooled estimation of R 0 was 2.69 (95% CI: 2.40, 2.98), and that of the CFR was 2.67 (2.25, 3.13). The CFR in different regions of the world varied significantly, from 2.49 (2.08, 2.94) in Asia to 3.40 (2.81, 4.04) in North America. We observed higher mean CFR values for the countries with lower tests (3.15 vs 2.16) and greater median population age (3.13 vs 2.27). However, R 0 did not vary significantly in different regions of the world.

CONCLUSIONS

An R 0 of 2.69 and a CFR of 2.67 indicate the severity of the COVID-19. Although R 0 and CFR may vary over time, space, and demographics, we recommend considering these figures in control and prevention measures.

The COVID-19 pandemic: Stay Home policy and exposure to risks of infection among Nigerians

The global threat which continues to accompany SARS-CoV-2 has led to a global response which adopts lockdown and stays home policy as means of curtailing its spread. This study investigates compliance with the Stay Home policy and exposure to COVID-19 in Nigeria. A survey was conducted from April 4 to May 8, 2020 using a cross-sectional mixed-methods approach to elicit responses from 879 participants across six geopolitical zones of Nigeria. Descriptive, χ 2, and multiple regression tests were used to analyze survey data using SPSS, whereas NVivo v12 was used for thematic analysis of qualitative data. States with complete lockdown had 72.4% of respondents complying fully with the policy compared with 44.2% of respondents in zones with the partial lockdown. Market places, classified as high-risk zones, were the most visited (n = 505; 71.0%). Though compliance was influenced by the nature of lockdown enforced (χ 2 = 70.385, df = 2; p < 0.05), being a female, a widow, and unemployed were associated with increased compliance. Exposure to COVID-19 was associated with being married, unemployed, and having no income. Fear, anxiety, and misperception play major roles in compliance. The authors conclude that compliance is not uniform and a more nuanced and targeted approach is required as the government continues to respond to the COVID-19 global pandemic.

Dynamic and features of SARS-CoV-2 infection in Gabon

In a context where SARS-CoV-2 population-wide testing is implemented, clinical features and antibody response in those infected have never been documented in Africa. Yet, the information provided by analyzing data from population-wide testing is critical to understand the infection dynamics and devise control strategies. We described clinical features and assessed antibody response in people screened for SARS-CoV-2 infection. We analyzed data from a cohort of 3464 people that we molecularly screened for SARS-CoV-2 infection in our routine activity. We recorded people SARS-CoV-2 diagnosis, age, gender, blood types, white blood cells (WBC), symptoms, chronic disease status and time to SARS-CoV-2 RT-PCR conversion from positive to negative. We calculated the age-based distribution of SARS-CoV-2 infection, analyzed the proportion and the spectrum of COVID-19 severity. Furthermore, in a nested sub-study, we screened 83 COVID-19 patients and 319 contact-cases for anti-SARS-CoV-2 antibodies. Males and females accounted for respectively 51% and 49% of people screened. The studied population median and mean age were both 39 years. 592 out of 3464 people (17.2%) were diagnosed with SARS-CoV-2 infection with males and females representing, respectively, 53% and 47%. The median and mean ages of SARS-CoV-2 infected subjects were 37 and 38 years respectively. The lowest rate of infection (8%) was observed in the elderly (aged > 60). The rate of SARS-Cov-2 infection in both young (18–35 years old) and middle-aged adults (36–60 years old) was around 20%. The analysis of SARS-CoV-2 infection age distribution showed that middle-aged adults accounted for 54.7% of SARS-CoV-2 positive persons, followed respectively by young adults (33.7%), children (7.7%) and elderly (3.8%). 68% (N = 402) of SARS-CoV-2 infected persons were asymptomatic, 26.3% (N = 156) had influenza-like symptoms, 2.7% (N = 16) had influenza-like symptoms associated with anosmia and ageusia, 2% (N = 11) had dyspnea and 1% (N = 7) had respiratory failure, which resulted in death. Data also showed that 12% of SARS-CoV-2 infected subjects, had chronic diseases. Hypertension, diabetes, and asthma were the top concurrent chronic diseases representing respectively 58%, 25% and 12% of recorded chronic diseases. Half of SARS-CoV-2 RT-PCR positive patients were cured within 14 days following the initiation of the anti-COVID-19 treatment protocol. 78.3% of COVID-19 patients and 55% of SARS-CoV-2 RT-PCR confirmed negative contact-cases were positive for anti-SARS-CoV-2 antibodies. Patients with severe-to-critical illness have higher leukocytes, higher neutrophils and lower lymphocyte counts contrarily to asymptomatic patients and patients with mild-to-moderate illness. Neutrophilic leukopenia was more prevalent in asymptomatic patients and patients with mild-to-moderate disease for 4 weeks after diagnosis (27.1–42.1%). In Patients with severe-to-critical illness, neutrophilic leukocytosis or neutrophilia (35.6–50%) and lymphocytopenia (20–40%) were more frequent. More than 60% of participants were blood type O. It is also important to note that infection rate was slightly higher among A and B blood types compared with type O. In this African setting, young and middle-aged adults are most likely driving community transmission of COVID-19. The rate of critical disease is relatively low. The high rate of anti-SARS-CoV-2 antibodies observed in SARS-CoV-2 RT-PCR negative contact cases suggests that subclinical infection may have been overlooked in our setting.

