BackgroundPast research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.MethodsWe reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).FindingsIn 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).InterpretationInjuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

ObjectivesThis study adapted WHO’s ‘Unity Study’ protocol to estimate the population prevalence of antibodies to SARS CoV-2 and risk factors for developing SARS-CoV-2 infection.DesignThis population-based, age-stratified cross-sectional study was conducted at the level of households (HH).ParticipantsAll ages and genders were eligible for the study (exclusion criteria: contraindications to venipuncture- however, no such case was encountered). 4998 HH out of 6599 consented (1 individual per HH). The proportion of male and female study participants was similar.Primary and secondary outcome measuresFollowing were the measured outcome measures- these were different from the planned indicators (i.e. two out of the three planned indicators were measured) due to operational reasons and time constraints: -Primary indicators: Seroprevalence (population and age specific).Secondary indicators: Population groups most at risk for SARS-CoV-2-infection.ResultsOverall seroprevalence of SARS-CoV-2 antibodies was 7.1%. 6.3% of individuals were IgG positive while IgM positivity was 1.9%. Seroprevalence in districts ranged from 0% (Ghotki) to 17% (Gilgit). The seroprevalence among different age groups ranged from 3.9% (0–9 years) to 10.1% (40–59 years). There were no significant differences in the overall seroprevalence for males and females. A history of contact with a confirmed COVID-19 case, urban residence and mask use were key risk factors for developing SARS-CoV-2 infection.ConclusionsThis survey provides useful estimates for seroprevalence in the general population and information on risk factors for developing SARS-CoV-2 infection in the country. It is premised that similar studies need to be replicated at the population level on a regular basis to monitor the disease and immunity patterns related to COVID-19.

Background Recent pandemic of the Noval Coronal Virus (COVID 19) has claimed more than 200000 lives and about 3.8 million infected worldwide. Countries are being gradually exposed to its devastating threat without being properly prepared and with inadequate response. COVID 19 first two cases were reported in Pakistan on February 26, 2020. We present a model depicting progression of epidemiology curve for Pakistan with and without interventions in view of its health system response capacity in near future. Methodology We used a modified compartmental epidemiological SEIR model to describe the outbreak of COVID-19 in Pakistan including the possibility of asymptomatic infection and presymptomatic transmission. The behavior of the dynamic model is determined by a set of clinical parameters and transmission rate. Results We estimated that in the absence of a set of proven interventions, the total susceptible population would be 43.24 million, exposed individuals would be almost 32 million, asymptomatic cases would be 13.13 million, mildly infected 30.64 million, severely infected slightly more than 6 million and critical cases would be around 967,000 in number. By that time, almost 760,000 fatalities of infected critical would have taken place. Comparing with the healthcare capacity of Pakistan, if we could flatten the curve to a level below the dashed grey line, the healthcare system will be capable of managing the cases with ideal healthcare facilities, where the grey line representing the healthcare capacity of Pakistan. With the intervention in place, the number of symptomatic infected individuals is expected to be almost 20 million. Conclusion We consider the impact of intervention and control measures on the spread of COVID-19 with 30% reduction in transmission from mild cases in case a set of interventions are judiciously in place to mitigate its impact.

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