Abstract
BackgroundCOVID-19 spread may have a dramatic impact in countries with vulnerable economies and limited availability of, and access to, healthcare resources and infrastructures. However, in sub-Saharan Africa, a low prevalence and mortality have been observed so far.MethodsWe collected data on individuals’ social contacts in the South West Shewa Zone (SWSZ) of Ethiopia across geographical contexts characterized by heterogeneous population density, work and travel opportunities, and access to primary care. We assessed how socio-demographic factors and observed mixing patterns can influence the COVID-19 disease burden, by simulating SARS-CoV-2 transmission in remote settlements, rural villages, and urban neighborhoods, under school closure mandate.ResultsFrom national surveillance data, we estimated a net reproduction number of 1.62 (95% CI 1.55–1.70). We found that, at the end of an epidemic mitigated by school closure alone, 10–15% of the population residing in the SWSZ would have been symptomatic and 0.3–0.4% of the population would require mechanical ventilation and/or possibly result in a fatal outcome. Higher infection attack rates are expected in more urbanized areas, but the highest incidence of critical disease is expected in remote subsistence farming settlements. School closure contributed to reduce the reproduction number by 49% and the attack rate of infections by 28–34%.ConclusionsOur results suggest that the relatively low burden of COVID-19 in Ethiopia observed so far may depend on social mixing patterns, underlying demography, and the enacted school closures. Our findings highlight that socio-demographic factors can also determine marked heterogeneities across different geographical contexts within the same region, and they contribute to understand why sub-Saharan Africa is experiencing a relatively lower attack rate of severe cases compared to high-income countries.
Highlights
COVID-19 spread may have a dramatic impact in countries with vulnerable economies and limited availability of, and access to, healthcare resources and infrastructures
Social contact data A total of 938 study participants were interviewed with 43% of them living in rural remote settlements, 35% in rural villages, and 22% from urban neighborhoods (Table 1)
The mean household size in remote settlements was 5.5, significantly larger (Tukey test p < 0.001) than in rural villages (4.6, 95% CI 4.4–4.8) and in urban neighborhoods (4.4, 95% CI 4.2–4.6), while no significant difference in the household size was found between the latter two settings (Tukey test p = 0.48)
Summary
COVID-19 spread may have a dramatic impact in countries with vulnerable economies and limited availability of, and access to, healthcare resources and infrastructures. Despite limited access to healthcare [1, 2] and relatively milder social distancing restrictions compared to those imposed in most high-income countries [3, 4], coronavirus disease 2019 (COVID-19) mortality rates have been relatively low throughout Africa [5]. As of January 24, 2021, 133,298 SARS-CoV-2 infections and 2063 deaths [5] were ascertained in the entire country, with thousands of cases reported in all the 12 regions of Ethiopia [9]. Collected samples are analyzed by 38 national, regional, hospital, and private laboratories [10] Both suspected and laboratory-confirmed cases are admitted to isolation centers and discharged after a negative laboratory test [9]. As of January 10, 2021, the overall rate for positive laboratory test results since the first detection of the epidemic in the country was 6.9% [9]
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