1
|
Zhang F, Karamagi H, Nsenga N, Nanyunja M, Karinja M, Amanfo S, Chase-Topping M, Calder-Gerver G, McGibbon M, Huber A, Wagner-Gamble T, Guo CG, Haynes S, Morrison A, Ferguson M, Awandare GA, Mutapi F, Yoti Z, Cabore J, Moeti MR, Woolhouse MEJ. Predictors of COVID-19 epidemics in countries of the World Health Organization African Region. Nat Med 2021; 27:2041-2047. [PMID: 34480125 PMCID: PMC8604723 DOI: 10.1038/s41591-021-01491-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
Countries of the World Health Organization (WHO) African Region have experienced a wide range of coronavirus disease 2019 (COVID-19) epidemics. This study aimed to identify predictors of the timing of the first COVID-19 case and the per capita mortality in WHO African Region countries during the first and second pandemic waves and to test for associations with the preparedness of health systems and government pandemic responses. Using a region-wide, country-based observational study, we found that the first case was detected earlier in countries with more urban populations, higher international connectivity and greater COVID-19 test capacity but later in island nations. Predictors of a high first wave per capita mortality rate included a more urban population, higher pre-pandemic international connectivity and a higher prevalence of HIV. Countries rated as better prepared and having more resilient health systems were worst affected by the disease, the imposition of restrictions or both, making any benefit of more stringent countermeasures difficult to detect. Predictors for the second wave were similar to the first. Second wave per capita mortality could be predicted from that of the first wave. The COVID-19 pandemic highlights unanticipated vulnerabilities to infectious disease in Africa that should be taken into account in future pandemic preparedness planning.
Collapse
Affiliation(s)
- Feifei Zhang
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom.
| | | | - Ngoy Nsenga
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Miriam Nanyunja
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Miriam Karinja
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Seth Amanfo
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Margo Chase-Topping
- School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Miles McGibbon
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alexandra Huber
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Chuan-Guo Guo
- Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Samuel Haynes
- School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Miranda Ferguson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gordon A Awandare
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra, Ghana
| | - Francisca Mutapi
- School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Zabulon Yoti
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | - Joseph Cabore
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | | | | |
Collapse
|
2
|
Calder-Gerver G, Mazeri S, Haynes S, Simonet C, Woolhouse M, Brown H. Real-time monitoring of COVID-19 in Scotland. J R Coll Physicians Edinb 2021; 51:S20-S25. [PMID: 34185034 DOI: 10.4997/jrcpe.2021.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To manage the public health risk posed by COVID-19 and assess the impact of interventions, policymakers must be able to closely monitor the epidemic's trajectory. METHODS Here we present a simple methodology based on basic surveillance metrics for monitoring the spread of COVID-19 and its burden on health services in Scotland. RESULTS We examine how the dynamics of the epidemic have changed over time and assess the similarities and differences between metrics. DISCUSSION We illustrate how our method has been used throughout the epidemic in Scotland, explore potential biases and conclude that our method has proven to be an effective tool for monitoring the epidemic's trajectory.