Time-varying Reproduction Numbers of COVID-19 in Georgia, USA, March 2, 2020 to November 20, 2020

BACKGROUND

In 2020, Severe Acute Respiratory Syndrome Coronavirus 2 impacted Georgia, USA. Georgia announced a state-wide shelter-in-place on April 2 and partially lifted restrictions on April 27. We estimated the time-varying reproduction numbers (Rt) of COVID-19 in Georgia, Metro Atlanta, and Dougherty County and environs from March 2, 2020, to November 20, 2020.

METHODS

We analyzed the daily incidence of confirmed COVID-19 cases in Georgia, Metro Atlanta, and Dougherty County and its surrounding counties, and estimated Rt using the R package EpiEstim. We used a 9-day correction for the date of report to analyze the data by assumed date of infection.

RESULTS

The median Rt estimate in Georgia dropped from between 2 and 4 in mid-March to < 2 in late March to around 1 from mid-April to November. Regarding Metro Atlanta, Rt fluctuated above 1.5 in March and around 1 since April. In Dougherty County, the median Rt declined from around 2 in late March to 0.32 on April 26. Then, Rt fluctuated around 1 in May through November. Counties surrounding Dougherty County registered an increase in Rt estimates days after a superspreading event occurred in the area.

CONCLUSIONS

In Spring 2020, Severe Acute Respiratory Syndrome Coronavirus 2 transmission in Georgia declined likely because of social distancing measures. However, because restrictions were relaxed in late April and elections were conducted in November, community transmission continued, with Rt fluctuating around 1 across Georgia, Metro Atlanta, and Dougherty County as of November 2020. The superspreading event in Dougherty County affected surrounding areas, indicating the possibility of local transmission in neighboring counties.

Modeling the Dynamics of COVID-19 in Nigeria

To understand the dynamics of COVID-19 in Nigeria, a mathematical model which incorporates the key compartments and parameters regarding COVID-19 in Nigeria is formulated. The basic reproduction number is obtained which is then used to analyze the stability of the disease-free equilibrium solution of the model. The model is calibrated using data obtained from Nigeria Centre for Disease Control and key parameters of the model are estimated. Sensitivity analysis is carried out to investigate the influence of the parameters in curtailing the disease. Using Pontryagin’s maximum principle, time-dependent intervention strategies are optimized in order to suppress the transmission of the virus. Numerical simulations are then used to explore various optimal control solutions involving single and multiple controls. Our results suggest that strict intervention effort is required for quick suppression of the disease.

Network dynamic model of epidemic transmission introducing a heterogeneous control factor

The COVID-19 epidemic is not only a medical issue but also a sophisticated social problem. We propose a network dynamics model of epidemic transmission introducing a heterogeneous control factor. The proposed model applied the classical susceptible- exposed-infectious-recovered model to the network based on effective distance and was modified by introducing a heterogeneous control factor with temporal and spatial characteristics. International aviation data were approximately used to estimate the flux fraction matrix, and the effective distance was calculated. Through parameter estimation and simulation, the theoretical values of the modified model fit well with practical values. By adjusting the parameters and observing the change of the results, we found that the modified model is more in line with the actual needs and has higher credibility in the comprehensive analysis. The assessment shows that the number of confirmed cases worldwide will reach about 20 million optimistically. In severe cases, the peak value will exceed 80 million, and the late stage of the epidemic shows a long tail shape, lasting more than one and a half years. The effective way to control the global epidemic is to strengthen international cooperation and to impose international travel restrictions and other measures.

