key: cord-0813559-kx982n12 authors: Craig, J.; Kalanxhi, E.; Hauck, S. title: National estimates of critical care capacity in 54 African countries. date: 2020-05-16 journal: nan DOI: 10.1101/2020.05.13.20100727 sha: 37cf3716499b576885c72e3be825949549f7400a doc_id: 813559 cord_uid: kx982n12 Background The coronavirus disease (COVID-19) pandemic is an emerging threat across the African continent where national critical care capacity is underdeveloped or unknown. In this paper, we compile data on critical care capacity -- including number of ICU beds, number of ventilators, and number of physician and non-physician anesthesia providers -- for 54 African countries. Methods Data was compiled from a variety of resources including World Bank databases, local and international news media, government reports, local healthcare workers, and published scientific literature. Results Overall, data on number of ICU beds were available for 49 (91%) countries and on number of ventilators for 46 (85%) countries, respectively. Data on physician anesthesia providers and non-physician providers was available for 47 (87%) and 37 (69%) of the 54 African countries. Conclusion Most low and lower middle-income African countries have limited critical care capacity available to cope with potential surges in critical care demand due to COVID-19 outbreaks. Keywords: COVID-19, SARS-CoV-2, critical care capacity, ICU, ventilators, Africa On March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus outbreak a pandemic. Since it first appeared in late 2019, there have been over 4 million cumulative confirmed COVID-19 cases and over 270,000 deaths reported globally. Many countries have implemented measures to reduce COVID-19 transmission and to prevent health facilities from being overwhelmed by demand for hospital care, intensive care unit (ICU) beds, and ventilator therapies needed to treat severe infections. Despite these interventions, many wellequipped countries have faced shortages in health equipment and trained personnel. The first confirmed COVID-19 case in Africa occurred in Egypt on February 14, 2020. Thus far, African countries have reported lower disease incidence with only 46,829 confirmed COVID-19 cases and 1,449 deaths across the continent as of 12 May 2020 (WHO, 2020) . Most African countries implemented airport closures, curfews, lockdowns, and other social distancing measures in March or April 2020 (WHO, 2020) . However, infectious disease surveillance and reporting infrastructure remains highly underdeveloped in many African countries, and COVID-19 testing is limited given the shortage of human resources and appropriate laboratory facilities. In addition, projections of COVID-19 case burden predict that most African countries will experience an uptick in total and severe COVID-19 infections in the next one to three months (CDDEP, 2020) . Across Africa, critical care capacity is far below international norms and public health officials have suggested there is a severe lack of ICU beds and ventilators (Murthy, 2015; Dunser, 2016; Okafor, 2009 ). According to a COVID-19 Readiness Survey conducted by WHO in March 2020, an estimated 9 ICU beds are available per 1 million people across the continent (WHO, 2020). However, self-reported information from 34 out of the 47 WHO member countries gave a largely incomplete picture of the current situation with regards to the region's critical care capacity. To better understand critical care capacity across the continent, we compiled data on number of ICU beds, number of ventilators, and number of physician anesthesia providers (PAP) and non-PAP, among other datapoints, for 54 African countries. This data is intended to inform and assist policy makers and public health officials at the national, regional, and international levels in equipping and preparing African countries to tackle the COVID-19 pandemic. National critical care capacity datapoints relevant to COVID-19 treatment included in the database were number of ICU beds, number of ventilators, and number of PAP and non-PAP. The estimated numbers of ICU beds and ventilators were obtained from published government reports or statements, published scientific literature, reports or statements from aide and other non-governmental organizations, local and international media (in all major continental languages), and in-country informants including government or public health officials and other local researchers and healthcare workers (Appendix 1, 2). Where possible, we cross-checked ICU bed and ventilator estimates with multiple sources. The number of PAP and non-PAP was obtained from the World Federation of Societies of Anaesthesiologists Global Anesthesia Workforce Survey (World Federation of Societies of Anaesthesiologists, 2019; Kempthorne, 2017). National demographic and economic information for the most recent year for which data was available was obtained from a variety of sources. Gross domestic product (GDP) at purchasing power parity (PPP) per capita in current international dollar for each country was obtained from the World Bank (The World Bank International Comparison Program Database, 2020). Population data and hospital beds per 1,000 people, and physicians per 1,000 people were obtained from the World Bank's World Development Indicators database (The World Bank, 2020). Regional