Literature DB >> 32353345

Estimation of COVID-19 burden in Egypt.

Khaled Elmeleegy1.   

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Year:  2020        PMID: 32353345      PMCID: PMC7185924          DOI: 10.1016/S1473-3099(20)30321-2

Source DB:  PubMed          Journal:  Lancet Infect Dis        ISSN: 1473-3099            Impact factor:   25.071


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The foundation of any estimation process is the use of independent unbiased samples. However, when attempting to estimate Egypt's burden of coronavirus disease 2019 (COVID-19) by studying exported cases, Ashleigh Tuite and colleagues established neither independence nor absence of bias for the cases used in their study. This approach is especially problematic in the light of widespread news of a tourist cruise ship in Egypt exporting COVID-19 across the world through hundreds of tourists who were onboard during the timeframe used by Tuite and colleagues in their Correspondence. Regarding sample independence, the authors used two scenarios to estimate the number of COVID-19 cases in Egypt: one with 14 cases and another assuming dependence between some of these cases and hence reducing the number of cases used to five. For the more conservative scenario, Tuite and colleagues estimated Egypt to have 19 310 cases (95% CI 6270–45 070) at the time. However, they acknowledged the cruise ship situation and revised their estimate to “near 6000 cases”. However, no analytical basis for this revision was given. For example, if all five cases considered were related to the cruise ship, this would amount to one single case and lead to a different model with a different estimate and different error margins. Regarding sample bias, if all cases in Tuite and colleagues' analysis were indeed related to the cruise ship, then the sample used would be very biased and thus invalid. Egypt has US$2549 of GDP per capita. Therefore, most Egyptians do not have the disposable income to spend on an upscale Nile cruise. Finally, Tuite and colleagues' most conservative estimate is close to 6000 cases by the end of their analysis (March 6, 2020). From March 6 to the date of publication (March 26), 20 days passed. COVID-19's case-count growth rate has been roughly doubling every 3 days in many countries that have lower population density and are more developed than Egypt. Assuming that the number of cases grows at the same rate of doubling every 3 days, Egypt would have had about 640 000 cases by March 26, a time when the whole world had just 593 300 cases reported. That is an extraordinary claim. Extraordinary claims require extraordinary proofs, which I could not find in the analysis by Tuite and colleagues.
  1 in total

1.  Estimation of the COVID-19 burden in Egypt through exported case detection.

Authors:  Ashleigh R Tuite; Victoria Ng; Erin Rees; David Fisman; Annelies Wilder-Smith; Kamran Khan; Isaac I Bogoch
Journal:  Lancet Infect Dis       Date:  2020-03-26       Impact factor: 25.071

  1 in total

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