Estimation of #exponential #growth rate and basic reproduction number of the #coronavirus disease 2019 (#COVID19) in #Africa (Infect Dis Pov., abstract)

[Source: Infectious Diseases of Poverty, full page: (LINK). Abstract, edited.]

Estimation of exponential growth rate and basic reproduction number of the coronavirus disease 2019 (COVID-19) in Africa

Salihu S. Musa, Shi Zhao, Maggie H. Wang, Abdurrazaq G. Habib, Umar T. Mustapha & Daihai He

Infectious Diseases of Poverty volume 9, Article number: 96 (2020)

 

Abstract

Background

Since the first case of coronavirus disease 2019 (COVID-19) in Africa was detected on February 14, 2020, the cumulative confirmations reached 15 207 including 831 deaths by April 13, 2020. Africa has been described as one of the most vulnerable region with the COVID-19 infection during the initial phase of the outbreak, due to the fact that Africa is a great commercial partner of China and some other EU and American countries. Which result in large volume of travels by traders to the region more frequently and causing African countries face even bigger health threat during the COVID-19 pandemic. Furthermore, the fact that the control and management of COVID-19 pandemic rely heavily on a country’s health care system, and on average Africa has poor health care system which make it more vulnerable indicating a need for timely intervention to curtail the spread. In this paper, we estimate the exponential growth rate and basic reproduction number (R0) of COVID-19 in Africa to show the potential of the virus to spread, and reveal the importance of sustaining stringent health measures to control the disease in Africa.

Methods

We analyzed the initial phase of the epidemic of COVID-19 in Africa between 1 March and 13 April 2020, by using the simple exponential growth model. We examined the publicly available materials published by the WHO situation report to show the potential of COVID-19 to spread without sustaining strict health measures. The Poisson likelihood framework is adopted for data fitting and parameter estimation. We modelled the distribution of COVID-19 generation interval (GI) as Gamma distributions with a mean of 4.7 days and standard deviation of 2.9 days estimated from previous work, and compute the basic reproduction number.

Results

We estimated the exponential growth rate as 0.22 per day (95% CI: 0.20–0.24), and the basic reproduction number, R0, as 2.37 (95% CI: 2.22–2.51) based on the assumption that the exponential growth starting from 1 March 2020. With an R0 at 2.37, we quantified the instantaneous transmissibility of the outbreak by the time-varying effective reproductive number to show the potential of COVID-19 to spread across African region.

Conclusions

The initial growth of COVID-19 cases in Africa was rapid and showed large variations across countries. Our estimates should be useful in preparedness planning against further spread of the COVID-19 epidemic in Africa.

Keywords: SARS-CoV-2; COVID-19; Africa; Epidemiology.

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Routine #childhood #immunisation during the #COVID19 pandemic in #Africa: a benefit–risk analysis of health benefits versus excess risk of #SARS-CoV-2 infection (Lancet Glob Health, abstract)

[Source: Lancet Global Health, full page: (LINK). Abstract, edited.]

Routine childhood immunisation during the COVID-19 pandemic in Africa: a benefit–risk analysis of health benefits versus excess risk of SARS-CoV-2 infection

Kaja Abbas, PhD  *, Simon R Procter, DPhil *, Kevin van Zandvoort, MSc, Andrew Clark, PhD, Sebastian Funk, PhD, Tewodaj Mengistu, PhD, Dan Hogan, PhD, Emily Dansereau, PhD, Prof Mark Jit, PhD, Stefan Flasche, PhD, LSHTM CMMID COVID-19 Working Group †

Open Access | Published: July 17, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30308-9

 

Summary

Background

National immunisation programmes globally are at risk of suspension due to the severe health system constraints and physical distancing measures in place to mitigate the ongoing COVID-19 pandemic. We aimed to compare the health benefits of sustaining routine childhood immunisation in Africa with the risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through visiting routine vaccination service delivery points.

