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SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict

INTRODUCTION: Ten years of conflict has displaced more than half of Northwest Syria's (NWS) population and decimated the health system, water and sanitation, and public health infrastructure vital for infectious disease control. The first NWS COVID-19 case was declared on July 9, 2020, but impa...

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Autores principales: Marzouk, Manar, Alhiraki, Omar Alrashid, Aguas, Ricardo, Gao, Bo, Clapham, Hannah, Obaid, Wael, Altaleb, Hani, Almhawish, Naser, Rihawi, Hazem, Abbara, Aula, Douedari, Yazan, Hariri, Mahmoud, Howard, Natasha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808433/
https://www.ncbi.nlm.nih.gov/pubmed/35123027
http://dx.doi.org/10.1016/j.ijid.2022.01.062
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author Marzouk, Manar
Alhiraki, Omar Alrashid
Aguas, Ricardo
Gao, Bo
Clapham, Hannah
Obaid, Wael
Altaleb, Hani
Almhawish, Naser
Rihawi, Hazem
Abbara, Aula
Douedari, Yazan
Hariri, Mahmoud
Howard, Natasha
author_facet Marzouk, Manar
Alhiraki, Omar Alrashid
Aguas, Ricardo
Gao, Bo
Clapham, Hannah
Obaid, Wael
Altaleb, Hani
Almhawish, Naser
Rihawi, Hazem
Abbara, Aula
Douedari, Yazan
Hariri, Mahmoud
Howard, Natasha
author_sort Marzouk, Manar
collection PubMed
description INTRODUCTION: Ten years of conflict has displaced more than half of Northwest Syria's (NWS) population and decimated the health system, water and sanitation, and public health infrastructure vital for infectious disease control. The first NWS COVID-19 case was declared on July 9, 2020, but impact estimations in this region are minimal. With the rollout of vaccination and emergence of the B.1.617.2 (Delta) variant, we aimed to estimate the COVID-19 trajectory in NWS and the potential effects of vaccine coverage and hospital occupancy. METHODS: We conducted a mixed-method study, primarily including modeling projections of COVID-19 transmission scenarios with vaccination strategies using an age-structured, compartmental susceptible-exposed-infectious-recovered (SEIR) model, supported by data from 20 semi-structured interviews with frontline health workers to help contextualize interpretation of modeling results. RESULTS: Modeling suggested that existing low stringency non-pharmaceutical interventions (NPIs) minimally affected COVID-19 transmission. Maintaining existing NPIs after the Delta variant introduction is predicted to result in a second COVID-19 wave, overwhelming hospital capacity and resulting in a fourfold increased death toll. Simulations with up to 60% vaccination coverage by June 2022 predict that a second wave is not preventable with current NPIs. However, 60% vaccination coverage by June 2022 combined with 50% coverage of mask-wearing and handwashing should reduce the number of hospital beds and ventilators needed below current capacity levels. In the worst-case scenario of a more transmissible and lethal variant emerging by January 2022, the third wave is predicted. CONCLUSION: Total COVID-19 attributable deaths are expected to remain relatively low owing largely to a young population. Given the negative socioeconomic consequences of restrictive NPIs, such as border or school closures for an already deeply challenged population and their relative ineffectiveness in this context, policymakers and international partners should instead focus on increasing COVID-19 vaccination coverage as rapidly as possible and encouraging mask-wearing.
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spelling pubmed-88084332022-02-02 SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict Marzouk, Manar Alhiraki, Omar Alrashid Aguas, Ricardo Gao, Bo Clapham, Hannah Obaid, Wael Altaleb, Hani Almhawish, Naser Rihawi, Hazem Abbara, Aula Douedari, Yazan Hariri, Mahmoud Howard, Natasha Int J Infect Dis Article INTRODUCTION: Ten years of conflict has displaced more than half of Northwest Syria's (NWS) population and decimated the health system, water and sanitation, and public health infrastructure vital for infectious disease control. The first NWS COVID-19 case was declared on July 9, 2020, but impact estimations in this region are minimal. With the rollout of vaccination and emergence of the B.1.617.2 (Delta) variant, we aimed to estimate the COVID-19 trajectory in NWS and the potential effects of vaccine coverage and hospital occupancy. METHODS: We conducted a mixed-method study, primarily including modeling projections of COVID-19 transmission scenarios with vaccination strategies using an age-structured, compartmental susceptible-exposed-infectious-recovered (SEIR) model, supported by data from 20 semi-structured interviews with frontline health workers to help contextualize interpretation of modeling results. RESULTS: Modeling suggested that existing low stringency non-pharmaceutical interventions (NPIs) minimally affected COVID-19 transmission. Maintaining existing NPIs after the Delta variant introduction is predicted to result in a second COVID-19 wave, overwhelming hospital capacity and resulting in a fourfold increased death toll. Simulations with up to 60% vaccination coverage by June 2022 predict that a second wave is not preventable with current NPIs. However, 60% vaccination coverage by June 2022 combined with 50% coverage of mask-wearing and handwashing should reduce the number of hospital beds and ventilators needed below current capacity levels. In the worst-case scenario of a more transmissible and lethal variant emerging by January 2022, the third wave is predicted. CONCLUSION: Total COVID-19 attributable deaths are expected to remain relatively low owing largely to a young population. Given the negative socioeconomic consequences of restrictive NPIs, such as border or school closures for an already deeply challenged population and their relative ineffectiveness in this context, policymakers and international partners should instead focus on increasing COVID-19 vaccination coverage as rapidly as possible and encouraging mask-wearing. The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. 2022-04 2022-02-02 /pmc/articles/PMC8808433/ /pubmed/35123027 http://dx.doi.org/10.1016/j.ijid.2022.01.062 Text en © 2022 The Author(s) Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Marzouk, Manar
Alhiraki, Omar Alrashid
Aguas, Ricardo
Gao, Bo
Clapham, Hannah
Obaid, Wael
Altaleb, Hani
Almhawish, Naser
Rihawi, Hazem
Abbara, Aula
Douedari, Yazan
Hariri, Mahmoud
Howard, Natasha
SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict
title SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict
title_full SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict
title_fullStr SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict
title_full_unstemmed SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict
title_short SARS-CoV-2 transmission in opposition-controlled Northwest Syria: modeling pandemic responses during political conflict
title_sort sars-cov-2 transmission in opposition-controlled northwest syria: modeling pandemic responses during political conflict
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808433/
https://www.ncbi.nlm.nih.gov/pubmed/35123027
http://dx.doi.org/10.1016/j.ijid.2022.01.062
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