SARS-CoV-2 Transmission in Alberta, British Columbia, and Ontario, Canada, December 25, 2019, to December 1, 2020

OBJECTIVE

This study aimed to investigate coronavirus disease (COVID-19) epidemiology in Alberta, British Columbia, and Ontario, Canada.

METHODS

Using data through December 1, 2020, we estimated time-varying reproduction number, Rt, using EpiEstim package in R, and calculated incidence rate ratios (IRR) across the 3 provinces.

RESULTS

In Ontario, 76% (92 745/121 745) of cases were in Toronto, Peel, York, Ottawa, and Durham; in Alberta, 82% (49 878/61 169) in Calgary and Edmonton; in British Columbia, 90% (31 142/34 699) in Fraser and Vancouver Coastal. Across 3 provinces, Rt dropped to ≤ 1 after April. In Ontario, Rt would remain < 1 in April if congregate-setting-associated cases were excluded. Over summer, Rt maintained < 1 in Ontario, ~1 in British Columbia, and ~1 in Alberta, except early July when Rt was > 1. In all 3 provinces, Rt was > 1, reflecting surges in case count from September through November. Compared with British Columbia (684.2 cases per 100 000), Alberta (IRR = 2.0; 1399.3 cases per 100 000) and Ontario (IRR = 1.2; 835.8 cases per 100 000) had a higher cumulative case count per 100 000 population.

CONCLUSIONS

Alberta and Ontario had a higher incidence rate than British Columbia, but Rt trajectories were similar across all 3 provinces.

A REVIEW ON EMERGING PATHOGENESIS OF COVID-19 AND POINTS OF CONCERN FOR RESEARCH COMMUNITIES IN NIGERIA

BACKGROUND

COVID-19 remains an emerging pandemic that continuously poses an alarming threat and challenge to economic, social and well-being of the people throughout the world. It also remains an evolving disease which complete pathogenesis that translates into clinical features is only just emerging by each second of the day. There have been observations about the emerging trends of the disease in Nigeria like in any other country in the world where there is outbreak. This study examined from evidence-based literature the emerging pathogenesis of COVID-19 and important points of concern of the disease in Nigeria.

MATERIALS AND METHODS

The paper reviewed published articles in PubMed and Google Scholar using search terms 'COVID-19" and "SARS-CoV-2", as well as searched for general COVID-19 information on internet.

RESULTS

The result summarized literature on emerging pathogenesis of COVID-19 and important points of concern as well as research questions as to the peculiar trends of the disease in Nigeria.

CONCLUSION

Pathogenesis of COVID-19 remains an emerging knowledge and there are many important research questions that need to be scientifically answered for a successful containment of COVID-19 in Nigeria. It is recommended that all members of intellectual research communities should join the fight against COVID-19 pandemic.

Change in outbreak epicentre and its impact on the importation risks of COVID-19 progression: A modelling study

BACKGROUND

The outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first detected in the city of Wuhan, China has now spread to every inhabitable continent, but now the attention has shifted from China to other epicentres. This study explored early assessment of the influence of spatial proximities and travel patterns from Italy on the further spread of SARS-CoV-2 worldwide.

METHODS

Using data on the number of confirmed cases of COVID-19 and air travel data between countries, we applied a stochastic meta-population model to estimate the global spread of COVID-19. Pearson's correlation, semi-variogram, and Moran's Index were used to examine the association and spatial autocorrelation between the number of COVID-19 cases and travel influx (and arrival time) from the source country.

RESULTS

We found significant negative association between disease arrival time and number of cases imported from Italy (r = -0.43, p = 0.004) and significant positive association between the number of COVID-19 cases and daily travel influx from Italy (r = 0.39, p = 0.011). Using bivariate Moran's Index analysis, we found evidence of spatial interaction between COVID-19 cases and travel influx (Moran's I = 0.340). Asia-Pacific region is at higher/extreme risk of disease importation from the Chinese epicentre, whereas the rest of Europe, South-America and Africa are more at risk from the Italian epicentre.

CONCLUSION

We showed that as the epicentre changes, the dynamics of SARS-CoV-2 spread change to reflect spatial proximities.

