Participating countries

In early March 2020, a group of Afghan epidemiologists approached CoMo for support with modelling Covid-19 in Afghanistan. Since then, the group, which includes colleagues from the Ministry of Public Health and from the World Health Organisation country and regional offices, has been collaborating with the CoMo Consortium to model various Covid-19 scenarios in Afghanistan.

The questions the team seek to answer include:

• What will be the likely numbers of cases and deaths?
• For resource allocation purposes, how many ICUs, beds and ventilators will be needed?
• How long should the country continue non-pharmaceutical interventions, such as handwashing, social distancing, school closures, working from home, and home quarantine, to understand their effectiveness for flattening the curve of Covid-19 cases and deaths? (This is extremely important for Afghanistan because 42% of the population is living below the poverty line and these interventions could have huge economic impacts.)

On 17 March 2020 a Sanitary Emergency was declared, and days later a nationwide lockdown. On 17 July, it was announced that lockdown would be loosened, however, as cases continued to rise, a less restrictive lockdown was extended. Despite having in place the world’s largest lockdown and a very strict policy scheme, cases of COVID-19 continue to rise in Argentina. 

The majority of cases are concentrated in the Province of Buenos Aires (364,635), and the Autonomous City of Buenos Aires (198,580). There is an urgent need for a tailored, evidence-based strategy to inform decisions on effective response measures to COVID-19 for Argentina.

In April the team engaged with the Ministry of Health (MoH) for Argentina and decided to run a model for one of the main affected areas of the country: the capital city. The MoH provided the team with the available data and the team in Oxford conducted preliminary analyses and model calibration to explore optimal lockdown reseal strategies. Once the team in Argentina finished analysing the different strategies under consideration, the CoMo Consortium provided feedback on the policy brief. The policy brief was presented to the Ministry of Health for Argentina at the end of November. 

Bangladesh has a total population of more than 160 million, tested its first COVID-19 case on 8 March. Within two weeks, the government declared the closure of public and private offices, transportation systems, schools and colleges. PCR testing capacity, oxygen availability, ICU beds and field hospital beds increased significantly, starting in April. The government also implemented several income-supported programs to revive the economy. Starting in early June, major restrictions were relaxed while schools remain closed through to 17 September. The country also experienced major cyclones in April and extensive flooding (July-August), resulting in major disruptions. Directives to open schools have been given, however, details are being worked out by the Ministry of Education. Discussions on vaccine acquisition continue.  

The Bangladesh Team has been engaged with the Public Health Expert Advisors of MOHFW and the Directorate General of Health Services since April, via providing a “Technical Brief” that contains actual and projected COVID-19 cases and deaths. This activity is continuing and the Bangladesh Team has recently introduced the CoMo model to the Director General, Additional Director General (Planning), and the Public Health Advisors Group at the Ministry of Health and Family Welfare, Government of Bangladesh. These policy/decision makers have expressed their strong interest in the CoMo model and have extended their support in initiating the required data sharing. In addition, they are also keen to understand the potential effects of various policy changes. 

The team has created the age-specific births and deaths data and started calibration using actual cases and deaths. The first phase is now complete and awaiting additional country specific data to further refine. The team members attend weekly country meetings to discuss work plans and progress as well as CoMo meetings. Team members also participate in training and technical sessions offered by the other members of the CoMo Consortium. Team members share modelling experience with other CoMo Consortium country teams. The team is preparing a Discussion Note in preparation for the funding call for NIHR Global Health Research Unit. The team is actively involved in communication with the Bangladesh Director General of Health and public health advisors to accumulate country specific data.

Weather events in April and in July-August may have affected the spread of the virus. There is a strong correlation between the levels of tests and confirmed cases. Testing continues at about 15% positivity rate. Death surveillance and a deeper look into the reasons of death is being explored. COVID-19 vaccine storage, distribution, administration and allocation remain major concerns.

The Observatório Covid-19 BR is an independent initiative resulting from a collaboration between Brazilian researchers aiming to contribute to the dissemination of reliable information that is based on detailed data and scientifically grounded analysis. The team created an open-source website to monitor the current state of the Covid-19 epidemic in Brazil, perform statistical analyses, and show results from the modelling of intervention scenarios. The team has several groups working in parallel on data collection and processing, statistical modelling, mathematical modelling and nowcasting. In particular, the Observatório Covid-19 BR has been working on adapting the CoMo Consortium model specifically for the Brazilian environment and current data availability.

