Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda

Bell, David A.; Hansen, Kristian Schultz; Kiragga, Agnes; Kambugu, Andrew; Kissa, John; Mbonye, Anthony K.

doi:10.4269/ajtmh.20-0546

Cited by 92 publications

(132 citation statements)

References 19 publications

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“…28 Estimates of mortality in Uganda follow a similar trend, with a lower predicted disease burden than the comparator regions (Europe, America and China) and the majority of risk arising indirectly due to disruptions to the health service. 29 Other studies have also reported a differential risk of severe disease in African settings compared with European countries due to underlying health conditions although there is considerable uncertainty in these analyses. 30,31…”

Section: Discussionmentioning

confidence: 99%

The potential impact of intervention strategies on COVID-19 transmission in Malawi: A mathematical modelling study

Mangal

Whittaker

Nkhoma

et al. 2020

Preprint

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Background COVID-19 mitigation strategies have been challenging to implement in resource-limited settings such as Malawi due to the potential for widespread disruption to social and economic well-being. Here we estimate the clinical severity of COVID-19 in Malawi, quantifying the potential impact of intervention strategies and increases in health system capacity. Methods The infection fatality ratios (IFR) in Malawi were estimated by adjusting reported IFR for China accounting for demography, the current prevalence of comorbidities and health system capacity. These estimates were input into an age-structured deterministic model, which simulated the epidemic trajectory with non-pharmaceutical interventions. The impact of a novel therapeutic agent and increases in hospital capacity and oxygen availability were explored, given different assumptions on mortality rates. Findings The estimated age-specific IFR in Malawi are higher than those reported for China, however the younger average age of the population results in a slightly lower population-weighted IFR (0.48%, 95% uncertainty interval [UI] 0.30% - 0.72% compared with 0.60%, 95% CI 0.4% - 1.3% in China). The current interventions implemented, (i.e. social distancing, workplace closures and public transport restrictions) could potentially avert 3,100 deaths (95% UI 1,500 - 4,500) over the course of the epidemic. Enhanced shielding of people aged ≥ 60 years could avert a further 30,500 deaths (95% UI 17,500 - 45,600) and halve ICU admissions at the peak of the outbreak. Coverage of face coverings of 60% under the assumption of 50% efficacy could be sufficient to control the epidemic. A novel therapeutic agent, which reduces mortality by 0.65 and 0.8 for severe and critical cases respectively, in combination with increasing hospital capacity could reduce projected mortality to 2.55 deaths per 1,000 population (95% UI 1.58 - 3.84). Conclusion The risks due to COVID-19 vary across settings and are influenced by age, underlying health and health system capacity.

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Section: Discussionmentioning

confidence: 99%

The potential impact of intervention strategies on COVID-19 transmission in Malawi: A mathematical modelling study

Mangal

Whittaker

Nkhoma

et al. 2020

Preprint

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“…The so-called “Africa paradox” has been the focus of several editorials in prominent journals, 9 10 11 12 13 proposing several explanatory theories. These include that exposure to other coronaviruses has induced cross reactive herd immunity, 14 that the younger age structure of African populations allows its populations to tolerate covid-19 better, 15 that experience gained during the Ebola crisis allowed public health agencies across Africa to contain covid-19 better, 16 and that certain live attenuated vaccines (BCG vaccine, oral polio vaccine, and measles vaccines) engendered robust non-specific innate immune responses that also protect against covid-19. 17 18 19 …”

