METHODS: We analysed COVID-19 seroprevalence and all-cause excess deaths data from the peri-urban district of Kabwe, Zambia between March 2020 and September 2021 with a novel mathematical model. Data encompassed three consecutive waves caused by the wild-type, Beta and Delta variants.
RESULTS: Across all three waves, we estimated a high cumulative attack rate, with 78% (95% credible interval [CrI] 71-85) of the population infected, and a high all-cause excess mortality, at 402 (95% CrI 277-473) deaths per 100,000 people. Ambitiously improving health care to a capacity similar to that in high-income settings could have averted up to 46% (95% CrI 41-53) of accrued excess deaths, if implemented from June 2020 onward. An early and accelerated vaccination rollout could have achieved the highest reductions in deaths. Had vaccination started as in some high-income settings in December 2020 and with the same daily capacity (doses per 100 population), up to 68% (95% CrI 64-71) of accrued excess deaths could have been averted. Slower rollouts would have still averted 62% (95% CrI 58-68), 54% (95% CrI 49-61) or 26% (95% CrI 20-38) of excess deaths if matching the average vaccination capacity of upper-middle-, lower-middle- or LICs, respectively.
CONCLUSIONS: Robust quantitative analyses of pandemic data are of pressing need to inform future global pandemic preparedness commitments.
方法:我们分析了来自Kabwe郊区的COVID-19血清阳性率和全因超额死亡数据,赞比亚在2020年3月至2021年9月之间建立了一个新的数学模型。数据包含由野生型引起的三个连续波,Beta和Delta变体。
结果:在所有三个波中,我们估计累积攻击率很高,78%(95%可信区间[CrI]71-85)的人群被感染,和高的全因超额死亡率,每100,000人中有402例(95%CrI277-473)死亡。将医疗保健水平提高到与高收入环境相似的能力,可以避免高达46%(95%CrI41-53)的累积超额死亡,如果从2020年6月起实施。早期和加速的疫苗接种推广,相反,本可以实现死亡人数的最高减少。在2020年12月开始接种疫苗,就像在一些高收入地区一样,并且每天的容量相同(每100人的剂量),高达68%(95%CrI64-71)的累积超额死亡本可以避免。较慢的推广仍然可以避免62%(95%CrI58-68),54%(95%CrI49-61),或26%(95%CrI20-38)的过量死亡,如果匹配的平均疫苗接种能力,分别,上-中-,中低端,或LIC。
结论:迫切需要对大流行数据进行强有力的定量分析,以便为未来的全球大流行准备承诺提供信息。