In early October 2020, Brazil passed the mark of 150,000 deaths from COVID-19, with over 30,000 of those deaths happening in the state of São Paulo. Decision making regarding mitigating strategies were made at state level and were implemented between March and April, when community transmission cases started being detected. In May, the São Paulo government made mask wearing compulsory, closed restaurants, parks and schools and recommended work from home. Hygiene and social distancing measures, such as mask wearing, are still compulsory, but schools, work places, restaurants and leisure areas are now reopening in most regions of the São Paulo state.

The group has been in touch with health secretaries and funerary services at municipality level and the scientific advisory committee at Sao Paulo state level to provide insights from modelling and data analysis to support policy making. The team has also been engaged in a national-level scientific project aiming to use modelling towards comparing vaccination strategies and school reopening scenarios.

More information on the team’s work can be found here covid19br.github.io

Over 40 countries from around the world are participating in the CoMo Consortium. Cambodia is delighted to be part of the CoMo Consortium.

The team includes Akindeh Nji, Dr Sheetal Silal, Professors Mbacham, Mbanya, Sobngwi, Ongolo, Nwaga, Penlap, Boudjeko and Bigoga.

The team is using the CoMo Consortium model to answer the following questions:

• How many cases is the country likely to have in a given period of time?
• When will we see the peak of the epidemic in Cameroon?
• When would our health system become overwhelmed?
• What are the comparative benefits of combinations of different non-pharmaceutical interventions?
• When can we relax some of the non-pharmaceutical interventions that are in place, such as social distancing, school closures, and border closures?
• How many cases is the country likely to have in a given period of time?
• When will we see the peak of the epidemic in Cameroon?
• When would our health system become overwhelmed?
• What are the comparative benefits of combinations of different non-pharmaceutical interventions?
• When can we relax some of the non-pharmaceutical interventions that are in place, such as social distancing, school closures, and border closures?

The team would also like to take advantage of economic modelling to inform policy based on the costs and benefits of the different measures that have been put in place in our country. To do this, we intend to adapt the current CoMo Consortium model to the Cameroonian situation. We also envisage adapting the CoMo Consortium model code to answer other questions that might arise via feedback from policymakers and the Covid-19 task force.

Over 40 countries from around the world are participating in the CoMo Consortium. Ecuador is delighted to be part of the CoMo Consortium.

The first case of COVID-19 in Ethiopia was confirmed on 13 March, 2020. As of 18 September, 2020, the total number of COVID-19 cases reported was 67,515, with total reported deaths being 1,072 and recovered cases 27,638. More than a million laboratory tests have been performed so far, making slightly more than 10,000 tests per million population. The overall positivity rate since the occurrence of the disease in the country is 5.62%. Addis Ababa, the capital of Ethiopia, seems to be the epicentre of the outbreak, however all regions in the country have reported cases.

Contacts have been established at the Ministry of Health and the Ethiopian Public Health Institute (EPHI) and the team is preparing for a policy briefing after finalising the modelling.

• Team members attend weekly country update meetings
• Team members participate in the CoMo training
• The team has extracted data for the modelling input
• Currently, the team is focusing on finalising the collection of all required data from MoH and EPHI and re-running the model to finalise the first phase

Over 40 countries from around the world are participating in the CoMo Consortium. Fiji is delighted to be part of the CoMo Consortium.

CoMo has assisted Dr Jean Pape and Dr Daniel Fitzgerald in making estimates for both baseline and non-pharmaceutical intervention scenarios at the national level for Haiti.

The North Sumatera Covid-19 research group is led by Dr Inke Lubis; other members include Dr Ivana Alona from Universitas Sumatera Utara and Dr Alwi Hasibuan from the North Sumatera Provincial Health Office. The team has been using the CoMo Consortium model to predict numbers of cases and deaths using the currently implemented interventions (self-isolation, school closures, working from home, handwashing and social distancing). We also have been exploring other combined interventions, including lockdown, which might be appropriate for the North Sumatran context. 

The team is seeking to answer the following questions:

• What will be the size of the expected epidemic using the current interventions?
• What are the best alternative intervention options (other than lockdown) to reduce deaths in a community with a high level of poverty?
• What is the number of tests needed to ensure adequate numbers of self-isolation in order to limit transmission?
• What is the most cost-effective strategy?
• What are the numbers of healthcare workers, hospital beds and critical care management teams needed during the epidemic?
• How long should the interventions (school closures, social distancing, working from home) be put in place?
• When should we expect the second wave of cases to arise once the interventions have been ended?
• What will be the economic impacts of the various intervention strategies?

