paho model updates for september 03, 2020 · paho model updates for september 03, 2020...

PAHO MODEL UPDATES FOR SEPTEMBER 03, 2020

covid19.healthdata.org Institute for Health Metrics and Evaluation

ESPAÑOL Las últimas proyecciones de COVID-19 realizados por IHME indican que en los países de la región de las Américas se alcanzará 962,365 muertes para el 1o de enero de 2021. Si el uso de cubrebocas en público aumenta al 95%, habrá 805,744 muertes, significando que se podrían salvar 156,621 vidas. Notas metodológicas Las actualizaciones del modelo para la primera semana de septiembre incluyen datos adicionales sobre muertes, casos y covariables hasta el 31 de agosto. Desde hace dos semanas, hemos usado la tasa de letalidad por caso infectado (TLI) la cual afecta sustancialmente el número de infecciones y defunciones estimadas en nuestro modelo, particularmente en los grupos de edad más jóvenes. En esta actualización, las proyecciones se presentan al 1º de enero de 2021. Las gráficas del prefacio muestran el patrón de la TLI por grupo de edad como se usaron anteriormente y la que se usan actualmente Estas curvas muestran la distribución de la TLI por grupo de edad en el mundo. En la primera se observa la TLI en escala logarítmica por grupo de edad y en la segunda el número de infectados por cada defunción, también por grupos de edad. Situación Actual

• Los casos diarios de COVID19 registrados por los países de la región están estables desde hace dos semanas. En cambio, las muertes diarias muestran una ligera disminución a partir de la segunda semana de agosto (gráficas 1 y 2).

• A la fecha, los países de la región que muestran una R efectiva (casos nuevos que causa cada infección) por arriba de 1 son Honduras, Costa Rica, Bolivia, Paraguay y Argentina. Hay que destacar también los que están por debajo de 1, pero arriba de 0.97, como es el caso de Chile, Cuba, Jamaica y Guyana (gráfica 3).

• Dado al bajo número de pruebas por cien mil habitantes en los países de América Latina se detectan menos de 10% de casos (gráfica 4). Observándose proporciones elevadas en las infecciones estimadas en algunos países de América Latina. En Perú y Ecuador se estima que más de un tercio de la población está infectada actualmente. En el caso de México, Brasil y Bolivia la población infectada fluctúa entre 17% y 22% (gráfica 5).

• La tasa de mortalidad diaria por encima de 4 por 1 millón de habitantes se ubica en Brasil, Bolivia, Argentina y Colombia; en Perú la tasa de mortalidad está por arriba de 8 por 1 millón de habitantes (grafica 6).

Factores impulsores de las tendencias de transmisión (movilidad, uso de cubrebocas, pruebas y estacionalidad)

• La región de las Américas muestra, en promedio, baja movilidad en comparación con otras regiones. Sin embargo, esto no se observa en Canadá y Estados Unidos en donde la movilidad es muy cercana a la que existía en enero, antes del inicio de la pandemia. En América Latina, la mayor movilidad se registra en Haití y Nicaragua y ligeramente menor en Brasil, México, Paraguay, Uruguay, Honduras, Cuba, Surinam y Guyana. Los países con menor movilidad detectada en la última semana de agosto son Chile, Perú y Panamá (gráficas 8a y 8b).

• La proporción de personas que salen de su casa usando cubrebocas varía en la región, pero en promedio, es alta desde el mes de julio. En Estados Unidos, Canadá y Haití la proporción es menor a 50%; en Brasil, Uruguay, Nicaragua la proporción va de 70 a 80% y en el resto de los países la proporción es mayor s 80% (gráficas 9a y 9b).



• El desempeño de los países de la región haciendo pruebas diagnósticas es muy desigual. Por un lado Estados Unidos y Chile realizaron más de 150 pruebas por 100 mil habitantes el 31 de agosto. Le siguen con más de 50 pero menos de 150 por 100 mil habitantes, Canadá, Colima, Perú, Surinam Uruguay y Panamá. El resto de los países realizan entre 25 y 49 por 100 mil habitantes y destacan por un desempeño muy pobre México, y Haití con menos de 10 pruebas por cien mil habitantes (gráficas 10a y 10b).

• Si se compara el riesgo de enfermarse por neumonía el 1 de febrero con el 1 de agosto, se observa que en el hemisferio norte es mayor en Canadá y Estados Unidos y el riesgo va descendiendo hasta desaparecer en el hemisferio sur. El efecto de la estacionalidad delas infecciones respiratorias las recoge esta variable (gráfica 11).

