Leveraging community mortality indicators to infer COVID-19 mortality and transmission dynamics in Damascus, Syria

Oliver J. Watson (), Mervat Alhaffar, Zaki Mehchy, Charles Whittaker, Zack Akil, Nicholas F. Brazeau, Gina Cuomo-Dannenburg, Arran Hamlet, Hayley A. Thompson, Marc Baguelin, Richard G. FitzJohn, Edward Knock, John A. Lees, Lilith K. Whittles, Thomas Mellan, Peter Winskill, Natasha Howard, Hannah Clapham, Francesco Checchi, Neil Ferguson, Azra Ghani, Emma Beals and Patrick Walker
Additional contact information
Oliver J. Watson: Imperial College London
Mervat Alhaffar: London School of Hygiene and Tropical Medicine
Zaki Mehchy: London Schools of Economics
Charles Whittaker: Imperial College London
Zack Akil: Google
Nicholas F. Brazeau: Imperial College London
Gina Cuomo-Dannenburg: Imperial College London
Arran Hamlet: Imperial College London
Hayley A. Thompson: Imperial College London
Marc Baguelin: Imperial College London
Richard G. FitzJohn: Imperial College London
Edward Knock: Imperial College London
John A. Lees: Imperial College London
Lilith K. Whittles: Imperial College London
Thomas Mellan: Imperial College London
Peter Winskill: Imperial College London
Natasha Howard: London School of Hygiene and Tropical Medicine
Hannah Clapham: National University of Singapore and National University Health System
Francesco Checchi: London School of Hygiene and Tropical Medicine
Neil Ferguson: Imperial College London
Azra Ghani: Imperial College London
Emma Beals: European Institute of Peace
Patrick Walker: Imperial College London

Nature Communications, 2021, vol. 12, issue 1, 1-10

Abstract: Abstract 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.

Date: 2021
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DOI: 10.1038/s41467-021-22474-9

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