The team includes Hamid Sharifi, Professor in Epidemiology; Yunes Jahani, Associate Professor in Biostatistics; Ali Mirzazadeh, Assistant Professor in Epidemiology; Sana Eybpoosh, Assistant Professor in Epidemiology; Mehran Nakhaei, a PhD student studying Biostatistics; and Milad Ahmadi Gohari, MSc in Biostatistics. The group works under the supervision of Dr Ali Akbar Haghdoost, Deputy Head of Education and Head of the Covid-19 Epidemiology Group at the Iranian Ministry of Health. 

The total number of cases in Iran has reached more than 582,000, with 33,300 deaths. There is a weekly rate of 36,000 new cases and 2,200 new deaths. The first reported case of COVID-19 in Iran was in February 2020. Since then the country had the first wave in March, a second wave in June, and is now witnessing a third and biggest wave of the epidemic. Multi non-pharmaceutical interventions played a key role in mitigating the pandemic to some extent in Iran, however, these were not long and rigid enough to prevent the second and third wave of the epidemic.

The team’s work with the CoMo Consortium allows us to compare, or cross-validate, our model outputs with the CoMo model results. 

The specific questions we are seeking to answer are:

• What combination of interventions (shelter in-place, self-quarantine, etc.) and timings would be most effective?
• Which different intervention combinations would be most feasible for the country, and what would their impact be on the epidemic?
• Do we need to consider sub-national strategies and, if so, what should they be?
• What are the best ways to relax prevention restrictions, e.g. staggered back-to-work schedules?
• How many resources, e.g. beds, ICU beds, ventilators, temporary isolation units, would be needed, particularly at the peak of the epidemic?
• What is the cost-effectiveness of different combinations of interventions?

The team has two advisors from the World Health Organisation, Dr Christoph Hamelmann and Shadrokh Sirous, who provide technical support and share expertise and relevant data from both the Regional Office and also the Headquarters. They also participate in strategic discussions guiding the national Covid-19 campaign, based on the models’ outputs.

The team is also working with 15+ epidemiologists from provincial medical universities and public health departments. The CoMo team in Iran has used local data to model the epidemic and the impact of the non-pharmaceutical interventions. The results have been presented to the National Response Committee, and also one scientific online panel (with 185 participants and 3 panellists). The team has had several meetings with the Ministry of Health and has sent the results of the model to them.

Currently we are working on updating the model based on new data. This image is from our modelling work in April.

The first case was registered on 16 March 2020. On 25 March 2020 the President of the Kyrgyz Republic declared a State of Emergency.  During the 1.5-month lockdown the country managed to effectively control the epidemic. Only 1,038 new cases were registered during this period. However, the full lockdown release on 11 May was followed by a tremendous outbreak of new cases, which totalled around 43,000 by the end of July. In July the outbreak reached its peak causing significant pressure on the health system and as a result many people lost their lives due to limited access to treatment and resources (1,051 cases post-lockdown vs.13 cases during lockdown).  At the beginning of August the wave plateaued and started going down.

The outputs of the two modelling rounds have been presented to the Ministry of Health and the Cabinet of the Prime Minister (in April and June). The team shared the findings with other stakeholders and a broader population through publishing policy briefs and reports, participating in public discussions via local TV, radio and other communication channels. Currently, the team has grown to a large group, involving other public health specialists and experts from other fields (private sector, civil society, economists etc.), which is providing expert counselling to the government.  

A  collaboration between the CoMo Consortium and the Soros Foundation in the Kyrgyz Republic was initiated in the end of March, followed by the establishment of a local team of experts including epidemiologists and health specialists. The team has contacted the Ministry of Health with a proposal for cooperation and partnership and to apply the CoMo model as an additional tool and evidence for policy decisions. The CoMo Consortium and the Ministry of Health exchanged a letter of collaboration. The Ministry of Health agreed to provide access to the live epidemiological data. Within the next three weeks, with the technical support of the CoMo Consortium, the team conducted the modelling exercise and at the end of April presented five hypothetical scenarios of interventions and their potential effect on the curve of the epidemic to the Ministry of Health and the cabinet of the Prime Minister. In addition, a policy brief based on the findings was published in the local mass media. On 11 May 2020 the government made a decision to fully release the lockdown. A few weeks later, the country experienced a significant increase in new cases and, as a consequence, a tremendous increase in deaths. In June, the CoMo-KG team conducted the second round of modelling and, at the end of June, presented the outputs to the Ministry of Health. The team published the outputs in local mass media which generated significant interest from the local community. The team members were invited to TV and radio programs for interviews and public discussions. Currently, the team is working on papers for publication in peer reviewed journals and is planning to conduct a cost-effectiveness study of various hypothetical scenarios of interventions.