Proyecciones • Las proyecciones en un escenario intermedio establecen que se acumularán 962 mil muertes por

COVID19 para el primero de enero de 2021. Esta proyección asume que los países con mortalidad diaria mayor a 8 por 1 millón de habitantes volverán a cerrar su economía por un periodo de seis semanas. Las defunciones por COVID descenderán alrededor de 3 mil al día y volverán a incrementarse por arriba de 5 mil en diciembre. Sin embargo, de mantener la relajación de los mandatos, el peor escenario proyecta 1.26 millones de muertes, con un incremento de las muertes diarias a más de 15 mil en diciembre (graficas 12 y 13).

• Los países que de acuerdo a las proyecciones necesitan re-imponer mandatos son: Perú Colombia y Honduras en septiembre; Costa Rica, México, Estados Unidos y Surinam en octubre; República Dominicana, Panamá y El Salvador en noviembre y el resto no requieren reestablecer mandatos antes del primero de diciembre (grafica 15).

• Incorporando el uso de cubrebocas a 95% de la población se podrían salvar en la región 156 mil vidas para el 1 de enero de 2021 (grafica 14).

• Para finales de 2020 se estima que 8 países de la región presenten más de 22% de su población infectada. Brasil, Colombia, Surinam, Republica Dominicana, Bolivia y Honduras entre 22 y 33%; México y Perú entre 33 y 39% y Ecuador con casi la mitad de su población infectada (gráfica 16).

• Para el primero de enero de 2021 se estima que la mayor mortalidad diaria por COVID la presentarán: Panamá, República Dominicana y Estados Unidos (grafica 17).

• Para la primera semana de enero de 2021 se estima que la segunda causa de muerte en la región será COVID 19, superada por la cardiopatía isquémica (tabla 3).

ENGLISH The latest COVID-19 projections made by IHME indicate that in the pan-American region, 962,365 deaths will be reached by January 1, 2021. If the use of face masks in public increases to 95%, there will be 805,744 deaths, meaning that 156,621 lives could be saved. Methodological notes Model updates for the first week of September include additional data on deaths, cases, and covariates through August 31. For the past two weeks, we have used the infection fatality rate (IFR) which substantially affects the number of infections and deaths estimated in our model, particularly in the younger age groups. In this update, projections are presented through January 1, 2021. The graphs in the preface show the pattern of IFR by age group as used previously and as currently used. These curves show the distribution of IFR by age group worldwide. The first shows the IFR in logarithmic scale by age group and the second the number of infections per death, also by age group.



Current situation

• Daily cases of COVID-19 recorded by countries in the region have been stable for two weeks. In contrast, daily deaths show a slight decrease as of the second week of August (Figures 1 and 2).

• To date, the countries in the region that show an effective R (new cases causing each infection) above 1 are Honduras, Costa Rica, Bolivia, Paraguay, and Argentina. Also noteworthy are those that are below 1 but above 0.97, such as Chile, Cuba, Jamaica, and Guyana (Figure 3).

• Given the low number of tests per 100,000 inhabitants in Latin American countries, less than 10% of cases are detected (Figure 4). High proportions of estimated infections are observed in some Latin American countries. In Peru and Ecuador, it is estimated that more than one-third of the population is currently infected. In the case of Mexico, Brazil, and Bolivia, the infected population fluctuates between 17% and 22% (Figure 5).

• A daily mortality rate above 4 per 1 million inhabitants is observed in Brazil, Bolivia, Argentina, and Colombia; in Peru the mortality rate is above 8 per 1 million inhabitants (Figure 6).

Drivers of transmission trends (mobility, mask use, testing, and seasonality)

• The PAHO region shows, on average, low mobility compared to other regions. However, this is not observed in Canada and the United States where mobility is very close to that which existed in January, before the start of the pandemic. In Latin America, mobility is highest in Haiti and Nicaragua and slightly lower in Brazil, Mexico, Paraguay, Uruguay, Honduras, Cuba, Suriname, and Guyana. The countries with the least mobility detected in the last week of August are Chile, Peru, and Panama (Figures 8a and 8b).

• The proportion of people who wear masks when leaving their homes varies in the region, but on average, it is high as of July. In the United States, Canada, and Haiti the proportion is less than 50%; in Brazil, Uruguay, and Nicaragua the proportion is between 70 and 80%, and in the rest of the countries the proportion is greater than 80% (Figures 9a and 9b).