Change in outbreak epicentre and its impact on the importation risks of COVID-19 progression: A modelling study

Background

The outbreak of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) that was first detected in the city of Wuhan, China has now spread to every inhabitable continent, but now the attention has shifted from China to other epicentres. This study explored early assessment of the influence of spatial proximities and travel patterns from Italy on the further spread of SARS-CoV-2 worldwide.

Methods

Using data on the number of confirmed cases of COVID-19 and air travel data between countries, we applied a stochastic meta-population model to estimate the global spread of COVID-19. Pearson's correlation, semi-variogram, and Moran's Index were used to examine the association and spatial autocorrelation between the number of COVID-19 cases and travel influx (and arrival time) from the source country.

Results

We found significant negative association between disease arrival time and number of cases imported from Italy (r = −0.43, p = 0.004) and significant positive association between the number of COVID-19 cases and daily travel influx from Italy (r = 0.39, p = 0.011). Using bivariate Moran's Index analysis, we found evidence of spatial interaction between COVID-19 cases and travel influx (Moran's I = 0.340). Asia-Pacific region is at higher/extreme risk of disease importation from the Chinese epicentre, whereas the rest of Europe, South-America and Africa are more at risk from the Italian epicentre.

Conclusion

We showed that as the epicentre changes, the dynamics of SARS-CoV-2 spread change to reflect spatial proximities.

A mathematical model of Coronavirus Disease (COVID-19) containing asymptomatic and symptomatic classes

The research work in this paper attempts to describe the outbreak of Coronavirus Disease 2019 (COVID-19) with the help of a mathematical model using both the Ordinary Differential Equation (ODE) and Fractional Differential Equation. The spread of the disease has been on the increase across the globe for some time with no end in sight. The research used the data of COVID-19 cases in Nigeria for the numerical simulation which has been fitted to the model. We brought in the consideration of both asymptomatic and symptomatic infected individuals with the fact that an exposed individual is either sent to quarantine first or move to one of the infected classes with the possibility that susceptible individual can also move to quarantined class directly. It was found that the proposed model has two equilibrium points; the disease-free equilibrium point ( DFE ) and the endemic equilibrium point ( E 1 ) . Stability analysis of the equilibrium points shows ( E 0 ) is locally asymptotically stable whenever the basic reproduction number,R 0 < 1 and ( E 1 ) is globally asymptotically stable wheneverR 0 > 1 . Sensitivity analysis of the parameters in theR 0 was conducted and the profile of each state variable was also depicted using the fitted values of the parameters showing the spread of the disease. The most sensitive parameters in theR 0 are the contact rate between susceptible individuals and the rate of transfer of individuals from exposed class to symptomatically infected class. Moreover, the basic reproduction number for the data is calculated asR 0 ≈ 1.7031 . Existence and uniqueness of solution established via the technique of fixed point theorem. Also, using the least square curve fitting method together with the fminsearch function in the MATLAB optimization toolbox, we obtain the best values for some of the unknown biological parameters involved in the proposed model. Furthermore, we solved the fractional model numerically using the Atangana-Toufik numerical scheme and presenting different forms of graphical results that can be useful in minimizing the infection.

Coronavirus (COVID-19) in Nigeria: Survival rate

The novel coronavirus is a new disease threatening the population size and economic activities across the world. Due to the poverty rate in Africa, as well as poor access to quality health care, inadequate medical staff and poor technology, Africa has been predicted to be one of the most severely affected continents in the world by COVID-19. The objective of this study was to examine the survival rate of COVID-19 patients in Nigeria using the Autoregressive Integrated Moving Average (ARIMA) forecasting approach. The source of the data used for this study was the secondary data obtained from the daily publication/report of the Nigeria Centre for Disease Control (NCDC) from 28th February 2020 to 30th June 2020. The mean daily survival rate of COVID-19 patients was found to be 27.5% with a median survival rate of 25.4% which is below 50%. Also, the ARIMA (0, 1, 1) was identified to be appropriate for predicting the survival rate of COVID-19 patients in Nigeria within the observed period. Further findings showed that little variation exists between the predicted and actual survival rate of COVID19 for June 2020 which indicates that the obtained ARIMA model (0, 1, 1) was adequate for the estimation of the survival rate of COVID-19 in Nigeria. Based on the findings of the study, the need for the Nigerian government to explore effective treatment strategies both internationally and locally to improve the survival rate of patients with the disease was strongly recommended. Also, the need for the government to encourage local manufacturing of Personal Protective Equipment (PPE) such as garment, which is expected to help health workers effectively manage affected persons without being infected at the front line was recommended.

