COVID-19 morbidity and mortality, estimation for Afghanistan
Produced by[1]:
Palwasha Anwari, MD,
MSc (Epidemiology)
Najibullah Safi, MD, MSc. HPM
Purpose: to inform
planning purpose for Afghanistan. It roughly gives the total number of infected
cases, hospitalizations, cases required intensive care (ICU) and deaths. It
also looked at what are needed in terms of hospital capacity, ICU and
ventilators.
FluSurge model
carries below assumptions
No.
1 Average length of non-ICU hospital
stay for influenza-related illness is 5 days.
No.
2 Average length of ICU stay for
influenza-related illness is 10 days.
No.
3 Average length of ventilator usage
for influenza-related illness is 10 days.
No.
4 Average proportion of admitted
influenza patients will need ICU care is 15%.
No.
5 Average proportion of admitted
influenza patients will need ventilators is 7.5%.
No.
6 Average proportion of influenza
deaths assumed to be hospitalized is 70%.
No.
7 Daily percentage increase in cases
arriving compared to previous day is 3%.
Scenarios:
·
Minimum (the best-case scenario), which
estimates the fewest possible number of hospitalizations
·
Mean (the most likely scenario), which estimates the number
of hospitalizations most likely to occur
·
Maximum (the worst-case scenario)
Model Input
1.
Age groups: into three categories and is taken
from Afghanistan National Statistics and Information Authority published
yearbook 2018-2019[2]
a.
0-19 years- children and school-aged children
b.
20-64 years- working adults
c.
+65 years- retirees
2. Number of basic
hospital resources
a. Total number of
non-ICU beds/Hospital beds= 13,623 beds based on Yearbook 2018-2019
b. Total number of
ICU- There are 200 ICU beds available in hospitals.
c. Total number of
ventilators- 200[3]
3.
Duration of pandemic
We assumed
12 weeks duration of pandemic- the maximum. (the minimum scenario is 6 weeks
and middle case is 8 weeks.
4. Attack rate
It is
assumed 25% of pandemic. 35% and 15% for maximum and minimum scenario.
Figure 1 weekly distribution of hospital admission of cases.
Results:
|
Figure 1 weekly distribution of hospital admission of cases.
|
Most likely scenario
|
Minimum scenario
|
Maximum scenario
|
|
Pandemic impact/attack rate
|
25%
|
15%
|
35%
|
Total hospital Admission
|
58,844
|
18,018
|
100,184
|
Total deaths
|
9,162
|
3,430
|
21,508
|
Weekly distribution of Hospital admission
The weekly distribution of hospital
admission due to pandemic was based on 12-week duration and 25% clinical gross
attack rate. The peak weeks are in the 6th
and 7th for all three scenarios. In mostly likely scenario around 8,827
(range of 2,703-15,028) cases will be admitted per week in hospitals during
peak time.
Currently we
have 200 ICUs across country. Need for ICU increases from week 1 (88 beds) to 1,946
ICU beds (973% of ICU capacity needed).
Need for
ventilator capacity increases from 44 ventilators in week 1 to 973 ventilators
in the 7th week (487%), the peak of admitted cases.
Death occurrence:
1. # of deaths from the disease: The total number of patients that died during
each pandemic week. Here, we assume that deaths start at the beginning of the 3rd
week from 92 to peak of 1,374 deaths in the 8th week.
2. # of deaths in hospital: The total number of patients would die in
hospitals during each pandemic week. The peck death will be in the week 8th
and 9th 962 death.
[1]
Contribution:
-
Dr. Anwari: lead the
process, shaped the idea, consulted CDC expert on using the model for COVID-19
estimates, did the data analysis and drafted the paper
-
Dr. Safi: assisted in
shaping the idea, provided input data, reviewed and adjusted the final
estimates
[2] Population source: Afghanistan
Statistical Yearbook 2018-2019, https://nsia.gov.af/library
[3]
Date source for ICU beds and number of ventilators- Directorate of National
Hospitals, Ministry of Public Health
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