Methods

We considered a high-impact scenario and a low-impact scenario to approximate the child deaths that could be caused by immunisation coverage reductions during COVID-19 outbreaks. In the high-impact scenario, we used previously reported country-specific child mortality impact estimates of childhood immunisation for diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, Streptococcus pneumoniae, rotavirus, measles, meningitis A, rubella, and yellow fever to approximate the future deaths averted before 5 years of age by routine childhood vaccination during a 6-month COVID-19 risk period without catch-up campaigns. In the low-impact scenario, we approximated the health benefits of sustaining routine childhood immunisation on only the child deaths averted from measles outbreaks during the COVID-19 risk period. We assumed that contact-reducing interventions flattened the outbreak curve during the COVID-19 risk period, that 60% of the population will have been infected by the end of that period, that children can be infected by either vaccinators or during transport, and that upon child infection the whole household will be infected. Country-specific household age structure estimates and age-dependent infection-fatality rates were applied to calculate the number of deaths attributable to the vaccination clinic visits. We present benefit–risk ratios for routine childhood immunisation, with 95% uncertainty intervals (UIs) from a probabilistic sensitivity analysis.

Findings

In the high-impact scenario, for every one excess COVID-19 death attributable to SARS-CoV-2 infections acquired during routine vaccination clinic visits, 84 (95% UI 14–267) deaths in children could be prevented by sustaining routine childhood immunisation in Africa. The benefit–risk ratio for the vaccinated children is 85 000 (4900–546 000), for their siblings (<20 years) is 75 000 (4400–483 000), for their parents or adult carers (aged 20–60 years) is 769 (148–2700), and for older adults (>60 years) is 96 (14–307). In the low-impact scenario that approximates the health benefits to only the child deaths averted from measles outbreaks, the benefit–risk ratio to the households of vaccinated children is 3 (0–10); if the risk to only the vaccinated children is considered, the benefit–risk ratio is 3000 (182–21 000).

Interpretation

The deaths prevented by sustaining routine childhood immunisation in Africa outweigh the excess risk of COVID-19 deaths associated with vaccination clinic visits, especially for the vaccinated children. Routine childhood immunisation should be sustained in Africa as much as possible, while considering other factors such as logistical constraints, staff shortages, and reallocation of resources during the COVID-19 pandemic.

Funding

Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation.

Keywords: SARS-CoV-2; COVID-19; Pediatrics; Vaccines; Africa Region.

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#Dexamethasone for #COVID19: data needed from #RCTs in #Africa (Lancet Glob Health, abstract)

[Source: Lancet Global Health, full page: (LINK). Summary, edited.]

Dexamethasone for COVID-19: data needed from randomised clinical trials in Africa

Helen Brotherton, Effua Usuf, Behzad Nadjm, Karen Forrest, Kalifa Bojang, Ahmadou Lamin Samateh et al.

Open Access | Published: July 14, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30318-1

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Over the past 6 months, potential COVID-19 treatments have come under intense  scrutiny on social media, shifting the public discourse without a strong scientific  rationale. There are now preliminary data showing that, in patients from Europe, low- dose dexamethasone reduces mortality by up to 33% in the most severely affected  patients needing invasive ventilation (rate ratio 0·65, 95% CI [0·51–0·82]; p<0·001) and by  20% in those needing oxygen (rate ratio 0·80, 95% CI [0·70–0·92]; p=0·002).1  We welcome the RECOVERY trial1  results and support the implementation of dexamethasone as standard of care in settings similar to the trial sites. However, there is a need for caution regarding the results of a single, albeit well designed, trial done in a high-income country to change guidelines elsewhere in the world where the population and the context of care might be vastly different.

(…)

Keywords: SARS-CoV-2; COVID-19; Intensive Care; Dexamethasone; Africa region.

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#COVID19 Across #Africa: #Epidemiologic #Heterogeneity and Necessity of Contextually Relevant #Transmission #Models and #Intervention Strategies (Ann Intern Med., summary)

[Source: Annals of Internal Medicine, full page: (LINK). Summary, edited.]

