Modeling COVID-19 Transmission in Africa: Country-wise Projections of Total and Severe Infections Under Different Lockdown Scenarios
Authors: Frost Isabel , Craig Jessica , Osena Gilbert , Hauck Stephanie , Kalanxhi Erta , Schueller Emily , Gatalo Oliver , Yang Yupeng , Tseng Katie , Lin Gary , Klein Eili 
Published: September 2020

ABSTRACTObjectivesAs of August 24th2020, there have been 1,084,904 confirmed cases of SARS-CoV-2 and 24,683 deaths across the African continent. Despite relatively lower numbers of cases initially, many African countries are now experiencing an exponential increase in case numbers. Estimates of the progression of disease and potential impact of different interventions are needed to inform policy making decisions. Herein, we model the possible trajectory of SARS-CoV-2 in 52 African countries under different intervention scenarios.DesignWe developed a compartmental model of SARS-CoV-2 transmission to estimate the COVID-19 case burden for all African countries while considering four scenarios: no intervention, moderate lockdown, hard lockdown, and hard lockdown with continued restrictions once lockdown is lifted. We further analyzed the potential impact of COVID-19 on vulnerable populations affected by HIV/AIDS and TB.ResultsIn the absence of an intervention, the most populous countries had the highest peaks in active projected number of infections with Nigeria having an estimated 645,081 severe infections. The scenario with a hard lockdown and continued post-lockdown interventions to reduce transmission was the most efficacious strategy for delaying the time to the peak and reducing the number of cases. In South Africa projected peak severe infections increase from 162,977 to 203,261, when vulnerable populations with HIV/AIDS and TB are included in the analysis.ConclusionThe COVID-19 pandemic is rapidly spreading across the African continent. Estimates of the potential impact of interventions and burden of disease are essential for policy makers to make evidence-based decisions on the distribution of limited resources and to balance the economic costs of interventions with the potential for saving lives.ARTICLE SUMMARYStrengths and limitations of this studyThough the rapid spread of SARS-CoV-2 through China, Europe and the United States has been well-studied, leading to a detailed understanding of its biology and epidemiology, the population and resources for combatting the spread of the disease in Africa greatly differ to those areas and require models specific to this context.Few models that provide estimates for policymakers, donors, and aid organizations focused on Africa to plan an effective response to the pandemic threat that optimizes the use of limited resources.This is a compartmental model and as such has inherent weaknesses; including the possible overestimation of the number of infections as it is assumed people are well mixed, despite many social, physical and geographical barriers to mixing within countries.Peaks in transmission are likely to occur at different times in different regions, with multiple epicenters.This model is not stochastic and case data are modeled from the first twenty or more cases, each behaving as an average case; in reality, there are no average cases; some individuals are likely to have many contacts, causing multiple infections, and others to have very few.