Anticipating the impact of COVID19 and comorbidities on the South African healthcare system by agent-based simulations

Jan Christian Schlüter,Jan Christian Schlüter,Jan Christian Schlüter,Wieland Staab,Leif Sörensen,Andreas Bossert,Andreas Bossert,Benjamin Wacker,Benjamin Wacker,Moritz Kersting,Moritz Kersting

doi:10.1038/s41598-021-86580-w

Abstract

Tuberculosis (TB) is the 10th leading cause of death worldwide, and since 2007 it has been the main cause of death from a single infectious agent, ranking above HIV/AIDS. The current COVID-19 is a pandemic which caused many deaths around the world. The danger is not only a coinfection as observed for TB and HIV for a long time, but that both TB and SARS-CoV-2 affect the respiratory organs and thus potentiate their effect or accelerate the critical course. A key public health priority during the emergence of a novel pathogen is the estimation of the clinical need to assure adequate medical treatment. This requires a correct adjustment to the critical case detection rate and the prediction of possible scenarios based on known patterns. The African continent faces constraining preconditions in regard to healthcare capacities and social welfare which may hinder required countermeasures. However, given the high TB prevalence rates, COVID-19 may show a particular severe course in respective African countries, e.g. South Africa. Using WHO’s TB and public infrastructure data, we conservatively estimate that the symptomatic critical case rate, which affects the healthcare system, is between 8 and 12% due to the interaction of COVID-19 and TB, for a TB population of 0.52% in South Africa. This TB prevalence leads to a significant increase in the peak load of critical cases of COVID-19 patients and potentially exceeds current healthcare capacities.

Highlights

Tuberculosis (TB) is the 10th leading cause of death worldwide, and since 2007 it has been the main cause of death from a single infectious agent, ranking above HIV/AIDS
We propose that risk groups, e.g. TB patients, increase the relevance of adequate measures against the COVID-19 pandemic
We show results from an agent-based epidemiological modified transport simulation where we included the proportion of TB infected in Nelson Mandela Bay Municipality (NMBM) in South Africa according to sociodemographic data

Summary

Introduction

Tuberculosis (TB) is the 10th leading cause of death worldwide, and since 2007 it has been the main cause of death from a single infectious agent, ranking above HIV/AIDS. Apart from severe human costs, these measures come at high economic costs[4] and may pose a particular burden on developing countries, e.g. on the African c ontinent[5,6] Under these circumstances patients suffering from comorbidities may not be assured required treatment once African countries face increasing COVID-19 infection numbers in the months[7,8]. A potential reason is the low number in tests per day in several countries, e.g. a little more than 5000 daily tests over a target volume of 10,000–15,000 in South Africa These countries are likely to face a rapid increase in infections over the coming weeks and require effective countermeasures. Despite criticism on the strict enforcement of the m easures[17], rigid lockdowns have shown positive results regarding the mitigation of COVID-19 spread e lsewhere[18]

Methods

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Conclusion