COVID-19 Across Africa: Epidemiologic Heterogeneity and Necessity of Contextually Relevant Transmission Models and Intervention Strategies

Jean Olivier Twahirwa Rwema, MD, MPH, Daouda Diouf, MSc, Nancy Phaswana-Mafuya, PhD, Jean Christophe Rusatira, MD, MPH, Alain Manouan, MSc, Emelyne Uwizeye, BSc, Fatou M. Drame, PhD, Ubald Tamoufe, MPH, MSc, Stefan David Baral, MD, MPH

DOI: https://doi.org/10.7326/M20-2628

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Coronavirus disease 2019 (COVID-19) has rapidly emerged as a global public health threat with epicenters in regions of China, parts of Europe, and larger urban centers across North America (1). By comparison, population-level COVID-19 diagnostic rates and associated morbidity and mortality have been limited to date in much of the African continent. Initially, multiple mathematical models projected substantial increases in COVID-19 incidence and related deaths across Africa, with one estimating 300 000 to 3 million people dying, although newer models have estimated lower mortality (2, 3). These models have assumed homogeneity in the transmission dynamics of respiratory pathogens between the African continent and other regions of the world as well as across the African continent. In addition, there has been limited integration of the diverse range of country-led mitigation strategies. Furthermore, these models have not included evaluation of competing health risks to COVID-19 associated with disruptions to the health and social systems in countries across the continent. Finally, they overlook the contextually specific heterogeneities in environmental, social, and structural factors that may potentiate or reduce COVID-19 risks in countries across Africa.

(…)

Keywords: SARS-CoV-2; COVID-19; Africa.

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The case for why #Africa should host #COVID19 candidate #vaccine #trials (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

The case for why Africa should host COVID-19 candidate vaccine trials

Jerome Amir Singh

The Journal of Infectious Diseases, jiaa303, https://doi.org/10.1093/infdis/jiaa303

Published: 03 June 2020

 

Abstract

In response to provocative comments by two European clinicians and scientists, the WHO Director General has declared that Africa will not host COVID-19 vaccine trials. Such a stance risks stigmatising COVID-19 vaccine trials in Africa and depriving Africa of critical research. To the contrary, there is a critical need for Africa to host COVID-19 vaccine trials on public health, scientific, and ethics grounds.

Issue Section: Perspectives

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; Vaccine; Africa.

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From Easing #Lockdowns to Scaling-Up #Community-Based #COVID19 #Screening, #Testing, and #Contact Tracing in #Africa – … (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

From Easing Lockdowns to Scaling-Up Community-Based COVID-19 Screening, Testing, and Contact Tracing in Africa – Shared Approaches, Innovations, and Challenges to Minimize Morbidity and Mortality

Jean B Nachega, Ashraf Grimwood, Hassan Mahomed, Geoffrey Fatti, Wolfgang Preiser, Oscar Kallay, Placide K Mbala, Jean-Jacques T Muyembe, Edson Rwagasore, Sabin Nsanzimana, Daniel Ngamije, Jeanine Condo, Mohsin Sidat, Emilia V Noormahomed, Michael Reid, Beatrice Lukeni, Fatima Suleman, Alfred Mteta, Alimuddin Zumla

Clinical Infectious Diseases, ciaa695, https://doi.org/10.1093/cid/ciaa695

Published: 31 May 2020

 

Abstract

The arrival of COVID-19 to the African continent resulted in a range of locally relevant lockdown measures, which curtailed the spread of SARS-CoV-2 but caused economic hardship for large sections of the population. African countries now face difficult choices regarding easing of lockdowns and sustaining effective public health control measures and surveillance.  Control of the COVID-19 pandemic will require efficient community screening, testing, contact tracing, and behavioral change interventions, adequate resources, and a well-supported, community-based team of trained, protected personnel.  We discuss COVID-19 screening-testing-contact tracing approaches used in selected African countries and the need for shared, affordable, innovative methods to overcome challenges and minimize mortality rates. This crisis presents a unique opportunity to align COVID-19 services with those already in place for HIV, TB, Malaria, and other non-communicable diseases (NCDs) through mobilization of Africa’s inter-professional healthcare workforce to contain the pandemic. By addressing the challenges, the detrimental effect of the COVID-19 pandemic on African citizens can be minimized.