Over 40 countries from around the world are participating in the CoMo Consortium. Lao PDR is delighted to be part of the CoMo Consortium.

Over 40 countries from around the world are participating in the CoMo Consortium. Malawi PDR is delighted to be part of the CoMo Consortium.

Covid-19 reached Malaysia in late January and was largely confined to imported cases. Local transmission began to emerge in early March and was linked to a religious gathering in late February. In order to control the pandemic, the Government has implemented a Movement Control Order until the end of the year. All travellers are also required to serve mandatory quarantine periods at designated centres. The Government has also implemented compulsory wearing of face masks in public areas and imposed an entry ban on citizens from countries that have recorded more than 150,000 cases.

The team in Malaysia are all investigators in the Covid-19 Epidemiological Studies Special Team Secretariat for Malaysia and we are collaborating with the Ministry of Health on two projects entitled Economic Evaluation of Managing COVID-19 Outbreak in Malaysia (led by Prof Dr Maznah Dahlui) and Disease Progression of COVID-19 Patients in Malaysia (led by Prof Dr Noran Naqiah Hairi).

Since June 2020, the team has started to conduct literature reviews on Covid-19 in Malaysia. At the same time, the team collected published and available data on estimates for the model parameters. With the available information obtained we have tried to run the model. Recently, the team received permissions and research ethics to collect live data from the Ministry of Health, Malaysia. The key tasks to be completed in the coming weeks include collecting all relevant data from the Ministry of Health and to re-run the model to refine the outcomes. The team is working with the CoMo Consortium to learn more about the model and to develop better projections of the disease burden to facilitate decision-making at national level.

In a bid to manage the Covid-19 situation in the country, the Malaysian government has implemented a movement control order (MCO), shutting down non-essential services in governmental and private sectors, extending school holidays and implementing a travel ban as well as imposing strict standard operating procedures for services that remain open. The MCO comprises several staggered phases, each aimed at flattening the Covid-19 curve yet maintaining the economic and social stability of the country. The first phase was enforced from 18- 31 March. The inevitable second phase subsequently took place from 1 – 4 April. This was followed by the third phase from the 15 – 28 April. The fourth phase was initially planned for 29 April until 12 May, however, with the downward trajectory of cases, on 1 May the government announced a slight loosening of MCO restrictions. This included allowing most businesses and government offices to reopen by adhering to strict standard operating procedures. This phase was termed the ‘Conditional MCO’ (CMCO) phase. Recently, the CMCO was further extended for several weeks until 9 June. It is also important to note that during the implementation of the MCO, several areas were put under ‘Enhanced MCO’ (EMCO) due to the high number of Covid-19 cases recorded in these areas. On 7 June, Prime Minister Muhyiddin Yassin announced that the Conditional Movement Control Order would end on 9 June, with the country entering into the Recovery Movement Control Order (RMCO) phase between 10 June and 31 December 2020

Mexico, The State of Queretaro and Tabasco has confirmed 737,603 cases and 76,047 deaths up to 22 September 2020. Around 24% of confirmed cases were hospitalised, whereas 76% were outpatients. Chronic hypertension was the most prevalent comorbidity (19.3%), followed by obesity (18.1%), and diabetes (15.5%). Tabasco has confirmed 31,057 cases (1,207 cases per 100K inhabitants), whereas Queretaro has confirmed 8,337 cases (365 cases per 100K inhabitants). 

The model is regularly calibrated based on confirmed cases and deaths reported through the surveillance system. Our main policy questions are related to the impact of non-pharmaceutical measures in COVID-19 transmission in Tabasco and Queretaro. Relevant outputs regarding the estimation of the number of reported cases, cumulative mortality, hospital occupancy, and reproduction number are simulated and discussed with the Ministry of Health. Technical discussions are usually remote and include multiple scenarios. Technical dialogue and collaboration is continuing with health care professionals, health authorities, and policymakers.

Over 40 countries from around the world are participating in the CoMo Consortium. Mozambique is delighted to be part of the CoMo Consortium.

