ETHIOPIAN PUBLIC HEALTH INSTITUTE(EPHI)

COVID 19 OVERVIEW

Public Health Emergency Operations Center

 Outline

 Introduction
 International and Ethiopian COVID-19 timeline

 Epidemiology of COVID 19

 COVID 19 Variants

 COVID 19 Vaccines

 Implementation Challenges and

 The way forward

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 INTRODUCTION
 Identified in Wuhan, China in
December 2019

 Initial case reported had association

with an animal/seafood market
exposure

 Travel-related exportation of cases

reported

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 COVID-19 pandemic Timeline

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 COVID-19 pandemic Timeline

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Epidemiology of COVID-19

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 Global Trend of cases
As of June 28,2021
•181,965,114 cases
•3,941,190 deaths and
166,471,190 recoveries
•Cases and death are
decreasing
•The first wave reach peak in
January 2021
•The second wave starts in
March and reach peak in the
third week of April; which was
mainly due to Alpha and Beta
variants, reponing of business
and non-adherence to PHSMs
•Cases are decreasing in May
and June which may be due to
vaccination

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 Weekly Trends of Cases and Deaths
• Globally, cases
increased by 1% and
deaths decreased by
5% in the last week
• In Europe, cases
increased by 14% in
the last week mainly
due to DELTA variant
• The most significant
increase both in cases
and death occurred in
Africa(34% and 28%)-
THIRD WAVE- due to
Delta variant

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 Trend of cases in Africa
As of June 28, 2021
• 5,461,564 Cumulative cases ,141,526
deaths and 4,774,242 recovories
• First wave started in May 2020, reach
peak in July and stayed for about 5
months
• Second wave start in November 2020
and reach peak in first week of January
2021 and stayed till mid of February
2021 about two and a half months)
• Main reasons for the second wave were
ALPHA(UK) and Beta(SA) variants,
non- adherence to PHSMs, different
social gatherings, re-opening of
business...

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 Weekly Trend in Africa
Casses in Deaths in
 As of June 28, 2021 Cases in the Weekly Deaths in the Weekly
the last 7 preceding cases % the last 7 preceding Death %
• 207,288 cases reported in Country days 7 days change days 7 days change

the last 7 days which has S.No 207,288 154,994 34% 3,480 2,712 28%
Africa
1 South Africa 103,697 70,739 47% 1,188 884 34%
34% increase from the 2 Tunisia 22,318 14,128 58% 619 524 18%
Zambia 19,058 16,641 15% 372 230 62%
preceding 7 days.
3
4 Namibia 11,937 7,556 58% 211 141 50%

• Uganda, Rwanda and 5

6
Uganda
Rwanda
7,329
5,369
9,926
2,371
-26%
126%
242
32
203
9
19%
256%
Kenya are the top three 7
Zimbabwe 4,390 1,776 147% 59 34 74%

East African countries with 8 Botswana 4,245 3,767 13% 47 70 -33%

surge of cases- Delta 9
10
Kenya
Egypt
3,601
3,249
3,616 -0.40%
4,265 -24%
127
233
51
247
149%
-6%
variant 11 Morocco 2,861 2,743 4% 36 30 20%
12 Algeria 2,527 2,516 0.40% 61 59 3%
• Ethiopia stands 19th per 13
Mozambique 2,337 906 158% 20 7 186%
the last weekly cases and 14 DRC 2,239 2,570 -13% 39 39 0%
cases decreased by 16% 15 Libya 1,803 1,664 8% 12 15 -20%
Réunion 1,061 1,206 -12% 6 8 -25%
compared to the preceding
16

17
Seychelles 993 1,150 -14% 8 9 -11%

week. 18 Angola 924 1,004 -8% 31 31 0%

19 Ethiopia 845 1,008 -16% 29 43 -33%
20 Malawi 722 347 108% 13 9 44%

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 COVID 19 Confirmed cases trend in Ethiopia as of 28 June2021

2400
First Wave Second Wave

1900

1400
#Cases

Daily CoVID 19 cases

900

7 days moving Average of Cases

400

-10013 23 2 12 22 2 12 22 1 11 21 Jul 11 21 31 10 20 30 9 19 29 9 19 29 8 18 28 8 18 28 7 17 27 6 16 26 8 18 28 7 17 27 7 17 27 6 16 26
1-

-600
Date

On Average on reporting 120 cases per day for last 07 days

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 Trend of death due to COVID 19 in Ethiopia as of 28 June 2021