Epidemic Spread and Its Management Through Governance and Leadership Response Influencing the Arising Challenges Around COVID-19 in Pakistan-A Lesson Learnt for Low Income Countries With Limited Resource

The coronavirus disease (COVID-19) was first reported in China (Wuhan) at the end of 2019. It has rapidly spread over 216 countries, including the USA, UK, Europe, Russia, and many Asian countries. It has affected more than 4.5 million people, and around 0.3 million deaths have been reported globally. Many preventive measures have been adopted worldwide to mitigate its spread. The government of Pakistan has also taken many preventive measures to combat the COVID-19 outbreak, such as rapid response by governance, continuous monitoring of the pandemic spread in the affected areas, and integration of resources from multiple sectors, including health, education, defense, and media. According to global statistics, the number of COVID-19 cases in the country remained remarkably lower than the expected number for the first 169 days, as compared to other countries. A total of 286,674 confirmed cases, including 16,475 active, 6,139 deaths, and 264,060 (92%) recoveries were reported. The study finds that strict adherence to national policies, effective governance, and unity at the national level resulted in better outcomes. Hence, the preventive measures, rapid responses, and strategies adopted for combating the challenges could be adopted as a learning tool for other countries having similar work environments and financial constraints. This paper can help and guide governance/public actions in response to the possible rebound of coronavirus this fall/winter.

Quarantine and the risk of COVID-19 importation

Using a stochastic model, we assess the risk of importation-induced local transmission chains in locations seeing few or no local transmissions and evaluate the role of quarantine in the mitigation of this risk. We find that the rate of importations plays a critical role in determining the risk that case importations lead to local transmission chains, more so than local transmission characteristics, i.e. strength of social distancing measures (NPI). The latter influences the severity of the outbreaks when they do take place. Quarantine after arrival in a location is an efficacious way to reduce the rate of importations. Locations that see no or low-level local transmission should ensure that the rate of importations remains low. A high level of compliance with post-arrival quarantine followed by testing achieves this objective with less of an impact than travel restrictions or bans.

Flattening the Risk: Pre-Exposure Prophylaxis for COVID-19

To date, more than 35 million people worldwide have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent of coronavirus disease 2019 (COVID-19), and more than one million have died in the COVID-19 pandemic. International economies are stalled and social isolation based on palpable fear of death remains the order of the day. The United States and other countries are moving toward resuming work activities and social interaction to boost economic recovery. While this makes financial sense, from a medical perspective our population has already suffered and will continue to suffer severe losses in the absence of a viable aggressive prophylaxis strategy for SARS-CoV-2. Herein, we present a plan to address this problem.

Enhancing Knowledge in Informal Settlements: Assessing Health Beliefs and Behaviors in Nigeria: A cross-sectional survey assessment of perceptions, practices, and resources in underserved urban communities in Lagos

Background

Community Health Education (CHE) programs have been shown to be effective in relieving the burden on healthcare systems in Sub-Saharan Africa.

Objective

This project aimed to determine the baseline level of health literacy, behavioral practices, and accessibility to resources in a set of 16 informal settlements located around Lagos, Nigeria in order to identify topics that should be emphasized in a new teaching curriculum directed at local Community Health Educators.

Methods

In June of 2017, a unique cross-sectional survey composed of 37 questions was conducted in informal settlements around Lagos. Sites selected were areas in which future CHE trainings were planned to take place and survey participants were chosen by trained community health educators based on convenience sampling with snowball effect. Survey questions included both multiple-choice and open-ended questions and were asked in the local language. We collected demographic information and assessed health literacy, health behaviors, and community practices. Results were analyzed using descriptive statistics to assess for differences between demographic groups.

Findings

Our survey collected 348 total responses. Respondents displayed a high level of knowledge regarding the benefits of hand washing (97.1%) and childhood immunizations (81.0%). Knowledge around infectious diseases and reproductive health was lower, including a large proportion of people (50%) incorrectly indicating that HIV could be spread through a mosquito bite. Malaria was reported to be the most prevalent disease affecting both adults (40.0%) and children (58.3%). Health access was limited, with most people not reporting access to a nearby health center (55.8%).