The Myanmar national modelling team using the CoMo Consortium model currently consists of three people: Sai Thein Than Tun, Shwe Sin Kyaw and Yu Nandar Aung. Sai is a mathematical modeller and PhD student at the University of Oxford; Shwe Sin is a research physician and economic modeller; and Yu is a public health and financing specialist, completing her master’s in health economics, health financing and policy at the London School of Economics.

The team analyses the CoMo model inputs, outputs and relevance to the Myanmar context, including generation of policy advocacy materials and the ways the model can be customised to fit Myanmar’s specific situation and/or policymakers’ needs. The country team’s further plans envision partnering with Myanmar’s policymakers to assist them in the decision-making process for Covid-19 epidemic control measures that are informed by outputs of the CoMo model.

The policy questions the team seeks to answer are:

• How long will the epidemic last without any interventions?
• How would different packages of interventions influence the progress and control of the epidemic?
• Given uncertainties in the duration of virus shedding, it is important to determine how long suspected symptomatic people or asymptomatic people with travel/contact history should stay in isolation and how different durations of isolation influence the epidemic’s pattern. 
• What is the impact of the Covid-19 epidemic on hospital uptake capacity?
• What are the costs of treating hospitalised Covid-19 patients with different severities of disease?
• Which non-pharmaceutical intervention/intervention package is most cost-effective for flattening the epidemic curve?
• What is the cost-effectiveness of different testing strategies?
• What is the cost-effectiveness of screening/non-screening of asymptomatic contacts?

As of 4 October 2020, Nepal has reported 86,823 cases and 535 deaths among which 29,517 (34%) were reported from the Kathmandu valley and 660,912 (70%) were male. Average case fatality rate was 0.62% with a predisposition for older age groups. Among the confirmed cases, 22,219 (25.6%) are active infections and 64,069 (73.8%) cases have recovered. A total of 1,074,448 RT-PCT tests has been performed with an average positives-test rate of 8% which has increased over the recent weeks (2,120 positives for 12,978 tests, 16% on 3 Oct 2020). A detailed report with model prediction for different response strategies was submitted to the Government of Nepal and findings presented. We collaborated with Oxford Policy Management (OPM) and DFID and engaged with the Ministry of Health of Nepal to explore the effectiveness of various strategies in flattening the curve and decreasing the deaths due to COVID-19 in Nepal. 

A report detailing the relevant outputs of predicted number of cases and deaths, hospital occupancy, and reproduction number over time with different intervention strategies was presented to the Government of Nepal. The findings were also presented to the team of officials from the Government of Nepal, the WHO Country Office in Nepal and other relevant stakeholders through a virtual meeting.

Nigeria lies within sub-Saharan Africa with the largest population in Africa and seventh largest in the world. The current population is estimated at over 200 million based on an annual growth rate of 3.2 percent. The first case of COVID-19 in Nigeria was confirmed on 27 February 2020, when an Italian citizen in Lagos tested positive for the virus. As of 18 September 18 2020, the total number of COVID-19 cases reported was 56,956, total reported deaths being 1,094 and recovered cases 48,305. The case fatality rate since the occurrence of the disease in the country is 1.9%. The demography shows that 36,193 (64%) of the confirmed cases were male and 20,763 (36%) were female and they fell with the age group 31-40 (26%). Lagos, the commercial capital of Nigeria seems to be the epicentre of the outbreak, however all regions in the country have reported cases. 

The team members attend a weekly country update meeting and participate in the CoMo training. The team also extracted data for the modelling input. Currently, the team is focusing on finalising collecting all required data from the Nigeria Centre for Disease Control (NCDC) and the National Population Commission (NPC) and re-running the model to finalise the first phase. The team is collaborating with the Nigeria Modelling group under the Nigeria Centre for Disease Control (NCDC).

Over 40 countries from around the world are participating in the CoMo Consortium. Palestine is delighted to be part of the CoMo Consortium.

The team members, Chris Mercado and Robert Medina, are working with the CoMo Consortium to consider what combination of interventions could work best in the Philippines.

The team is comparing the CoMo Consortium model against other, locally developed, models. This will support the development of a local model that better reflects the dynamic local situation and appropriate responses to the Covid-19 epidemic in the country. Other models being used are the official FASSSTER COVID-19 module and the UP COVID-19 Pandemic Response Team model.