COVID-19, SARS-Cov-2, Screening Testing, Contact Trace, Africa

Issue Section: Viewpoints

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; Africa.

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#COVID19 in #Africa: Care and #Protection for Frontline #HCWs (Global Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Global Health. 2020 May 15;16(1):46. doi: 10.1186/s12992-020-00574-3.

COVID-19 in Africa: Care and Protection for Frontline Healthcare Workers

Matthew F Chersich 1, Glenda Gray 2, Lee Fairlie 3, Quentin Eichbaum 4 5, Susannah Mayhew 6, Brian Allwood 7, Rene English 8, Fiona Scorgie 3, Stanley Luchters 9 10 11 12, Greg Simpson 13, Marjan Mosalman Haghighi 14, Minh Duc Pham 15 11, Helen Rees 3

Affiliations: 1 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. mchersich@wrhi.ac.za. 2 South African Medical Research Council, Cape Town, South Africa. 3 Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 4 Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. 5 Division of Medical Education and Administration, Vanderbilt University School of Medicine, Nashville, TN, USA. 6 Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK. 7 Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. 8 Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. 9 Department of Population Health, Aga Khan University, Nairobi, Kenya. 10 Department of Public Health and Primary Care,  International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium. 11 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. 12 Burnet Institute, Melbourne, Australia. 13 Wildlife Forensic Academy, Buffelsfontein Nature Reserve, Cape Town, South Africa. 14 The University of Sydney, Faculty of Medicine and Health, Sydney, South Africa. 15 Disease Elimination, Burnet Institute, Melbourne, Australia.

PMID: 32414379 DOI: 10.1186/s12992-020-00574-3

 

Abstract

Medical staff caring for COVID-19 patients face mental stress, physical exhaustion, separation from families, stigma, and the pain of losing patients and colleagues. Many of them have acquired SARS-CoV-2 and some have died. In Africa, where the pandemic is escalating, there are major gaps in response capacity, especially in human resources and protective equipment. We examine these challenges and propose interventions to protect healthcare workers on the continent, drawing on articles identified on Medline (Pubmed) in a search on 24 March 2020. Global jostling means that supplies of personal protective equipment are limited in Africa. Even low-cost interventions such as facemasks for patients with a cough and water supplies for handwashing may be challenging, as is ‘physical distancing’ in overcrowded primary health care clinics. Without adequate protection, COVID-19 mortality may be high among healthcare workers and their family in Africa given limited critical care beds and difficulties in transporting ill healthcare workers from rural to urban care centres. Much can be done to protect healthcare workers, however. The continent has learnt invaluable lessons from Ebola and HIV control. HIV counselors and community healthcare workers are key resources, and could promote social distancing and related interventions, dispel myths, support healthcare workers, perform symptom screening and trace contacts. Staff motivation and retention may be enhanced through carefully managed risk ‘allowances’ or compensation. International support with personnel and protective equipment, especially from China, could turn the pandemic’s trajectory in Africa around. Telemedicine holds promise as it rationalises human resources and reduces patient contact and thus infection risks. Importantly, healthcare workers, using their authoritative voice, can promote effective COVID-19 policies and prioritization of their safety. Prioritizing healthcare workers for SARS-CoV-2 testing, hospital beds and targeted research, as well as ensuring that public figures and the population acknowledge the commitment of healthcare workers may help to maintain morale. Clearly there are multiple ways that international support and national commitment could help safeguard healthcare workers in Africa, essential for limiting the pandemic’s potentially devastating heath, socio-economic and security impacts on the continent.