• The prevalence of countries in the region performing diagnostic tests is very uneven. On the one hand, the United States and Chile carried out more than 150 tests per 100,000 inhabitants on August 31st. They are followed by Canada, Colima, Peru, Suriname, Uruguay, and Panama, with more than 50 but less than 150 per 100,000 inhabitants. The rest of the countries performed between 25 and 49 per 100,000 inhabitants, with Mexico and Haiti standing out for their very poor performance with less than 10 tests per 100,000 inhabitants (Figures 10a and 10b).

• Comparing the risk of getting sick from pneumonia on February 1 with August 1 shows that the risk is higher in the northern hemisphere in Canada and the United States, and is decreasing until it disappears in the southern hemisphere. The effect of the seasonality of respiratory infections is reflected in this variable (Figure 11).

Projections

• Projections in an intermediate scenario establish that 962,000 deaths will accumulate from COVID-19 by January 1, 2021. This projection assumes that countries with daily mortality greater than 8 per 1 million inhabitants will close their economies again for a period of six weeks. Deaths from COVID-19 will drop by about 3,000 per day and increase again to over 5,000 in December. However, if the relaxation of the mandates is maintained, the worst-case scenario projects 1.26 million deaths, with an increase in daily deaths to more than 15 thousand in December (Figures 12 and 13).

• The countries that are projected to need to re-impose mandates are Peru, Colombia, and Honduras in September; Costa Rica, Mexico, Suriname, and the United States in October; and the Dominican Republic, Panama, and El Salvador in November. The rest of the countries in the region will not need to re-impose mandates before December 1 (Figure 15).

• By implementing mask use in 95% of the population, over 156,000 lives could be saved in the region by January 1, 2021 (Figure 14).



• By the end of 2020, it is estimated that eight countries in the region will have more than 22% of their population infected. Brazil, Colombia, Suriname, Dominican Republic, Bolivia, and Honduras between 22 and 33%; Mexico and Peru between 33 and 39% and Ecuador with almost half of its population infected (Figure 16).

• By January 1, 2021, it is estimated that the highest daily mortality from COVID-19 will occur: Panama, Dominican Republic, and United States (Figure 17).

• By the first week of January 2021 it is estimated that the second leading cause of death in the region will be COVID-19, surpassed by ischemic heart disease (Table 3).

Region of the Americas MODEL UPDATES

COVID-19 Results Briefing: the Region of the Americas

Institute for Health Metrics and Evaluation (IHME)

September 03, 2020

This briefing contains summary information on the latest projections from the IHME model on COVID-19 inthe Region of the Americas. The model was run on September 02, 2020.

Model updates

Starting this week, we are reporting our projections up to January 01, 2021. Updates to the model this weekinclude additional data on deaths, cases, and updates on covariates. Since our model two weeks ago, we havebeen using an updated infection to fatality ratio (IFR) that substantially affects the number of estimatedinfections, particularly in younger age groups. The Preface Figure shows the age pattern as previously usedand the new age pattern. This curve is a global pattern and affects all locations.

Preface Figure.

0.01%

0.10%

1.00%

10.00%

0 5 10 20 30 40 50 60 70 80 95

Age

Infe

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10)

Previous model Updated model

0

5,000

10,000

15,000

0 5 10 20 30 40 50 60 70 80 95

Age

Infe

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Previous model Updated model

covid19.healthdata.org 1 Institute for Health Metrics and Evaluation

Region of the Americas CURRENT SITUATION

Current situation

Figure 1. Reported daily COVID-19 cases

0

50,000

100,000

150,000

Apr May Jun Jul Aug SepMonth

Cou

nt

Daily cases



Table 1. Ranking of COVID-19 among the leading causes of mortality this week, assuming uniform deathsof non-COVID causes throughout the year

Cause name Weekly deaths RankingCOVID-19 23,490 1Ischemic heart disease 22,182 2Stroke 10,124 3Chronic obstructive pulmonary disease 7,401 4Tracheal, bronchus, and lung cancer 6,369 5Lower respiratory infections 6,211 6Chronic kidney disease 6,184 7Alzheimer’s disease and other dementias 5,890 8Diabetes mellitus 5,822 9Cirrhosis and other chronic liver diseases 4,153 10

Figure 2a. Reported daily COVID-19 deaths and smoothed trend estimate

0

1,000

2,000

3,000

4,000

Apr May Jun Jul Aug Sep

Dai

ly d

eath

s



Figure 2b. Estimated cumulative deaths by age group

0

5

10

<5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 99Age group

Sha

re o

f cum

ulat

ive

deat

hs, %

Figure 3. Mean effective R on August 20, 2020. The estimate of effective R is based on the combined analysisof deaths, case reporting and hospitalizations where available. Current reported cases reflect infections 11-13days prior so estimates of effective R can only be made for the recent past. Effective R less than 1 meansthat transmission should decline all other things being held the same.

