Seeding COVID-19 across Sub-Saharan Africa: An Analysis of Reported Importation Events across 49 Countries

  1. Laura A. Skrip
  2. Prashanth Selvaraj
  3. Brittany Hagedorn
  4. Andre Lin Ouédraogo
  5. Navideh Noori
  6. Amanda Orcutt
  7. Dina Mistry
  8. Jamie Bedson
  9. Laurent Hébert-Dufresne
  10. Samuel V. Scarpino
  11. Benjamin M. Althouse

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Abstract

The first case of COVID-19 in sub-Saharan Africa (SSA) was reported by Nigeria on February 27, 2020. Whereas case counts in the entire region remain considerably less than those being reported by individual countries in Europe, Asia, and the Americas, variation in preparedness and response capacity as well as in data availability has raised concerns about undetected transmission events in the SSA region. To capture epidemiological details related to early transmission events into and within countries, a line list was developed from publicly available data on institutional websites, situation reports, press releases, and social media accounts. The availability of indicators—gender, age, travel history, date of arrival in country, reporting date of confirmation, and how detected—for each imported case was assessed. We evaluated the relationship between the time to first reported importation and the Global Health Security Index (GHSI) overall score; 13,201 confirmed cases of COVID-19 were reported by 48 countries in SSA during the 54 days following the first known introduction to the region. Of the 2,516 cases for which travel history information was publicly available, 1,129 (44.9%) were considered importation events. Imported cases tended to be male (65.0%), with a median age of 41.0 years (range: 6 weeks–88 years; IQR: 31–54 years). A country’s time to report its first importation was not related to the GHSI overall score, after controlling for air traffic. Countries in SSA generally reported with less publicly available detail over time and tended to have greater information on imported than local cases.

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  1. Version published to 10.4269/ajtmh.20-1502
  2. Version published to 10.1101/2020.04.01.20050203v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.04.01.20050203: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations: While we attempted to search all available sources, data included in our line list are likely not exhaustive. We also recognize that news sources used to supplement official sources may be less reliable in the information they provide. Information was extracted from available text material only. Videos of press conferences or radio announcements were not considered unless their content appeared in published press articles. By opting to maintain an individual-level database, we were unable to reflect some information provided by national authorities in aggregate form. Where possible, we reconciled totals across individual entries with aggregate information or adjusted for the latter, such as with the importation percentages for South Africa, Senegal, and Mauritius. Furthermore, data were not reported consistently for some indicators. For instance, we note that data being disseminated to the public are often for purposes of information sharing and education rather than to guide detailed decision making. Moreover, with increasing incidence, less information is provided publicly about cases at the individual-level, leading to lack of information on sex, age, and status (importation versus local transmission) for the majority of cases in South Africa, for instance. This precluded our investigation into whether cases with unclassified status may resemble known importations versus locally transmitted cases.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.04.01.20050203v1 on medRxiv