The COVID-19 pandemic has resulted in substantial mortality worldwide. However, to date, countries in the Middle East and Africa have reported considerably lower mortality rates than in Europe and the Americas. Motivated by reports of an overwhelmed health system, we estimate the likely under-ascertainment of COVID-19 mortality in Damascus, Syria. Using all-cause mortality data, we fit a mathematical model of COVID-19 transmission to reported mortality, estimating that 1.25% of COVID-19 deaths (sensitivity range 1.00% – 3.00%) have been reported as of 2 September 2020. By 2 September, we estimate that 4,380 (95% CI: 3,250 – 5,550) COVID-19 deaths in Damascus may have been missed, with 39.0% (95% CI: 32.5% – 45.0%) of the population in Damascus estimated to have been infected. Accounting for under-ascertainment corroborates reports of exceeded hospital bed capacity and is validated by community-uploaded obituary notifications, which confirm extensive unreported mortality in Damascus. Reported COVID-19 mortality rates have been relatively low in Syria, but there has been concern about overwhelmed health systems. Here, the authors use community mortality indicators and estimate that <3% of COVID-19 deaths in Damascus were reported as of 2 September 2020.
【저자키워드】 SARS-CoV-2, Epidemiology, Computational models, Developing world, 【초록키워드】 COVID-19, Europe, Mortality, COVID-19 pandemic, hospital, health systems, sensitivity, death, Community, health system, COVID-19 mortality, COVID-19 transmission, Middle East, all-cause mortality, lower mortality, Americas, accounting, country, reported, mathematical, exceeded, Damascus, 【제목키워드】 Mortality, Transmission dynamics, Community, COVID-19 mortality, Damascus,