<0.87

0.87−0.89

0.9−0.93

0.94−0.96

0.97−0.99

1−1.02

1.03−1.05

1.06−1.09

1.1−1.12

>=1.13



Figure 4. Estimated percent infected with COVID-19 on August 31, 2020

<0.5

0.5−5.9

6−11.4

11.5−16.9

17−22.4

22.5−27.9

28−33.4

33.5−38.9

39−44.4

>=44.5

Figure 5. Percent of COVID-19 infections detected. This is estimated as the ratio of reported COVID-19cases to estimated COVID-19 infections based on the SEIR model.

0

5

10

15

Feb Mar Apr May Jun Jul Aug Sep

Per

cent

of i

nfec

tions

det

ecte

d

African Region

Region of the Americas

South−East Asia Region

European Region

Eastern Mediterranean Region

Western Pacific Region



Figure 6. Daily COVID-19 death rate per 1 million on August 31, 2020

<1

1 to 1.9

2 to 2.9

3 to 3.9

4 to 4.9

5 to 5.9

6 to 6.9

7 to 7.9

>=8


Region of the Americas CRITICAL DRIVERS

Critical drivers

Table 2. Current mandate implementation

All

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Sta

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me

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Trav

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mits

Venezuela (Bolivarian Republic of)Uruguay

United States of AmericaTrinidad and Tobago

SurinameSaint Vincent and the Grenadines

Saint LuciaSaint Kitts and Nevis

PeruParaguayPanama

NicaraguaMexico

JamaicaHonduras

HaitiGuyana

GuatemalaGrenada

El SalvadorEcuador

Dominican RepublicDominica

CubaCosta Rica

ColombiaChile

CanadaBrazil

Bolivia (Plurinational State of)Belize

BarbadosBahamasArgentina

Antigua and Barbuda

Mandate in place No mandate



Figure 7. Total number of mandates

Venezuela (Bolivarian Republic of)Uruguay

United States of AmericaTrinidad and Tobago

SurinameSaint Vincent and the Grenadines

Saint LuciaSaint Kitts and Nevis

PeruParaguayPanama

NicaraguaMexico

JamaicaHonduras

HaitiGuyana

GuatemalaGrenada

El SalvadorEcuador

Dominican RepublicDominica

CubaCosta Rica

ColombiaChile

CanadaBrazil

Bolivia (Plurinational State of)Belize

BarbadosBahamasArgentina

Antigua and Barbuda


# of mandates

0

1

2

3

4

5

6

Mandate imposition timing



Figure 8a. Trend in mobility as measured through smartphone app use compared to January 2020 baseline

−50

−25

0

Jan Feb Mar Apr May Jun Jul Aug Sep

Per

cent

red

uctio

n fr

om a

vera

ge m

obili

ty

African Region



European Region



Figure 8b. Mobility level as measured through smartphone app use compared to January 2020 baseline(percent)

=<−50

−49 to −45

−44 to −40

−39 to −35

−34 to −30

−29 to −25

−24 to −20

−19 to −15

−14 to −10

>−10



Figure 9a. Trend in the proportion of the population reporting always wearing a mask when leaving home

0

20

40

60

Jan Feb Mar Apr May Jun Jul Aug Sep

Per

cent

of p

opul

atio

n

African Region



European Region



Figure 9b. Proportion of the population reporting always wearing a mask when leaving home on August 31,2020

<45%

45 to 49%

50 to 54%

55 to 59%

60 to 64%

65 to 69%

70 to 74%

75 to 79%

80 to 84%

>=85



Figure 10a. Trend in COVID-19 diagnostic tests per 100,000 people

0

50

100

150


Test

per

100

,000

pop

ulat

ion

African Region



European Region



Figure 10b. COVID-19 diagnostic tests per 100,000 people on August 30, 2020

<5

5 to 9.9

10 to 24.9

25 to 49

50 to 149

150 to 249

250 to 349

350 to 449

450 to 499

>=500



Figure 11. Increase in the risk of death due to pneumonia on February 1 compared to August 1

<−80%

−80 to −61%

−60 to −41%

−40 to −21%

−20 to −1%

0 to 19%

20 to 39%

40 to 59%

60 to 79%

>=80%


Region of the Americas PROJECTIONS AND SCENARIOS

Projections and scenarios

Figure 12. Cumulative COVID-19 deaths until January 01, 2021 for three scenarios. The reference scenariois our forecast of what we think is most likely to happen. The mandate easing scenario is what would happenif governments continue to ease social distancing mandates. The universal mask mandate scenario is whatwould happen if mask use increased immediately to 95%.