The CMMC19 is an interdisciplinary team of researchers from AGH University of Science and Technology and the University of Oxford. The main purpose for the CMMC19 research is to have a better insight into how the COVID-19 pandemic affects Polish society and how to reduce that impact by using state of the art techniques in statistical methods, mathematical modelling and machine learning. The team created a website – https://cmmc19.wms.agh.edu.pl/ – that provides daily updated information regarding the distribution of new cases and deaths which is based on detailed data starting on the day when the first case in Poland was confirmed.A further aim is to deploy the model responsible for the prediction of future interventions for the country.

The first confirmed case was on 4 March 2020. Within a short period of time the government decided to lock down schools and universities for a period of two weeks starting on 12 March . After that, every school had to  provide students with e-learning classes. Similarly restaurants and leisure areas remained closed. Within two months the number of cases was slowly increasing until reaching its first spike of about 15,000 active cases in the middle of June. Schools as well as universities remained closed until the summer break began in late June. Before September the number of active cases did not increase significantly. Nevertheless, within two weeks of reopening schools, on 1 September, the situation drastically changed and resulted in new restrictions. In the middle of November the epidemic in Poland reached its biggest spike of 445,000 currently infected cases. Since then, the number of active cases seems to be slowly decreasing.

Senegal experienced two waves of the COVID19 epidemic. The first wave was from 2 March 2020 to mid-November 2020 with 15,598 confirmed cases and 328 deaths. The second wave was from mid-November 2020 until 30 March 30 2021 with 22,811 confirmed cases and 720 deaths. We noticed that the second wave was more serious in terms of the number of confirmed cases and deaths than the first wave. The Senegalese population is very young, the average age is 19. People aged between 16 and 40 years old are the most affected by COVID19.

The team’s activity within the framework of the CoMo Consortium, is simulating vaccination strategies, school reopening scenarios and the evolution of incidence curve and death.

The Pasteur Institut of Dakar (IPD) is very involved in the response to the COVID-19 epidemic, through virological lab tests, production of Rapid Diagnostic Tests, epidemiological field investigation and data analysis. The Epidemiology, Clinical Research and Data Science (ECRDS) department has several groups working in parallel on the development of a web platform for data recording, data management and quick reporting through dashboards. The ECRDS team also perform advanced data analysis, statistical and mathematical modelling. Frequently, the data science team provides updated reports on statistical analysis to support decision making. The IPD is a member of the National Committee for the Management and Response to Epidemics.

Over 40 countries from around the world are participating in the CoMo Consortium. Sierra Leone is delighted to be part of the CoMo Consortium.

The Modelling and Simulation Hub, Africa (MASHA) is a research group led by Dr Sheetal Silal and is based at the University of Cape Town. MASHA’s research focus is the development and application of mathematical modelling and computer simulation to predict the dynamics and control of infectious diseases to evaluate the impact of policies aimed at reducing morbidity and mortality. MASHA is a member of the South African Modelling Consortium for Covid-19, a technical group comprising experts in modelling, health economics, policy support, clinical planning and virology.  The team is providing support to the South African government at both national and provincial levels to predict numbers of Covid-19 cases over the short- and medium-term, to estimate resource requirements and to inform scenario planning. The team has built a novel model (the MASHA-COVID model) and tailored it to the South African context, taking into consideration unique vulnerabilities, age distribution and spatial dynamics.

Northwest Syria (NWS) is a geographical area which is bordered by Turkey on one side and areas under government control on the other. It contains 2.6 million internally displaced people out of a population of 4.2 million. The first case of COVID-19 was diagnosed on 9 July 2020. As of 16 September, there have been a total of 451 confirmed cases and 4 COVID-19 attributed deaths.

The local CoMo team in Northwest Syria involves 3 policymakers from EWARN and HIS unit and UDER organisation. The policymaking process is fragmented in NWS following years of conflict. We are in continuous engagement with policymakers in the health and education sector. We have presented our findings to the National and International Task Force and we have addressed questions from the Interim Ministry of Health regarding the impact on the epidemic of opening schools on 15 September. The CoMo modelling findings are used by NGOs such as UDER as a tool for advocacy for increasing the coverage of wearing face masks in NWS.

