Prediction and analysis of Covid-19 epidemic in Libya

Dr. Tarek Gibreel

Since the breakout of covid-19 and its Despite the remarkable gained knowledge in
becoming a pandemic, international and short time, key knowledge gaps regarding the
national health organizations have raised risk virus and the disease remains.
alert to ‘very high’ and governments have
The virus: SARS-cov-2 virus causing the
announced the introduction of various plans
COVID-19 disease is a zoonotic virus. Bats
to contain and slow the spread of the virus appear to be the initial reservoir and
within their borders. With the dramatic Pangolins the intermediate reservoir.
increase in the daily death toll in developed
countries such as Italy and Spain, confusion Routes of transmission
and panic spread around the world. The Transmission is mainly via droplets and
situation in Libya was no different if not contaminated surfaces. Although recent
reports described airborne spread as a driver
worse. Despite the NCDC excellent efforts in
of transmission, the WHO still doesn’t
developing and implementing a national recognize it as a route of transmission;
action plan to contain the spread of the virus, however, it can be envisaged if certain
its effort came short in various technical and aerosol-generating procedures are conducted
administrative areas which can be most in health care facilities.
attributed to the lack of financial support and
the security challenges that currently face the Transmission rate (R0): 2.8 (number of
newly infected people from a single case)
country. These shortages are intensified by
the weak inter/intra-agencies communication. Household transmission: (transmission
within the family) ranges from 3-10%.
In my opinion, the one issue that may hinder
the national efforts is the absent of firm Contact Tracing: (transmission within
implementation of the plan. One of the general contacts) ranged from 1% - 5%
shortages that strike me the most is the weak .
involvement of the scientific community in Incubation period: 2-14 days represents the
the development, drafting and revising of the current official estimated range with average
of 5 days.
national strategies. Even more importantly,
their weak involvement in alleviating the ICU demands: range of (26% to 32%) of
ever-growing confusion among the public, hospitalized patients
regarding the present situation and how the
disease will spread in the country. Case fatality rate: ranged (1% – 10%), with
WHO placed it around 3.4%
The purpose of this essay is to put into
perspective the magnitude of the epidemic
and examine the effect of the ongoing Distribution of Covid-19 cases by Age:
containment measures in slowing down the Under 50 50 and over
spread of the disease using an 0 - 19 2% 50 - 59 14%
20 - 29 7% 60 - 69 15%
epidemiological modelling approach and 30 - 39 10% 70 - 79 18%
analyse the generated trends on the basis of 40 - 49 13% 80+ 21%
data provided by the Libyan ongoing
containment plan.
 Social distancing measures:
Various measure were proposed by experts
and adopted by health organizations
including:
 Case isolation
 School closure
 Minimum workspace attendance
 Community contact reduction

Effect of social distancing:

 Reduction of social exposure was proposed

by experts to reduce the transmission rate
which is assumed to halt the spread of the
infection.
 Reducing social exposure by 50% will half
the transmission rate, whereas reduction of
social exposure by 75% can bring down the
transmission rate to below 1 that would mark
the fade out of the epidemic.
 Epidemiologically, the purpose of
Implementing social distancing measure
during the covid-19 epidemic is to reduce the
Containment strategies: Two major
transmission rate R0 from (2.8 to <1) which
approaches for containing COVID-19 were
require drastic implementation of social
put forward: mitigation and suppression
distancing.
 Mitigation: slowing down the spread of the In order to understand the magnitude of the
epidemic through isolation and quarantining epidemic in Libya, I used a Differential
of cases but not interrupting the transmission Equation Model (SIR model), which is a
completely, leaving the development of herd compartmental model that is used by
immunity. This approach is unlikely to epidemiologist to draw first impression
contain the pandemic and may severely picture of the epidemic expected to run
burden healthcare systems, especially the through a community.
intensive care units.
 Suppression which can be achieved through Running SIR model based on current
reducing the infectivity of the coronavirus by available date and if NO social distancing
the implementation of strict lockdown measures (case isolation, school closure, and
measures (social distancing in entire community contact reduction) was
populations, the closure of schools and implemented. (Figure 2)
community spaces) and extending these
measures until vaccines can be developed (18
months).
 Infected population:

 Expected number to be around 329,822

 The disease reaches its peak around:
01/08/2020
 At risk population (age group >50) account
for: 68% approx. 224,278
 Patients require admission to ICU:13,192

Infectious disease transmission is a

complicated process that involves many
variables occurs in changing community.
Models established for this process can be
misleading if the analysis doesn’t involve all
Infected population:
variable affecting the spread of the disease.
 Expected number to be around 1,903,345 However, basic modelling can be conducted
 The disease reaches its peak around: as a starting point to forecast the magnitude of
10-15/05/2020 the disease and how the introduced measure
 At risk population (age group >50) account may reduce the impact of the disease on the
for: 68% approx. 1,294,274 healthcare capacity.
 Patients require admission to ICU: 121,814 Even with introduction of social distancing a
Running SIR model with all the social total of 329,822 will end up contracting the
distancing measure proposed by the NCDC disease in the current wave of the disease
and imposed by the government early on the among which 65,964 may require
onset of the epidemic (even before the hospitalization or admission to ICU at any
reporting of first case) that result in 50% point.
reduction in social exposure Figure 3. Fortunately, the introduction of such
measures flattened the curve of infected
population and the peak spread-out over a
period of 2-3 weeks. The time gained by
rigorously applying COVID-19 containment
measures can/has been used to reinforce the
healthcare facilities and strengthen their IPC
capacity.

Although running the modelling logarithm

under stringent social distancing conditions
(to reduce the R0 <1) is not applicable for the
time being due to lack of sufficient data, but
we can expect to halt the spread of the disease
and cases will continue to be reported as
sporadic cases.
The small number of reported cases of Final remarks:
covid-19 in Libya can be attributed to the
The resolution of this epidemiological
following:
modelling and analysis of the epidemic can
 The adopted policy of only screening largely be increased as more data become
suspected cases and their contacts, leave 80% available.
of infected population either asymptomatic or
References:
with mild to moderate disease unreported. In
fact, the lack of widespread, systematic Centers for Disease Control and Prevention.
testing in most countries is the main source of CDC 2011 Estimates: Findings. Available
discrepancies in reported cases online: https://ncdc.org.ly/Ar/
internationally.
 The relatively young population, 90% of the Report of the WHO-China Joint Mission on
population under the age of 50. Age group Coronavirus Disease 2019 (COVID-19),
strongly associated with mild to moderate https://www.who.int/docs/default-
disease. source/coronaviruse/who-china-joint-
 Taking into account the civil war currently mission-on-covid-19-final-report.pdf
sweeping the country which naturally limits The Spatiotemporal Epidemiological Modeler
public movement and the early (STEM) tool, Eclipse Foundation. Spatio
implementation of social distancing measures, Temporal Epidemiological Modeler project.
one can expect the success of the Available online: www.eclipse.org/STEM
containment measure to exceed 50% as
proposed in the model and our current Correlation between universal BCG
transmission rate to be near 1 (R0=1) which vaccination policy and reduced morbidity and
strongly slows down the epidemic. mortality for COVID-19: an epidemiological
 Libya’s strong and long lasting vaccination study,
policy, in which BCG vaccine was introduced https://www.medrxiv.org/content/10.1101/202
in the early 1950s. Libya was the 1st country 0.03.24.20042937v1
in the region to introduce BCG vaccination on
massive scale and in 1971 Libya has passed a
legislation that made BCG vaccination
compulsory. In recent report by Aaron Miller
et al, exploring the correlation between
universal BCG vaccination policy and
reduced morbidity and mortality for COVID-
19, a strong association was observed
between low reported number of infected
cases and countries with long-standing BCG
policies. Moreover, a BCG vaccine is
currently in its phase 3 of clinical trials to
reduce the incidence and severity of COVID-
19 among healthcare workers.