50

45

40
Daily reported death.
35
7 days moving Average of death
30
# of Death

25

20

15

10

0
ar ar pr pr pr ay ay ay Jun Jun Jun -Jul -Jul -Jul -Jul ug ug ug Sep Sep Sep Oct Oct Oct ov ov ov ec ec ec Jan Jan Jan F eb Feb F eb ar ar ar Apr Apr Apr ay ay ay Jun Jun
-M 3-M 2-A 2-A 2-A 2-M 2Trend
-M -M 1- 1death
1- 21- 1 1due
1 21 3to1 0-COVID
1 20 30 9 119 9 29 in Ethiopia
1 2 8 18 2as 8 8of18 25
28 June1 2 2021
A -A -A - - - 9- 9- 9- -N -N -N -D -D -D 7- 7- 7- - - - -M -M -M 7- 7- 7- -M -M -M 6- 6-
3 6 16 26 8 18 28 1 2 7 17 27 1
1 2 1 2 1 22

On Average, 5 deaths reported per day for the last 07days

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Summary of change in cumulative confirmed COVID-19 cases and tests by region

(week 26,2021)

Tests Tests Cases Cases

# # Tests # Of # Cases
change in change per100k in per100k in per100k in per100k in
S/No Region Tests in in week cases in in week week-25 week-26 week-25 week-26
tests in cases
week 25 26 week 25 26        

1 Addis Ababa 28,159 21,631 516 393 -23.2% -23.8% 744.9 572.2 13.6 10.4

2 Somali 626 708 2 2 13.1% 0.0% 9.7 10.9 0.0 0.0

3 Oromia 2,705 1,690 221 88 -37.5% -60.2% 6.6 4.1 0.5 0.2

4 Amhara 1,100 1,185 39 88 7.7% 125.6% 4.5 4.9 0.2 0.4

5 Tigray 631 477 163 108 -24.4% -33.7% 10.5 7.9 2.7 1.8

6 Dire Dawa 82 199 0 3 142.7% - 15.4 37.4 0.0 0.6

7 Afar 1,144 576 3 0 -49.7% -100.0% 55.7 28.1 0.1 0.0

8 Gambella 386 314 10 20 -18.7% 100.0% 78.7 64.0 2.0 4.1

9 SNNP 1,539 791 43 18 -48.6% -58.1% 8.4 4.3 0.2 0.1

10 Sidama 120 115 1 5 -4.2% 400.0% 2.1 2.0 0.0 0.1

11 Harari 1,298 1,203 3 16 -7.3% 433.3% 467.0 432.8 1.1 5.8

12 B/ Gumuz 213 22 6 0 -89.7% -100.0% 17.1 1.8 0.5 0.0

  Total 38,003 28,911 1,007 741 -23.9% -26.4% 34.4 26.2 0.9 0.7

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 Treatment Center Reports
New Cumulative
Indicators

# of Confirmed COVID 19 cases admitted 17 60381

# of COVID-19 hospitalized patients discharged 32 54979

(Recovered)
# of Facility Deaths 6 3627

# HBIC Death ** 0 32

# of Community deaths 643

265
Total # of confirmed patients on admission at treatment center

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 1000
1200

200
400
600
800

0
1-Feb-21
3-Feb-21
5-Feb-21
7-Feb-21
9 -Feb-21
11-Feb-21
13-Feb-21
15-Feb-21
17-Feb-21
19-Feb-21
21-Feb-21
23-Feb-21

MV
25-Feb-21
27-Feb-21
1-Mar-21
3-Mar-2 1
5-Mar-21
7 -Mar-21
9-Mar-21
Available MVs

11-Mar-21
13-Mar-21
Critical cases On

15 -Mar-21

Sever Cases on ICU

Available ICU Beds
17-Mar-21
19-Mar-21
21-Mar-21
23-Mar-21
25-Mar-21
27-Mar-21
2 9-Mar-21
31-Mar-21
2-Apr-21
4-Apr-21
6-Apr-21
8-Apr-21
10-Apr-21
12-Apr-21
14-Apr-21
16-Apr-21
18-Apr-21
2 0-Apr-21
22-Apr-21
954

24-Apr-21
26-Apr-21
28-Apr-21
30-Apr-21
2-May-21
4-May-21
6-May-21
8-May-21
10-May-21
12 -May-21
Daily Critical Care capacity vs Availability Feb 1, 2021 - June 26,2021

14-May-21
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Severe & critical care

16-May-21
18-May-21
20-May-21
22-May-21
24-May-21
2 6-May-21
28-May-21
30-May-21
1-Jun-21
3-Jun-21
5-Jun-21
7-Jun-21
9-Jun-21
11-Jun-21
13-Jun-21
15-Jun-21
1 7-Jun-21
19-Jun-21
21-Jun-21
23-Jun-21
25 -Jun-21
 Third wave in Africa