sub-groupings of African countries followed those of the United Nations Statistics Division and do not represent official endorsement or geopolitical position (United Nations Population Division, 2020). Disputed and dependent territories were excluded. For comparisons across countries and regions, we translated available count data and data reported per 1,000 people into rate data reported per 100,000 people. Data availability is summarized in Table 1 , and a complete index of data availability is provided in Appendices 1 and 2. Data on GDP PPP per capita, population, hospital beds per 100,000 people, and physicians per 100,00 people were available for over 90% of the 54 African countries. Local and international news media were the major sources for data on number of ICU beds and ventilators. Data on number of ICU beds were available for 49 (91%) countries and on number of ventilators for 46 (85%) countries. Data on physician anesthesia providers (PAP) and nonphysician providers (non-PAP) was available for 47 (87%) and 37 (69%) countries, respectively. It was not possible to discern equipment and human resources capacity at public versus private health facilities or in rural versus urban settings. In addition, we were unable to separately estimate equipment and human resources available for pediatric versus adult patient populations. Therefore, numbers presented here represent total equipment and human resources availability across country and patient segments. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 16, 2020. . https://doi.org/10.1101/2020.05.13.20100727 doi: medRxiv preprint Critical care capacity data segregated by income and region is summarized in Figures 1 and 2 and Table 2 , and a complete listing of data is available in Appendix 2. (Of the 54 countries included in the analysis, there was only one country, Seychelles, classified as high income. It is therefore omitted from Table 2 which reports averages across income groups.) Across the continent, there were an average of 135.19 hospital beds and 35.36 physicians per 100,000 people ranging from 67.39 beds and 9.57 physicians per 100,000 people in low-income countries to 302.50 beds and 115.24 physicians in upper middle-income countries. The average number of hospital beds per 100,000 was highest in Southern Africa and lowest in West Africa while the average number of physicians per 100,000 was highest in North Africa and lowest in West and Middle Africa. Across all 54 countries included in the analysis, there was an average of 3.10 ICU beds and 0.97 ventilators per 100,000 people. The average number of ICU beds per 100,000 people ranged from 0.53 in low-income countries to 8.59 in upper-middle countries and 33.07 in Seychelles, the sole high-income country included in this analysis. The average number of ventilators per 100,000 people ranged from 0.14 in low-income countries to 2.49 in upper-middle income countries. The average number of ICU beds was lowest in West Africa with only 1.10 ICU bed per 100,000 people, and the average number of ventilators was lowest in East Africa with only 0.23 ventilators per 100,000 people. Overall, there was an average of 2.42 total (physician and non-physician) anesthesia providers per 100,000 people ranging from 1.24 and 0.66 in low-income countries and in the Middle African region, respectively, to 6.91 and 6.64 providers per 100,000 in upper middle-income countries and the North Africa region, respectively. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 16, 2020. . . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 16, 2020. . Overall, the availability of hospital beds, physicians, ICU beds, ventilators, and anesthesia providers in 54 African countries is far below the capacities of other countries where the demand from COVID-19 has exceeded existing resources. As expected, there is particularly limited critical care capacity in low and lower middle-income African countries. For comparison, in the US, Italy, Germany, and China, there are between 280 and 1,200 total hospital beds and between 240 and 710 ICU beds per 100,000 people (Kamal, 2020; Wunsch, 2008) For most countries included in this analysis, there was a lack of verified data available from published scientific papers and reports, or from government Ministries of Health, or other equivalent national agencies. Where possible, we attempted to cross-check our data with multiple sources. In addition, for several countries, we were unable to identify various data points. Despite these limitations, this database on African critical care capacity is the most comprehensive available to our knowledge, and alongside COVID-19 case burden projections, may be useful in guiding and informing national, regional, and continental outbreak preparedness and response. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 16, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 16, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 16, 2020 . . https://doi.org/10.1101 /2020 *Year of data only listed in separate column where there was variation across countries. Otherwise, year of data point is listed under the column name Local or international news *In many cases, multiple sources were reviewed to verify the accuracy of the data; however only the first identified source is listed here. "-" indicates no data available.