Section: Introductionmentioning

confidence: 99%

Covid-19 deaths in Africa: prospective systematic postmortem surveillance study

Mwananyanda

Gill

MacLeod

et al. 2021

BMJ

165

164

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Objective To directly measure the fatal impact of coronavirus disease 2019 (covid-19) in an urban African population. Design Prospective systematic postmortem surveillance study. Setting Zambia’s largest tertiary care referral hospital. Participants Deceased people of all ages at the University Teaching Hospital morgue in Lusaka, Zambia, enrolled within 48 hours of death. Main outcome measure Postmortem nasopharyngeal swabs were tested via reverse transcriptase quantitative polymerase chain reaction (PCR) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Deaths were stratified by covis-19 status, location, age, sex, and underlying risk factors. Results 372 participants were enrolled between June and September 2020; PCR results were available for 364 (97.8%). SARS-CoV-2 was detected in 58/364 (15.9%) according to the recommended cycle threshold value of <40 and in 70/364 (19.2%) when expanded to any level of PCR detection. The median age at death among people with a positive test for SARS-CoV-2 was 48 (interquartile range 36-72) years, and 69% (n=48) were male. Most deaths in people with covid-19 (51/70; 73%) occurred in the community; none had been tested for SARS-CoV-2 before death. Among the 19/70 people who died in hospital, six were tested before death. Among the 52/70 people with data on symptoms, 44/52 had typical symptoms of covid-19 (cough, fever, shortness of breath), of whom only five were tested before death. Covid-19 was identified in seven children, only one of whom had been tested before death. The proportion of deaths with covid-19 increased with age, but 76% (n=53) of people who died were aged under 60 years. The five most common comorbidities among people who died with covid-19 were tuberculosis (22; 31%), hypertension (19; 27%), HIV/AIDS (16; 23%), alcohol misuse (12; 17%), and diabetes (9; 13%). Conclusions Contrary to expectations, deaths with covid-19 were common in Lusaka. Most occurred in the community, where testing capacity is lacking. However, few people who died at facilities were tested, despite presenting with typical symptoms of covid-19. Therefore, cases of covid-19 were under-reported because testing was rarely done not because covid-19 was rare. If these data are generalizable, the impact of covid-19 in Africa has been vastly underestimated.

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“…[6][7][8] The so-called 'Africa paradox' has been the focus of a number of editorials in prominent journals [9][10][11][12][13] proposing several explanatory theories. These include: 1) exposure to non-CV19 coronaviruses has induced cross-reactive herd immunity; 14 2) the younger age structure of African populations allows its populations to better tolerate CV19; 15 3) experience gained during the Ebola crisis allowed public health agencies across Africa to better contain CV19; 16 and 4) that certain live attenuated vaccines -Bacille Calmette Guerin (BCG) vaccine, the oral polio vaccine and measles vaccines -engendered robust non-specific innate immune responses that also protect against CV19. [17][18][19] We postulate a more mundane explanation for the Africa paradox: insufficient data.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa

Mwananyanda

Gill

MacLeod

et al. 2020

Preprint

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ObjectivesLimited SARS CoV 2 testing in many African countries has constrained availability of data on the impact of COVID-19 (CV19). To address this gap, we conducted a systematic post-mortem surveillance study to directly measure the fatal impact of CV19 in an urban African population.DesignWe enrolled deceased individuals at the University Teaching Hospital (UTH) Morgue in Lusaka, Zambia. We obtained nasopharyngeal swabs for testing via reverse-transcriptase quantitative PCR (RT-qPCR) against the SARS-2 Coronavirus. We stratified deaths by CV19 status, by location, age, sex, and underlying risk factors.SettingUTH is Zambia’s largest tertiary care referral hospital and its morgue registers ∼80% of Lusaka’s deaths.ParticipantsParticipants of all ages were enrolled if within 48 hours of death and if the next of kin or representative provided written informed consent.ResultsWe enrolled 372 participants between June and September 2020, and had PCR results for 364 (99.5%). CV19 was detected in 70/364 (19.2%). The median age for CV19+ deaths was 48 years (IQR 36-72 years) and 70% were male. Most CV19+ deaths (51/70, 72.8%) occurred in the community; none had been tested for CV19 antemortem. Among the 19/70 facility deaths, six were tested antemortem. Among the 52/70 CV19 deaths with symptoms data, 44/52 had typical symptoms of CV19 (cough, fever, shortness of breath), of whom only five were tested antemortem. We identified CV19 among seven children; only one had been tested antemortem. The proportion of CV19+ deaths increased with age, but 75.7% of CV19+ deaths were aged <60 years. The five most common co-morbidities among CV19+ deaths were: tuberculosis (31.4%); hypertension (27.1%); HIV/AIDS (22.9%); alcohol use (17.1%); and diabetes (12.9%).ConclusionsContrary to expectations, CV19+ deaths were common in Lusaka. The majority occurred in the community where testing capacity is lacking. Yet few who died at facilities were tested, despite presenting with typical symptoms of CV19. Therefore, CV19 cases were under reported because testing was rarely done, not because CV19 was rare. If our data are generalizable, the impact of CV19 in Africa has been vastly underestimated.

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Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda

Cited by 92 publications

References 19 publications

The potential impact of intervention strategies on COVID-19 transmission in Malawi: A mathematical modelling study

The potential impact of intervention strategies on COVID-19 transmission in Malawi: A mathematical modelling study

Covid-19 deaths in Africa: prospective systematic postmortem surveillance study

COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa

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