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COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns - PubMed

COVID-19 in the 47 countries of the WHO African region: a modelling analysis of past trends and future patterns

Joseph Waogodo Cabore et al. Lancet Glob Health. 2022 Aug.

Abstract

Background: COVID-19 has affected the African region in many ways. We aimed to generate robust information on the transmission dynamics of COVID-19 in this region since the beginning of the pandemic and throughout 2022.

Methods: For each of the 47 countries of the WHO African region, we consolidated COVID-19 data from reported infections and deaths (from WHO statistics); published literature on socioecological, biophysical, and public health interventions; and immunity status and variants of concern, to build a dynamic and comprehensive picture of COVID-19 burden. The model is consolidated through a partially observed Markov decision process, with a Fourier series to produce observed patterns over time based on the SEIRD (denoting susceptible, exposed, infected, recovered, and dead) modelling framework. The model was set up to run weekly, by country, from the date the first infection was reported in each country until Dec 31, 2021. New variants were introduced into the model based on sequenced data reported by countries. The models were then extrapolated until the end of 2022 and included three scenarios based on possible new variants with varying transmissibility, severity, or immunogenicity.

Findings: Between Jan 1, 2020, and Dec 31, 2021, our model estimates the number of SARS-CoV-2 infections in the African region to be 505·6 million (95% CI 476·0-536·2), inferring that only 1·4% (one in 71) of SARS-CoV-2 infections in the region were reported. Deaths are estimated at 439 500 (95% CI 344 374-574 785), with 35·3% (one in three) of these reported as COVID-19-related deaths. Although the number of infections were similar between 2020 and 2021, 81% of the deaths were in 2021. 52·3% (95% CI 43·5-95·2) of the region's population is estimated to have some SARS-CoV-2 immunity, given vaccination coverage of 14·7% as of Dec 31, 2021. By the end of 2022, we estimate that infections will remain high, at around 166·2 million (95% CI 157·5-174·9) infections, but deaths will substantially reduce to 22 563 (14 970-38 831).

Interpretation: The African region is estimated to have had a similar number of COVID-19 infections to that of the rest of the world, but with fewer deaths. Our model suggests that the current approach to SARS-CoV-2 testing is missing most infections. These results are consistent with findings from representative seroprevalence studies. There is, therefore, a need for surveillance of hospitalisations, comorbidities, and the emergence of new variants of concern, and scale-up of representative seroprevalence studies, as core response strategies.

Funding: None.

© 2022 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY NC ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity. There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

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Conflict of interest statement

Declaration of interests We declare no competing interests.

Figures

Figure 1
Figure 1

Adapted POMP model for SARS-CoV-2 transitions and outcomes POMP=partially observed Markov decision process.

Figure 2
Figure 2

Trends in SARS-CoV-2 infections and COVID-19-related deaths, Jan 1, 2020–Dec 31, 2021 COVID-19 mortality trends for different country-income levels (A) and regional economic communities (B) in the WHO African region.

Comment in

  • Underestimated COVID-19 mortality in WHO African region.

    Bradshaw D, Dorrington R, Moultrie T, Groenewald P, Moultrie H. Bradshaw D, et al. Lancet Glob Health. 2022 Nov;10(11):e1559. doi: 10.1016/S2214-109X(22)00425-9. Lancet Glob Health. 2022. PMID: 36240818 Free PMC article. No abstract available.

  • Underestimated COVID-19 mortality in WHO African region - Authors' reply.

    Cabore JW, Karamagi H, Kipruto HK, Mungatu JK, Asamani JA, Droti B, Titi-Ofei R, Seydi ABW, Kidane SN, Balde T, Gueye AS, Makubalo L, Moeti MR. Cabore JW, et al. Lancet Glob Health. 2022 Nov;10(11):e1560. doi: 10.1016/S2214-109X(22)00415-6. Lancet Glob Health. 2022. PMID: 36240819 Free PMC article. No abstract available.

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