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

Abstract

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.

Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi

“…To date, Malawi has experienced three COVID-19 waves (May to August 2020, January to March 2021, and June to September 2021) ( Mangal et al, 2021 ). Our social mixing study was conducted after the end of the second wave (April-May 2021) and during the first half of the third wave (June-July 2021).…”

“…However, this is unlikely due to relatively very low current COVID-19 vaccination coverage in LICs ( Duan et al, 2021 ). Moreover, despite the 3 pandemic waves in a LIC like Malawi, NPIs were only restricted to face mask wearing, rotational working, limited transit vehicles, self-quarantine for returning travellers, restricted gatherings, closure of non-essential businesses, social distancing, and reduced public transportation capacity, without implementation of a formal countrywide lockdown ( Mangal et al, 2021 ).…”

Social mixing patterns relevant to infectious diseases spread by close contact in urban Blantyre, Malawi

“…To date, Malawi has experienced three COVID-19 waves (May to August 2020, January to March 2021, and June to September 2021) 31 . Our social mixing study was conducted after the end of the second wave (April-May 2021) and during the first half of the third wave (June-July 2021).…”

COVID-19, the environment and animal life in Malawi compared to other countries: A brief scooping review for a research agenda in the developing countries

“…This study has found that unlike in the developed world, studies that have focused on evaluating the impact of COVID-19 on the environment and animal population in developing world remain scanty, consistent with outcomes of another review study that was conducted elsewhere between December 2019 and April 2020 ( Shakil et al, 2020 ). Although the current study review did not also find studies that specifically assessed effects of COVID-19 on the environment in Malawi, unlike on people's health and economy ( UNDP, 2020 ; Alfonso, 2020 ; Thula et al, 2020 ; Baulch et al, 2020 ; Mzumara et al, 2021 ; Mangal et al, 2021 ; Sonenthal et al, 2020 ; FEWS, 2020 ), the question that was posed by Shakil et al (2020) on “whether or not the impact of COVID-19 on climate or environmental changes differ between more-affected and less-affected countries” has been partly answered by the current study. This is because, for the studies that were identified from the developed countries, the majority are based on the premise that the environment benefited more from the reduced human and industrial activity as caused by the total lock-down measures that were implemented.…”