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

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  • 1 Institute for Disease Modeling, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington;
  • 2 Consultant to the Bill & Melinda Gates Foundation, Seattle, Washington;
  • 3 Department of Computer Science, Vermont Complex Systems Center, University of Vermont, Burlington, Vermont;
  • 4 Department of Computer Science, University of Vermont, Burlington, Vermont;
  • 5 Network Science Institute, Northeastern University, Boston, Massachusetts;
  • 6 Department of Marine and Environmental Sciences, Northeastern University, Boston, Massachusetts;
  • 7 Department of Physics, Northeastern University, Boston, Massachusetts;
  • 8 Department of Health Sciences, Northeastern University, Boston, Massachusetts;
  • 9 ISI Foundation, Turin, Italy;
  • 10 University of Washington, Seattle, Washington;
  • 11 New Mexico State University, Las Cruces, New Mexico

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.

Author Notes

Address correspondence to Benjamin M. Althouse, Institute for Disease Modeling, Global Health Division Bill & Melinda Gates Foundation, 500 5th Ave. N, Seattle, WA 98109. E-mail: balthouse@idmod.org

Disclosure: Data are available with the manuscript.

Financial support: L. A. S., P. S., B. H., A. L. O., N. N., D. M., A. O., and B. M. A. were funded by the Bill & Melinda Gates Foundation through the Global Good Fund. L. H.-D. acknowledges support from the National Institutes of Health 1P20 GM125498-01 Centers of Biomedical Research Excellence Award. S. V. S. is supported by startup funds provided by Northeastern University.

Authors’ addresses: Laura A. Skrip, Prashanth Selvaraj, Brittany Hagedorn, Andre Lin Ouédraogo, Navideh Noori, Amanda Orcutt, and Dina Mistry, Department of Epidemiology, Institute for Disease Modeling, Seattle, WA, E-mails: lskrip@idmod.org, pselvaraj@idmod.org, bhagedorn@idmod.org, aouedraogo@idmod.org, nnoori@idmod.org, aorcutt@idmod.org, and dmistry@idmod.org. Jamie Bedson, Bill & Melinda Gates Foundation, Seattle, WA, E-mail: bma85@uw.edu. Laurent Hébert-Dufresne, Department of Computer Science, University of Vermont, Burlington, VT, E-mail: laurent.hebert-dufresne@uvm.edu. Samuel V. Scarpino, College of Science, Northeastern University D’Amore-McKim School of Business, Boston, MA, E-mail: s.scarpino@northeastern.edu. Benjamin M. Althouse, Department of Epidemiology, Institute for Disease Modeling, Seattle, WA, Information School, University of Washington, Seattle, WA, and Department of Biology, New Mexico State University, Las Cruces, NM, E-mail: balthouse@idmod.org.

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