Keywords: Africa; COVID-19; Healthcare workers; Human resources for health; Infection control, mental health; SARS-Cov-2.

Keywords: SARS-CoV-2; COVID-19; HCWs; Africa.

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Projected early #spread of #COVID19 in #Africa through 1 June 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Projected early spread of COVID-19 in Africa through 1 June 2020

Carl AB Pearson1,2, Cari Van Schalkwyk2, Anna M Foss1, Kathleen M O’Reilly1, SACEMA Modelling and Analysis Response Team2,3, CMMID COVID-19 working group1,4, Juliet RC Pulliam2

Affiliations: 1 London School of Hygiene & Tropical Medicine, London, United Kingdom; 2 South African DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Republic of South Africa; 3 Members of the SACEMA Modelling and Analysis Response Team are listed at the end of this article; 4 Members of the CMMID COVID-19 working group are listed at the end of this article

Correspondence:  Carl AB Pearson

Citation style for this article: Pearson Carl AB, Van Schalkwyk Cari, Foss Anna M, O’Reilly Kathleen M, SACEMA Modelling and Analysis Response Team, CMMID COVID-19 working group, Pulliam Juliet RC. Projected early spread of COVID-19 in Africa through 1 June 2020. Euro Surveill. 2020;25(18):pii=2000543. https://doi.org/10.2807/1560-7917.ES.2020.25.18.2000543

Received: 07 Apr 2020;   Accepted: 07 May 2020

 

Abstract

For 45 African countries/territories already reporting COVID-19 cases before 23 March 2020, we estimate the dates of reporting 1,000 and 10,000 cases. Assuming early epidemic trends without interventions, all 45 were likely to exceed 1,000 confirmed cases by the end of April 2020, with most exceeding 10,000 a few weeks later.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; Africa.

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Limiting the #spread of #COVID19 in #Africa: one size #mitigation strategies do not fit all countries (Lancet Glob Health, summary)

[Source: The Lancet Global Health, full page: (LINK). Summary, edited.]

Limiting the spread of COVID-19 in Africa: one size mitigation strategies do not fit all countries

Shaheen Mehtar, Wolfgang Preiser, Ndèye Aissatou Lakhe, Abdoulaye Bousso, Jean-Jacques Muyembe TamFum, Oscar Kallay et al.

Open Access | Published: April 28, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30212-6

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On March 11, 2020, when coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by WHO, there were comparatively few cases reported from Africa.1 Our Comment draws on early imported COVID-19 cases in South Africa, Senegal, Democratic Republic of the Congo, and Egypt as case studies to discuss important mitigation strategies of COVID-19 in Africa.

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Keywords: SARS-CoV-2; COVID-19; Africa.

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#COVID19 #pandemic in west #Africa (Lancet Glob Health, summary)

[Source: The Lancet Global Health, full page: (LINK). Summary, edited.]

COVID-19 pandemic in west Africa

Melisa Martinez-Alvarez †, Alexander Jarde †, Effua Usuf, Helen Brotherton, Mustapha Bittaye, Ahmadou L Samateh et al.

Open Access | Published: April 01, 2020 | DOI: https://doi.org/10.1016/S2214-109X(20)30123-6

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The coronavirus disease 2019 (COVID-19) outbreak, which started in the Hubei province of China in 2019, has now spread to all continents, affecting 177 countries by March 27, 2020.1 Successful efforts in containing the COVID-19 virus in Asia resulted in WHO declaring Europe as the epicentre of the disease on March 13.2 Whether warmer temperatures will slow the spread of the COVID-19 virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a point of much speculation. This hypothesis has led some European countries to produce initial policies relying on decreased transmission rates during the summer months,3 and the belief that African countries will face smaller epidemics than their European counterparts. However, no strong evidence base exists for such claims; SARS-CoV-2 might have simply arrived later to warmer countries.

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Keywords: SARS-CoV-2; COVID-19; Africa.

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