• Press conference given by WHO Afro region

• Africa is facing a fast-surging third wave of COVID-19 pandemic
• COVID-19 cases have risen for five consecutive weeks
• onset of the third wave on 3 May 2021.
• As of 20 June—day 48 into the new wave—Africa had recorded around 474 000 new cases
—a 21% increase compared with the first 48 days of the second wave.
• Resurging in 14 African countries

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 A combination of factors including

• weak observance of public health measures,

– increased social interaction and movement
– the spread of variants are powering the new surge.
– Low vaccination (1% of Africa’s population has been fully vaccinated)
• Delta Variant
– In the Democratic Republic of the Congo and Uganda that are
experiencing COVID-19 resurgence, detected in most samples
sequenced in the past month.
– Across Africa, the variant—first identified in India—has been reported
in 14 countries.  

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 NEW Variants of SARS CoV 2

– Viruses mutate all the time and most changes are

inconsequential.
– Some even harm the virus.
– But others can make the disease more infectious or
threatening (tend to dominate).
– Multiple SARS-CoV-2 variants are circulating globally.
Variant classifications by A US government interagency
group
1. Variant of Interest:
2. Variant of Concern:
3. Variant of High Consequence:
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/variant-surveillance/variant-info.html

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Public Health Emergency Operations Center
 Variantes of Concern (VOC)

• A SARS-CoV-
Earliest
2 variant that meets WHO lab Pango  
el  lineage 
GISAID
clade/lineage
Nextstrain   documented  
clade  samples 
Date of
designation 
the definition of a VOI
United
• Increase in Kingdom,  
Alpha  GRY (formerly Sep-2020 
transmissibility B.1.1.7 
GR/501Y.V1) 
20I (V1)  18-Dec-2020

• Increase in virulence South Africa,  

• Decrease in Beta  B.1.351  GH/501Y.V2  20H (V2)
May-2020 
18-Dec-2020

effectiveness of public
health and social Gamma 
P.1  GR/501Y.V3  20J (V3)
Brazil,  
11-Jan-2021
Nov-2020 
measures or available
diagnostics, vaccines, VOI: 4-Apr-
therapeutics. Delta 
B.1.617.2   G/478K.V1  21A
India,  
Oct-2020 
2021 
VOC: 11-May-
202

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 Variants of Interest (VOI) 

Pango   GISAID Nextstrain   Earliest Date of

• Compared to a WHO label  lineage  clade/lineage  clade  documented  
samples 
designation 

reference isolate, United States of

B.1.427/B.1.4
• its genome has
Epsilon   29   GH/452R.V1  21C   America,    5-Mar-2021 
Mar-2020 

mutations with Zeta  P.2  GR/484K.V2

20B/S.484K Brazil,  
  Apr-2020  17-Mar-2021 
established or Multiple
suspected Eta  B.1.525  G/484K.V3  21D countries, 
Dec-2020 
17-Mar-2021 

phenotypic Philippines,  
implications, and Theta  P.3  GR/1092K.V1  21E  Jan-2021  24-Mar-2021 

either Iota  B.1.526   GH/253G.V1 21F 

United States of
America,   24-Mar-2021 
• Cause community Nov-2020 

transmission Kappa  B.1.617.1   G/452R.V3  21B  

India,  
Oct-2020   4-Apr-2021 

Lambda C.37 GR/452Q.V1 20D Peru, Aug-2020

14-Jun-2021

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 COVID 19 VACCINES

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 Possibility of third wave in Ethiopia

 There is possibility of third wave due to different reasons

1. Low vaccine coverage
2. Non Adherence to PHSM including mass gathering
3. Cold season is favorable for transmission
4. New Variant of concern on spreading (especially Delta
Variant detected in India first)

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 Major challenges

 The humanitarian situation at conflict-stricken areas of the

country, which can aggravate the transmission
 The PHSM implementation gap
 New variants(VOC and VOI)
 COVID-19 cases in Africa are increasing weekly as the region
starts to see a clear third wave of the pandemic.
 Numbers of health worker infections are still a concern.
 Reemergence of other public health concerns.

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 Proposed actions

 Strengthening facility level surveillance system (active case search and

testing)
 Boost critical care capacity to prevent health facilities from being
overwhelmed.
 Continue controlling the pandemic with a combination of vaccination
where available and adherence to all set public health measures.
 Sequencing for VOC, screening at POE for cases
 Service integration and involvement of private sectors
 Different Awareness creation through mass media
 Directive 30 implementation and law enforcement
 Enhance testing to reach all area including testing with Ag RDT

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 Thanks

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