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High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa

A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments(1), younger populations(2-4)) have yet to be framed within a comprehensive analysis accounting...

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Autores principales: Rice, Benjamin L., Annapragada, Akshaya, Baker, Rachel E., Bruijning, Marjolein, Dotse-Gborgbortsi, Winfred, Mensah, Keitly, Miller, Ian F., Motaze, Nkengafac Villyen, Raherinandrasana, Antso, Rajeev, Malavika, Rakotonirina, Julio, Ramiadantsoa, Tanjona, Rasambainarivo, Fidisoa, Yu, Weiyu, Grenfell, Bryan T., Tatem, Andrew J., Metcalf, C. Jessica E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cold Spring Harbor Laboratory 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386522/
https://www.ncbi.nlm.nih.gov/pubmed/32743598
http://dx.doi.org/10.1101/2020.07.23.20161208
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author Rice, Benjamin L.
Annapragada, Akshaya
Baker, Rachel E.
Bruijning, Marjolein
Dotse-Gborgbortsi, Winfred
Mensah, Keitly
Miller, Ian F.
Motaze, Nkengafac Villyen
Raherinandrasana, Antso
Rajeev, Malavika
Rakotonirina, Julio
Ramiadantsoa, Tanjona
Rasambainarivo, Fidisoa
Yu, Weiyu
Grenfell, Bryan T.
Tatem, Andrew J.
Metcalf, C. Jessica E.
author_facet Rice, Benjamin L.
Annapragada, Akshaya
Baker, Rachel E.
Bruijning, Marjolein
Dotse-Gborgbortsi, Winfred
Mensah, Keitly
Miller, Ian F.
Motaze, Nkengafac Villyen
Raherinandrasana, Antso
Rajeev, Malavika
Rakotonirina, Julio
Ramiadantsoa, Tanjona
Rasambainarivo, Fidisoa
Yu, Weiyu
Grenfell, Bryan T.
Tatem, Andrew J.
Metcalf, C. Jessica E.
author_sort Rice, Benjamin L.
collection PubMed
description A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments(1), younger populations(2-4)) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ‘slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here.
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spelling pubmed-73865222020-07-31 High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa Rice, Benjamin L. Annapragada, Akshaya Baker, Rachel E. Bruijning, Marjolein Dotse-Gborgbortsi, Winfred Mensah, Keitly Miller, Ian F. Motaze, Nkengafac Villyen Raherinandrasana, Antso Rajeev, Malavika Rakotonirina, Julio Ramiadantsoa, Tanjona Rasambainarivo, Fidisoa Yu, Weiyu Grenfell, Bryan T. Tatem, Andrew J. Metcalf, C. Jessica E. medRxiv Article A surprising feature of the SARS-CoV-2 pandemic to date is the low burdens reported in sub-Saharan Africa (SSA) countries relative to other global regions. Potential explanations (e.g., warmer environments(1), younger populations(2-4)) have yet to be framed within a comprehensive analysis accounting for factors that may offset the effects of climate and demography. Here, we synthesize factors hypothesized to shape the pace of this pandemic and its burden as it moves across SSA, encompassing demographic, comorbidity, climatic, healthcare and intervention capacity, and human mobility dimensions of risk. We find large scale diversity in probable drivers, such that outcomes are likely to be highly variable among SSA countries. While simulation shows that extensive climatic variation among SSA population centers has little effect on early outbreak trajectories, heterogeneity in connectivity is likely to play a large role in shaping the pace of viral spread. The prolonged, asynchronous outbreaks expected in weakly connected settings may result in extended stress to health systems. In addition, the observed variability in comorbidities and access to care will likely modulate the severity of infection: We show that even small shifts in the infection fatality ratio towards younger ages, which are likely in high risk settings, can eliminate the protective effect of younger populations. We highlight countries with elevated risk of ‘slow pace’, high burden outbreaks. Empirical data on the spatial extent of outbreaks within SSA countries, their patterns in severity over age, and the relationship between epidemic pace and health system disruptions are urgently needed to guide efforts to mitigate the high burden scenarios explored here. Cold Spring Harbor Laboratory 2020-07-29 /pmc/articles/PMC7386522/ /pubmed/32743598 http://dx.doi.org/10.1101/2020.07.23.20161208 Text en http://creativecommons.org/licenses/by-nc-nd/4.0/It is made available under a CC-BY-NC-ND 4.0 International license (http://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Article
Rice, Benjamin L.
Annapragada, Akshaya
Baker, Rachel E.
Bruijning, Marjolein
Dotse-Gborgbortsi, Winfred
Mensah, Keitly
Miller, Ian F.
Motaze, Nkengafac Villyen
Raherinandrasana, Antso
Rajeev, Malavika
Rakotonirina, Julio
Ramiadantsoa, Tanjona
Rasambainarivo, Fidisoa
Yu, Weiyu
Grenfell, Bryan T.
Tatem, Andrew J.
Metcalf, C. Jessica E.
High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa
title High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa
title_full High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa
title_fullStr High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa
title_full_unstemmed High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa
title_short High variation expected in the pace and burden of SARS-CoV-2 outbreaks across sub-Saharan Africa
title_sort high variation expected in the pace and burden of sars-cov-2 outbreaks across sub-saharan africa
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386522/
https://www.ncbi.nlm.nih.gov/pubmed/32743598
http://dx.doi.org/10.1101/2020.07.23.20161208
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