Description of CoMo activities

1. Formed a local modelling team in the NWS, comprised of policymakers from NGOs, the Health Information System Unit, and EWARN. 
2. Continuous collaboration with CoMo consortium and policymakers in NWS.
3. Presented the modelling findings to the National Task Force, attended by the Ministry of Health for the Syrian interim government, and representatives of NGOs  for example, White Helmet (18 July 2020).
4. Presented the modelling findings to the International Task Force, attended by a representative of the WHO in NWS, UNOCHA, and INGOs operating in Syria  (21 July 2020).
5. Established continuous collaboration with policymakers following the presentation: we have addressed their requests such as modelling the impact of school opening on COVID-19 deaths, modelling 2 scenarios – school opening within 1.5 months, and opening school at the end of the year.
6. Presented the modelling findings for opening schools to policymakers in the education sector in NWS (14 September 2020). 
7. Planned presentation to the education donor in NWS Foreign Commonwealth Development Office (FCDO) (5 October 2020).
8. Collaboration with other CoMo teams. Invited a member of CoMo Bangladesh team to share their experience in modelling with the NWS team and to exchange knowledge.
9. Got support from Kyrgyzstan team and Afghanistan team. 

The Thailand team includes Associate Professor Wirichada Pan-Ngum, Dr Ricardo Águas, Dr Sompob Saralamba, Dr Nantasit Luangasanatip, Dr Aronrag Cooper Meeyai and Dr Sai Thein Than Tun.

In response to the Covid-19 pandemic, members of the Mathematical and Economic Modelling group (MAEMOD), based in Bangkok, and others, joined the CoMo Consortium. The team has been using the CoMo Consortium model to explore different interventions including self-isolation:  for Thailand this mainly involves isolation in hospital, working from home, social distancing, hand hygiene, and the wearing of face masks. The government believes that finding and isolating cases will help to control the number of new cases per day. However, testing large numbers of people is costly and thus who to test is also an important question.

The questions we therefore seek to answer are:

• How can we find and isolate active cases of Covid-19?
• Who should be tested?
• When can some of the rules on social distancing be relaxed, for example letting some businesses reopen?

The Thai government is looking for ways to boost the economy while making sure case numbers are not increasing. There are still many uncertainties about the government’s plan on how to proceed, although the number of cases has been monitored closely and in real time. There were worries about schools re-opening as well as concerns about the economy, and tourism in particular, which is the main source of income in many large cities. The Thai modelling working group meets regularly to share and discuss the results of their models and write weekly recommendation reports for the Ministry of Public Health. 

The team is working with the CoMo Consortium by helping with the development of the model and associated web-tools to serve all CoMo Consortium members; by providing feedback and sharing experiences on the use of the model to help guide policy related to decision making for controlling the spread of Covid-19;  and assisting and mentoring other members who have less experience in modelling or who lack modelling resources in their setting, to help them drive the use of the model in their work on their country’s specific questions.

The first case of COVID-19 in Timor-Leste was registered on 21 March 2020. The President declared a State of Emergency on 28 March 2020. Up until 26 June, the country registered 24 cases with no hospitalisations or deaths. The State of Emergency prompted the country to implement non-pharmaceutical interventions (NPIs) including working from home, school closures, mask wearing and hand washing and banned public gatherings and travel. The State of Emergency was renewed on 5 August and has been extended every month with a gradual relaxation of restrictions. Hence, until 17 September 2020 the country registered 27 COVID-19 cases; 26 recovered and one active case, with no deaths.

A presentation was made to the National Directorate of Diseases Control of the Minister for Health, Timor-Leste on the 17 July 2020. A policy brief and a technical report are being drafted and are due to be submitted soon to the Ministry of Health and copied to the WHO country office and relevant stakeholders.

Initial collaboration with the local university (Universidade Nacional Timor-Lorosae) through Dr Joao Martins, PhD, as a member of the Study Group of the Integrated Centre for Crisis Management Timor-Leste (Centro Integrado Gestao Crize) was initiated in May and was formalised in early June through an exchange of letter of collaboration with the University of Oxford through Prof Lisa White. Since then CoMo-TL was formed and members have grown from three to seven. The team is composed of Timorese scientists, epidemiologists, public health experts and academics from the University of Oxford (Luzia Freitas), Universidade Nacional Timor-Lorosae (Dr Joao Martins and Antonio Ximenes), the Ministry of Health – Surveillance & Epidemiology (Merry Niha Varela), Universidade da Paz (Dr Antoninho Monteiro), Charles Darwin University (Dr Merita Monteiro) and Menzies School of Health Research (Lucsendar R.F. Alves). 

