@article{fdi:010079785,
  title = {{R}econciling model predictions with low reported cases of {COVID}-19 in {S}ub-{S}aharan {A}frica : insights from {M}adagascar},
  author = {{E}vans, {M}. {V}. and {G}architorena, {A}ndres and {R}akotonanahary, {R}. {J}. {L}. and {D}rake, {J}. {M}. and {A}ndriamihaja, {B}. and {R}ajaonarifara, {E}. and {N}gonghala, {C}. {N}. and {R}oche, {B}enjamin and {B}onds, {M}. {H}. and {R}akotonirina, {J}.},
  editor = {},
  language = {{ENG}},
  abstract = {{COVID}-19 has wreaked havoc globally with particular concerns for sub-{S}aharan {A}frica ({SSA}), where models suggest that the majority of the population will become infected. {C}onventional wisdom suggests that the continent will bear a higher burden of {COVID}-19 for the same reasons it suffers from other infectious diseases: ecology, socio-economic conditions, lack of water and sanitation infrastructure, and weak health systems. {H}owever, so far {SSA} has reported lower incidence and fatalities compared to the predictions of standard models and the experience of other regions of the world. {T}here are three leading explanations, each with different implications for the final epidemic burden: (1) low case detection, (2) differences in epidemiology (e.g. low{R}(0)), and (3) policy interventions. {T}he low number of cases have led some {SSA} governments to relaxing these policy interventions. {W}ill this result in a resurgence of cases? {T}o understand how to interpret the lower-than-expected {COVID}-19 case data in {M}adagascar, we use a simple age-structured model to explore each of these explanations and predict the epidemic impact associated with them. {W}e show that the incidence of {COVID}-19 cases as of {J}uly 2020 can be explained by any combination of the late introduction of first imported cases, early implementation of non-pharmaceutical interventions ({NPI}s), and low case detection rates. {W}e then re-evaluate these findings in the context of the {COVID}-19 epidemic in {M}adagascar through {A}ugust 2020. {T}his analysis reinforces that {M}adagascar, along with other countries in {SSA}, remains at risk of a growing health crisis. {I}f {NPI}s remain enforced, up to 50,000 lives may be saved. {E}ven with {NPI}s, without vaccines and new therapies, {COVID}-19 could infect up to 30% of the population, making it the largest public health threat in {M}adagascar for the coming year, hence the importance of clinical trials and continually improving access to healthcare.},
  keywords = {{COVID}-19 ; {M}adagascar ; infectious disease modelling ; non-pharmaceutical ; interventions ; age-structured contacts ; outbreak response ; {MADAGASCAR}},
  booktitle = {},
  journal = {{G}lobal {H}ealth {A}ction},
  volume = {13},
  numero = {1},
  pages = {1816044 [9 ]},
  year = {2020},
  DOI = {10.1080/16549716.2020.1816044},
  URL = {https://www.documentation.ird.fr/hor/fdi:010079785},
}