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India simulations from Johns Hopkins, application for Nigeria

Johns Hopkins University’s Center for Disease Dynamics, Economics and Policy just realised its covid-19 simulations and recommendations for India. The Center used a well-validated model, IndiaSIM, and available data from China and India using information such as age, gender, severity of infection, case-fatality rates, as well as seasonality and looked at a number of scenarios.

The study identified three scenarios:

* indicates required
  • High – current country-wide lockdowns but insufficient physical distancing and compliance
  • Medium – Moderate to full compliance with current country-wide lockdowns and no change in virulence by season
  • Low – decreased virulence and temperature/humidity sensitivity

In the high scenario, there is a peak in early May with 250 million people in India (excluding any cases that have since recovered) and 2.5 million people hospitalised. These figures do not include the total number of people that would contract covid-19, nor the total number that would require hospitalisation, and instead offer a point-in-time analysis of the type of required capacity for India. While this analysis has not yet been conducted for Nigeria, applying similar rates would mean a peak infection rate (people showing symptoms, people hospitalised, and people asymptomatic) of 36 million people in Nigeria. Applying similar ratios for hospitalisation, this would mean 360,000 people requiring hospitalisation at the same time.

The projections for India strongly highlight a few important points that Nigeria should consider – even as projections are being developed for Nigeria:

  • We need to urgently increase and deploy testing on a wider scale. Nigeria has completed fewer tests than South Africa, and increasing the number of detected cases can help with communications and managing resources.
  • We need to urgently source more ventilators. The model suggests ventilator demand will be 1 million for India, compared to the current availability estimated between 30-50,000 ventilators (in comparison the USA has 160,000 ventilators and
  • We need to implore our elders to stay at home, and not go out or receive visitors. Reducing all non-essential outings and physical contact (social distancing) focused on the elderly helps to delay infections in the India model, i.e., three week complete isolation allows delays in infections to later in the year (“flattening the curve”) until July. We should also focus on children under five according to Johns Hopkins, most likely due to the high under-five mortality rate in India – and in Nigeria.
  • We need to consider state level lockdowns, based on data. These data-driven lockdowns can help to “change the trajectory of the epidemic” and stem the likely economic damage of widescale lockdowns.
  • We need to have appropriate cleaning at the facilities and adequate personal protective equipment (PPE) for our health workers. And we need more temporary hospitals. Hospital outbreaks affect the sensitivity of the model and for India suggested that large temporary hospitals are needed urgently, and that hospital-based transmission can “fuel the epidemic”. Further, mortality in healthcare workers can further increase deaths.

 

 

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