The CoMo-TL members have started data collection and have conducted virtual meetings as the members were located in three different countries: Oxford UK, Darwin Australia and Dili Timor-Leste. Initial modelling on future projections was undertaken, however, due to the minimum number of cases, the team decided to do counterfactual modelling instead from March until June 2020. The first presentation by the CoMo-TL team members in Dili, Timor-Leste to the National Director of Diseases Control of the Ministry of Health Timor-Leste was conducted on the 17 July in Hotel Timor. Attending the presentation were technical personnel who work under the National Director of Diseases Control and they showed great enthusiasm and appreciation. Following the presentation, the World Health Organization (WHO) country office Timor-Leste expressed their interest through an exchange of e-mail conversation with CoMo-TL members for collaboration with CoMo if or when the country faces a second wave or if there is community transmission. 

With technical support from the CoMo Hub in Oxford, CoMo-TL drafted a technical report and submitted this to the Ministry of Health on 19 October 2020. The technical report focuses on the counterfactual model (retrospective model) from the period of 20 March to 26 June 2020 and evaluates the impact of the disease on the country should there be a delay in interventions and assesses the number of cases and deaths that have been averted with the implementation of the State of Emergency. The report has also been shared with the WHO country office and relevant stakeholders.

Recently, due to the rising number of COVID-19 cases and the potential growth in community transmission in the country, the WHO country office Timor-Leste made an official request to CoMo-TL on 29 March 2021 to undertake future projection modelling for COVID-19 cases in the country with technical support from the CoMo team in Oxford. A meeting to discuss the detail of the work to be undertaken by CoMo was subsequently held on1 April 2021 with Prof Lisa White from the University of Oxford and Director of the CoMo Consortium; the WHO country office Timor-Leste; and CoMo_TL members, including two new members – Nevio Sarmento from Charles Darwin University and Ismael Barreto who has recently graduated from the London School of Economics and is currently working at the WHO country office Timor-Leste.  CoMo-TL members are now collecting the data needed for the modelling work which will be supported by the CoMo team in Oxford. CoMo-TL will present the outcome in the near future.

Tunisia experienced a first wave of the epidemic between February and May 2020. This first wave was very well controlled: on 26 June 2020 when the second wave started there were 1,162 confirmed cases, 89 active cases and a total of 50 deaths. The date chosen for the beginning of the second wave is 26 June, which corresponds to the full opening-up of the frontiers. This second wave was caused by an uncontrolled frontier opening and was less well controlled than the first one. In fact, on 1 November we recorded 61,115 cases, 54,735 active cases and a total of 1,348 deaths.  

The Covid-19 modelling task force was created in February 2020 during the first wave of the epidemic. This task force includes two teams, one from the Pasteur Institute of Tunis and the other from the National School of Computer Science of Tunis. In September 2020, the Task Force integrated the Tunisian Ministry of Health’s working group on modelling. In this context the task force is responsible for simulations of the evolution of the epidemic with the CoMo model.

The team’s activity within the framework of the CoMo Consortium, is the simulation and evolution of the epidemic – more precisely, the evaluation of the number of deaths and evaluation of bed occupancy rates – and also, the simulation of the government’s policies.

With over 10 million cases and 245,000 deaths, the USA has experienced one of the most severe (and accelerating) COVID-19 outbreaks of any country. Pre-existing sociodemographic disparities in health access and outcomes have been severely exacerbated by the pandemic, and over 40% of COVID-19 mortality has occurred in long term care settings.  Governmental response has been largely left to individual states, where it has been susceptible to open politicisation of public health recommendations and mandates.  As of 21 October, a third surge in cases – largely in areas previously spared from the outbreak – threatens once again to overwhelm health care capacity. 

Dr. Hupert served as a scientific advisor to the New York State COVID Task Force. Dr. Hupert worked with Prof. Lisa J. White, starting in February 2020, to customise the first version of the R-based CoMo model for use in the United States, specifically for New York City and State. Since then, he has supported the development of the CoMo application and collaborative and has provided particular assistance with the hospital-based components of the model.  Studies of New York City, State, and the USA as a whole have continued to inform selected policy discussions at the State and National levels.

Dr. Hupert is a physician/researcher focused on public health emergency response logistics and health care operations research. He served 10 years as Senior Medical Advisor to the US Centers for Disease Control and Prevention (CDC) Division of Preparedness and Emerging Infections. He was also Medical Advisor for the US Hospital Preparedness Program and served on the Scientific Advisory Board of the National Institute of Health’s Modelling of Infectious Disease Agent Study (MIDAS).

Timeline of key events during the pandemic