The potential effects of widespread community transmission of SARS-CoV-2 infection in the World Health Organization African Region: a predictive model.
世界卫生组织非洲地区SARS-CoV-2 广泛社区传播的潜在影响: 预测模型。
- 作者列表："Cabore JW","Karamagi HC","Kipruto H","Asamani JA","Droti B","Seydi ABW","Titi-Ofei R","Impouma B","Yao M","Yoti Z","Zawaira F","Tumusiime P","Talisuna A","Kasolo FC","Moeti MR
:The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been unprecedented in its speed and effects. Interruption of its transmission to prevent widespread community transmission is critical because its effects go beyond the number of COVID-19 cases and deaths and affect the health system capacity to provide other essential services. Highlighting the implications of such a situation, the predictions presented here are derived using a Markov chain model, with the transition states and country specific probabilities derived based on currently available knowledge. A risk of exposure, and vulnerability index are used to make the probabilities country specific. The results predict a high risk of exposure in states of small size, together with Algeria, South Africa and Cameroon. Nigeria will have the largest number of infections, followed by Algeria and South Africa. Mauritania would have the fewest cases, followed by Seychelles and Eritrea. Per capita, Mauritius, Seychelles and Equatorial Guinea would have the highest proportion of their population affected, while Niger, Mauritania and Chad would have the lowest. Of the World Health Organization's 1 billion population in Africa, 22% (16%-26%) will be infected in the first year, with 37 (29 - 44) million symptomatic cases and 150 078 (82 735-189 579) deaths. There will be an estimated 4.6 (3.6-5.5) million COVID-19 hospitalisations, of which 139 521 (81 876-167 044) would be severe cases requiring oxygen, and 89 043 (52 253-106 599) critical cases requiring breathing support. The needed mitigation measures would significantly strain health system capacities, particularly for secondary and tertiary services, while many cases may pass undetected in primary care facilities due to weak diagnostic capacity and non-specific symptoms. The effect of avoiding widespread and sustained community transmission of SARS-CoV-2 is significant, and most likely outweighs any costs of preventing such a scenario. Effective containment measures should be promoted in all countries to best manage the COVID-19 pandemic.
严重急性呼吸系统综合症coronavirus-2 (SARS-CoV-2) 的传播速度和影响前所未有。阻断其传播以防止广泛的社区传播至关重要，因为其影响超出了新型冠状病毒肺炎和死亡的数量，并影响了卫生系统提供其他基本服务的能力。突出这种情况的影响，这里提出的预测是使用马尔可夫链模型得出的，过渡状态和国家特定的概率是根据目前可用的知识得出的。暴露的风险和脆弱性指数用于使概率针对具体国家。结果预测了阿尔及利亚、南非和喀麦隆等小国暴露的高风险。尼日利亚的感染人数将最多，其次是阿尔及利亚和南非。毛里塔尼亚的案件最少，其次是塞舌尔和厄立特里亚。人均、毛里求斯、塞舌尔和赤道几内亚受影响的人口比例最高，尼日尔、毛里塔尼亚和乍得最低。世界卫生组织在非洲的 10亿人口中，第一年将有 22% 人 (16%-26%) 感染，其中 37 人 (29 - 44) 百万症状病例和 150 078 (82 735-189 579) 死亡。估计将有 4.6 (3.6-5.5) 新型冠状病毒肺炎住院治疗，其中 139 521 (81 876-167 044) 将是需要氧气的严重病例，和 89 043 (52 253-106 599) 需要呼吸支持的危重病例。所需的缓解措施将使卫生系统的能力严重紧张，特别是二级和三级服务，而由于诊断能力弱和非特异性症状，许多病例可能在初级保健设施中未被发现。避免SARS-CoV-2 的广泛和持续社区传播的效果是显著的，并且很可能超过防止这种情况的任何成本。应在所有国家推广有效的遏制措施，以最好地管理新型冠状病毒肺炎大流行病。
METHODS::Since mid-December of 2019, coronavirus disease 2019 (COVID-19) infection has been spreading from Wuhan, China. The confirmed COVID-19 patients in South Korea are those who came from or visited China. As secondary transmissions have occurred and the speed of transmission is accelerating, there are rising concerns about community infections. The 54-year old male is the third patient diagnosed with COVID-19 infection in Korea. He is a worker for a clothing business and had mild respiratory symptoms and intermittent fever in the beginning of hospitalization, and pneumonia symptoms on chest computerized tomography scan on day 6 of admission. This patient caused one case of secondary transmission and three cases of tertiary transmission. Hereby, we report the clinical findings of the index patient who was the first to cause tertiary transmission outside China. Interestingly, after lopinavir/ritonavir (Kaletra, AbbVie) was administered, β-coronavirus viral loads significantly decreased and no or little coronavirus titers were observed.
METHODS::In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.
METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.