Collapse
Affiliation(s)
- Giles Calder-Gerver
- The Usher Institute, College of Medicine and Veterinary Medicine, Ashworth 1, Charlotte Auerbach Road, University of Edinburgh Edinburgh EH9 3FL, UK,
| | - Stella Mazeri
- The Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - Samuel Haynes
- Institute of Cell Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Camille Simonet
- Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Mark Woolhouse
- The Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Helen Brown
- The Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
3
|
van Bunnik BAD, Morgan ALK, Bessell PR, Calder-Gerver G, Zhang F, Haynes S, Ashworth J, Zhao S, Cave RNR, Perry MR, Lepper HC, Lu L, Kellam P, Sheikh A, Medley GF, Woolhouse MEJ. Segmentation and shielding of the most vulnerable members of the population as elements of an exit strategy from COVID-19 lockdown. Philos Trans R Soc Lond B Biol Sci 2021. [PMID: 34053266 DOI: 10.1101/2020.05.04.20090597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
This study demonstrates that an adoption of a segmenting and shielding strategy could increase the scope to partially exit COVID-19 lockdown while limiting the risk of an overwhelming second wave of infection. We illustrate this using a mathematical model that segments the vulnerable population and their closest contacts, the 'shielders'. Effects of extending the duration of lockdown and faster or slower transition to post-lockdown conditions and, most importantly, the trade-off between increased protection of the vulnerable segment and fewer restrictions on the general population are explored. Our study shows that the most important determinants of outcome are: (i) post-lockdown transmission rates within the general and between the general and vulnerable segments; (ii) fractions of the population in the vulnerable and shielder segments; (iii) adherence to protective measures; and (iv) build-up of population immunity. Additionally, we found that effective measures in the shielder segment, e.g. intensive routine screening, allow further relaxations in the general population. We find that the outcome of any future policy is strongly influenced by the contact matrix between segments and the relationships between physical distancing measures and transmission rates. This strategy has potential applications for any infectious disease for which there are defined proportions of the population who cannot be treated or who are at risk of severe outcomes. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'.
Collapse
Affiliation(s)
- Bram A D van Bunnik
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Alex L K Morgan
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul R Bessell
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | | | - Feifei Zhang
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Samuel Haynes
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Meghan R Perry
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, UK
| | | | - Lu Lu
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Paul Kellam
- Department of Medicine, Division of Infectious Diseases, Imperial College London, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark E J Woolhouse
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
4
|
van Bunnik BAD, Morgan ALK, Bessell PR, Calder-Gerver G, Zhang F, Haynes S, Ashworth J, Zhao S, Cave RNR, Perry MR, Lepper HC, Lu L, Kellam P, Sheikh A, Medley GF, Woolhouse MEJ. Segmentation and shielding of the most vulnerable members of the population as elements of an exit strategy from COVID-19 lockdown. Philos Trans R Soc Lond B Biol Sci 2021; 376:20200275. [PMID: 34053266 PMCID: PMC8165590 DOI: 10.1098/rstb.2020.0275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This study demonstrates that an adoption of a segmenting and shielding strategy could increase the scope to partially exit COVID-19 lockdown while limiting the risk of an overwhelming second wave of infection. We illustrate this using a mathematical model that segments the vulnerable population and their closest contacts, the ‘shielders’. Effects of extending the duration of lockdown and faster or slower transition to post-lockdown conditions and, most importantly, the trade-off between increased protection of the vulnerable segment and fewer restrictions on the general population are explored. Our study shows that the most important determinants of outcome are: (i) post-lockdown transmission rates within the general and between the general and vulnerable segments; (ii) fractions of the population in the vulnerable and shielder segments; (iii) adherence to protective measures; and (iv) build-up of population immunity. Additionally, we found that effective measures in the shielder segment, e.g. intensive routine screening, allow further relaxations in the general population. We find that the outcome of any future policy is strongly influenced by the contact matrix between segments and the relationships between physical distancing measures and transmission rates. This strategy has potential applications for any infectious disease for which there are defined proportions of the population who cannot be treated or who are at risk of severe outcomes. This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.
Collapse
Affiliation(s)
- Bram A D van Bunnik
- Usher Institute, University of Edinburgh, Edinburgh, UK.,School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Alex L K Morgan
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul R Bessell
- The Roslin Institute, University of Edinburgh, Edinburgh, UK
| | | | - Feifei Zhang
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Samuel Haynes
- School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Meghan R Perry
- Clinical Infection Research Group, Regional Infectious Diseases Unit, Western General Hospital, UK
| | | | - Lu Lu
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Paul Kellam
- Department of Medicine, Division of Infectious Diseases, Imperial College London, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark E J Woolhouse
- Usher Institute, University of Edinburgh, Edinburgh, UK.,School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|