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African responses to Covid id-19: approaches, , gaps and ways forw rward Dr Lesong Conteh & Dr Lucy Kanya LSE Health, Department of Health Policy Outline of the Webinar Introduction to AHOP COVID-19 What was hypothesized across

  1. African responses to Covid id-19: approaches, , gaps and ways forw rward Dr Lesong Conteh & Dr Lucy Kanya LSE Health, Department of Health Policy

  2. Outline of the Webinar • Introduction to AHOP COVID-19 • What was hypothesized across Africa? • What is currently happening? • What do we know? • What don’t we know? • Why the current Covid-19 impact? • What does the future hold?

  3. A r region ional al partne nership ip to to promot mote What is AHOP? evidence ce-in info forme rmed policy-ma makin king

  6. Up coming Covid-19 Outputs

  7. Covid-19 19 What was hypothesised for Afr frica?

  11. Covid-19 19 Current Sit ituation?

  12. Current Sit ituation • What do we know?

  13. https://covid19.who.int/ Accessed 20 th April 2020

  18. Africa CDC

  21. Current Sit ituation • What don’t we know?

  27. Covid-19 19 Why the im impact so far?

  28. Demographics In sub-Saharan Africa 3% of the population are ≥ 65 years old 43% < 15 years old European Union 20% of the population are ≥ 65 years or older 17% are < 15 years

  30. Swift introduction of containment measures? • Most African countries implemented lockdowns far earlier than high- income countries. • By the end of April at least 42 African countries had done so; 38 of these were in place for at least 21 days.

  31. The Oxford COVID-19 Government Response Tracker (OxCGRT)

  32. Health System Resilience Prin rincip iples of of Heal alth Systems s Resili ilience in in th the Con ontext of of COVID-19 Response 1. Develop flexible pathways for medical supplies 2. Prioritise a list of essential health services. 3. Build trust with local communities 4. Foster good communication at all system levels 5. Support, recognise and encourage staff 6. Facilitate rapid resource flow to front line providers and greater flexibility in its use 7. Ensure agile tracking of health information. 8. Cultivate effective partnerships and networks Policy Brief from DFID- and NIHR commissioned research initiatives

  33. The ‘Ebola Legacy’? Gl Global Lea Leadership to to Su Suppor ort Afr fric ica's s Res esponse to to COVID-19 19

  34. Other suggestions? • Covid-19 is there we are just not testing and identifying it? • Excess mortality data to support this? • Transport links ? • Protection of other vaccines on the EPI schedule ? • Very few people who are obese, although the numbers are rising? • We do not know as yet…….

  35. Covid-19 19 Evidence & In Insights fr from Eth thiopia

  36. COVID-19 in Ethiopia: A big escape or a long wait?

  37. Authors Dr. Dawit Wondimagegn 1 , Abiy Seifu Estifanos 2 , Dr.Helen Yifter Bitew 1 , Dr. Tesfamariam Aklilu 1 , Dr. Yidnekachew Asrat 1 ,Kehabtimer Shiferaw, Dr Adane Petros 1 , Dr. Tewodros Haile 1 ,Dr. Adamu Addissie 2 , Prof. Damen Hailemariam 2 , Dr. Wondwossen Amogne 1 1 School of Medicine, Addis Ababa University 2 School of Public Health, Addis Ababa University COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  38. Contents Introduction Method Results Discussions Recommendations COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  39. More than 110 million population Among 13 top priority African countries 35 times a week flight to China has one of the lowest confirmed cases COVID-19 in in Eth thiopia: : A big ig es escape or r a lo long wait?