Conclusions

Areas of knowledge that should be emphasized in future versions of CHE training curricula include infectious diseases, reproductive health, and reinforcement of the importance of sanitation and clean water. The curriculum should address the reality of limited health access and develop strategies to improve this.

Estimation of the case fatality rate of COVID-19 epidemiological data in Nigeria using statistical regression analysis

Following the emergence of COVID-19 outbreak, numbers of studies have been conducted to curtail the global spread of the virus by identifying epidemiological changes of the disease through developing statistical models, estimation of the basic reproduction number, displaying the daily reports of confirmed and deaths cases, which are closely related to the present study. Reliable and comprehensive estimation method of the epidemiological data is required to understand the actual situation of fatalities caused by the epidemic. Case fatality rate (CFR) is one of the cardinal epidemiological parameters that adequately explains epidemiology of the outbreak of a disease. In the present study, we employed two statistical regression models such as the linear and polynomial models in order to estimate the CFR, based on the early phase of COVID-19 outbreak in Nigeria (44 days since first reported COVID-19 death). The estimate of the CFR was determined based on cumulative number of confirmed cases and deaths reported from 23 March to 30 April, 2020. The results from the linear model estimated that the CFR was 3.11% (95% CI: 2.59% - 3.80%) with R ² value of 90% and p-value of < 0.0001. The findings from the polynomial model suggest that the CFR associated with the Nigerian outbreak is 3.0% and may range from 2.23% to 3.42% with R ² value of 93% and p-value of <0.0001. Therefore, the polynomial regression model with the higher R ² value fits the dataset well and provides better estimate of CFR for the reported COVID-19 cases in Nigeria.

COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

BACKGROUND

The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases.

METHODS

We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis.

FINDINGS

High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model.

INTERPRETATION

Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.

Is Nigeria really on top of COVID-19? Message from effective reproduction number

Following the importation of coronavirus disease (COVID-19) into Nigeria on 27 February 2020 and then the outbreak, the question is: How do we anticipate the progression of the ongoing epidemic following all the intervention measures put in place? This kind of question is appropriate for public health responses and it will depend on the early estimates of the key epidemiological parameters of the virus in a defined population.In this study, we combined a likelihood-based method using a Bayesian framework and compartmental model of the epidemic of COVID-19 in Nigeria to estimate the effective reproduction number (R(t)) and basic reproduction number (R0) - this also enables us to estimate the initial daily transmission rate (β0). We further estimate the reported fraction of symptomatic cases. The models are applied to the NCDC data on COVID-19 symptomatic and death cases from 27 February 2020 and 7 May 2020.In this period, the effective reproduction number is estimated with a minimum value of 0.18 and a maximum value of 2.29. Most importantly, the R(t) is strictly greater than one from 13 April till 7 May 2020. The R0 is estimated to be 2.42 with credible interval: (2.37-2.47). Comparing this with the R(t) shows that control measures are working but not effective enough to keep R(t) below 1. Also, the estimated fraction of reported symptomatic cases is between 10 and 50%.Our analysis has shown evidence that the existing control measures are not enough to end the epidemic and more stringent measures are needed.

Correlation between Preventive Health Behaviors and Psycho-Social Health Based on the Leisure Activities of South Koreans in the COVID-19 Crisis

COVID-19 has caused unprecedented damage worldwide, and quarantine and lockdown measures have been undertaken globally. This study focused on the differences in preventive behaviors and psycho-social health of South Koreans, as people continue engaging in leisure activities under self-regulation without a lockdown measure imposed by the government. For the sample, the frame of the “2018 Population and Housing Census” in South Korea was applied, and data from 1770 people were analyzed. The results showed that the groups participating in culture and arts and social activities displayed characteristics with high prevention. Additionally, the groups that continued leisure activities for more than five years and with family showed high preventive behaviors. Meanwhile, participation in leisure activities with friends of the opposite sex lowered preventive behavior. In terms of psycho-social health, all groups were affiliated to the potential stress group and there were no differences in the period and participation time for leisure activities. Furthermore, the group participating in leisure activities with their school and group experienced psychological stability. When lockdown measures are eased, the aforementioned characteristics should be considered to design government policy; they can also be used as a reference for public health in case of a future outbreak of an epidemic.