0

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800,000

1,200,000

0

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Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

Cum

ulat

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hsC

umulative deaths per 100,000

Continued SD mandate easing

Reference scenario

Universal mask use

Fig 13. Daily COVID-19 deaths until January 01, 2021 for three scenarios. The reference scenario is ourforecast of what we think is most likely to happen. The mandate easing scenario is what would happen ifgovernments continue to ease social distancing mandates. The universal mask mandate scenario is whatwould happen if mask use increased immediately to 95%.

0

5,000

10,000

15,000

0.0

0.5

1.0

1.5


Dai

ly d

eath

sD

aily deaths per 100,000


Reference scenario

Universal mask use



Fig 14. Daily COVID-19 infections until January 01, 2021 for three scenarios. The reference scenario isour forecast of what we think is most likely to happen. The mandate easing scenario is what would happenif governments continue to ease social distancing mandates. The universal mask mandate scenario is whatwould happen if mask use increased immediately to 95%.

0

1,000,000

2,000,000

3,000,000

0

100

200

300


Dai

ly in

fect

ions

Daily infections per 100,000


Reference scenario

Universal mask use

Fig 15. Month of assumed mandate re-implementation. (Month when daily death rate passes 8 per million,when model assumes mandates will be re-imposed.)

September

November

DecemberNo mandates before Jan 1



Figure 16. Forecasted percent infected with COVID-19 on January 01, 2021

<0.5

0.5−5.9

6−11.4

11.5−16.9

17−22.4

22.5−27.9

28−33.4

33.5−38.9

39−44.4

>=44.5

Figure 17. Daily COVID-19 deaths per million forecasted on January 01, 2021 in the reference scenario

<1

1 to 1.9

2 to 2.9

3 to 3.9

4 to 4.9

5 to 5.9

6 to 6.9

7 to 7.9

>=8



Table 3. Ranking of COVID-19 among the leading causes of mortality in the full year 2020. Deaths fromCOVID-19 are projections of cumulative deaths on Jan 1, 2021 from the reference scenario. Deaths fromother causes are from the Global Burden of Disease study 2019 (rounded to the nearest 100).

Cause name Annual deaths RankingIschemic heart disease 1,153,500 1COVID-19 959,685 2Stroke 526,400 3Chronic obstructive pulmonary disease 384,900 4Tracheal, bronchus, and lung cancer 331,200 5Lower respiratory infections 323,000 6Chronic kidney disease 321,600 7Alzheimer’s disease and other dementias 306,300 8Diabetes mellitus 302,700 9Cirrhosis and other chronic liver diseases 215,900 10

Mask data source: Premise; Facebook Global symptom survey (This research is based on survey resultsfrom University of Maryland Social Data Science Center); Kaiser Family Foundation; YouGov COVID-19Behaviour Tracker survey

A note of thanks:

We would like to extend a special thanks to the Pan American Health Organization (PAHO) for keydata sources; our partners and collaborators in Argentina, Brazil, Bolivia, Chile, Colombia, Cuba, theDominican Republic, Ecuador, Egypt, Honduras, Israel, Japan, Malaysia, Mexico, Moldova, Panama, Peru,the Philippines, Russia, Serbia, South Korea, Turkey, and Ukraine for their support and expert advice; andto the tireless data collection and collation efforts of individuals and institutions throughout the world.

In addition, we wish to express our gratitude for efforts to collect social distancing policy information inLatin America to University of Miami Institute for Advanced Study of the Americas (Felicia Knaul, MichaelTouchton), with data published here: http://observcovid.miami.edu/; Fundación Mexicana para la Salud(Héctor Arreola-Ornelas) with support from the GDS Services International: Tómatelo a Pecho A.C.; andCentro de Investigaciones en Ciencias de la Salud, Universidad Anáhuac (Héctor Arreola-Ornelas); Lab onResearch, Ethics, Aging and Community-Health at Tufts University (REACH Lab) and the University ofMiami Institute for Advanced Study of the Americas (Thalia Porteny).

Further, IHME is grateful to the Microsoft AI for Health program for their support in hosting our COVID-19data visualizations on the Azure Cloud. We would like to also extend a warm thank you to the many otherswho have made our COVID-19 estimation efforts possible.


http://observcovid.miami.edu/

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