  40. Method Focused Group Discussion Panel discussion • Narrative analysis Clinical with a larger • Public Health of the evidence group • Health System Leadership • Policy COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  41. Findings of brainstorming Testing related issues Immunity and low Public health Time in the phase’s susceptibility Measures of Pandemic Self and institutional High infectious disease rate ?early intervention 10 th week reporting providing protection Disclosure Environment Quarantine Pre growth phase Contact tracing Age, Urban/rural ratio Isolation Prolonged incubation Social determinants: culture, diet, Banning mass period and asymptomatic pets gathering shedding Testing Capacity Immunizations, Hygiene hypothesis Border Closure Narrow case definition Genetic diversity School closure Specimen Cross immunity with other virus Health education and Collection/transportation campaigns Training and Experience Prevalence of Comorbidities Standardization for local use Travel and Movement rate Low adjuvant investigations General naiveté for modern medicine COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  42. Testing Related Issues COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  43. Testing related factors 65,760 tests 389 Confirmed cases COVID-19 in in Eth thiopia: : A big ig es escape or r a lo long wait?

  44. Testing related issues • Testing coverage • Number of tests for each confirmed cases • Case fatality COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  45. COVID-19 in in Eth thiopia: : A big ig es escape or r a lo long wait?

  46. Comparison of Mortality before and after the COVID-19 pandemic and from the last year 415 371 351 342 326 308 303 264 255 251 245 245 203 221 221 169 Sep Oct Nov Dec Jan Feb March April 2011 2012

  47. Immunity and low susceptibility COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  48. Burden of infectious disease and COVID-19 • Negative association of burden of TB and Malaria with COVID-19 • BCG Vaccination COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  49. Malaria and COVID-19 COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  50. Genetic diversity viral and Host • ACE2 receptor overexpression • Patient derived mutations • Around 30 • Difference in virulence More than 270 times COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  51. Environment • Altitude • Temperature and Humidity COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  52. Altitude Does the pathogenesis of SAR-CoV-2 virus decrease at high-altitude? Respiratory Physiology & Neurobiology. 2020 ;277:103443. COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  53. Altitude Does the pathogenesis of SAR-CoV-2 virus decrease at high-altitude? Respiratory Physiology & Neurobiology. 2020 ;277:103443. COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  54. Altitude COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  55. Temperature and humidity • Other corona viruses show seasonality 1 • Most viable at low relative humidity [20%] and low temperatures (4 degree Celsius) 2 • Cold and dry conditions may facilitate the spread of the covid-19 2 1 K. H. Chan, et al. Advances in Virology., Vol. 2011, 2011. 2 Kai Feng et al. arxiv:2003.05003 [q-bio.pe]. 2020 COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  56. Temperature and humidity COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  57. Temperature and humidity COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  58. Temperature and humidity COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  59. Social determinants • Age • Urban/Rural ratio • International exposures COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  60. Urban vs. rural Rural COVID-19 Cases Lag Urban Areas but Are Growing Much More Rapidly , April 3, 2020, S.J. Goetz, Z. Tian; NERCRD and Penn State University COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  61. Urban vs. rural Rural COVID-19 Cases Lag Urban Areas but Are Growing Much More Rapidly , April 3, 2020, S.J. Goetz, Z. Tian; NERCRD and Penn State University COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  62. Social determinants Africa Center for Strategic Studies, Mapping Risk Factors for the Spread of COVID-19 in Africa, infographic , April 3, 2020. COVID-19 in in Eth thio iopia ia: A big ig esc scape or a lo long wait it?

  63. Comorbidities • Hypertension: 16% 1 • Diabetes: 3.2% 1 • Smoking: 5% 2 • Cardiovascular disease: 4-24% 3 • Cancer: 0.3% 3 • Asthma and COPD: 4% and 17% 3 1 Prevalence of high bloodpressure, hyperglycemia, dyslipidemia, metabolic syndrome and their determinants in Ethiopia: Evidences from the National NCDs STEPS Survey, 2015 2 WHO report on the global tobacco epidemic, 2019 Country profile Ethiopia 3 Epidemiology of major Non-communicable Disease in Ethiopia: Asystematic review, Awoke Misganawet al. J Health Popul Nutr. 2014 Mar.

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