Thread by @AliHMokdad

IHME’s latest forecasts indicate that #COVID19 deaths by Jan 1 has increased in @WHOEMRO from 165,847 last week to 182,311. As of today, about 56,681 deaths have occurred in the region, and our estimates suggest 125,630 deaths from now until January 1. 1/30

If mask wearing in public increases to 95%, there will be around 99,217 deaths, and about 83,094 lives could be saved. This is about a 66% reduction in the number of deaths expected between now and January 1. 2/30

If a herd immunity strategy is pursued, we estimate 201,761 deaths by Jan 1. 3/30
covid19.healthdata.org/global?view=to…

.@IHME_UW expects that the daily death rate will start increasing in the coming week and will reach about 2,826 deaths per day by January 1. 4/30

These forecasts assume that countries will on average re-impose a package of social distancing mandates when the daily death rate reaches 8 per million. 5/30

Our current projections show that several countries will re-impose mandates by Jan 1: Libya in October; Oman, Palestine, and Morocco in November; and Bahrain, UAE, Iraq, Iran, and Lebanon in December. 6/30

By the week of January 1, #COVID19 is expected to the fourth leading cause of death in @WHOEMRO. 7/30

#COVID19 infections and deaths started to increase in the region over the last week while reductions in mobility and mask use remain low. We expect a major surge in daily cases and deaths in November and December, driven by seasonality and decreased vigilance. 8/30

#COVID19 transmission as captured by reported cases has started to increase again. 9/30

Deaths were declining since early July but are now rising. 10/30

About 16% of deaths in the region are among those aged 45 or younger. 11/30

Effective R (the number of new infections caused by each infection) on Sep3, based on the combined analysis of data on cases, hospitalizations, and deaths, suggests that transmission is increasing in five countries: Iran, Lebanon, Oman, Libya, and Palestine. 12/30

The percentage of the population infected with COVID-19 is still very low, with the highest rates observed in Bahrain, Iran, Iraq, Oman, Saudi Arabia, and Kuwait. 13/30

The fraction of infections being detected has risen just a little during the epidemic; the fraction of infections detected and reported as confirmed cases is about 7.5%. This rate has not improved in the past month. 14/30

Countries with daily death rates over 1 per million are Bahrain, Lebanon, Palestine, Morocco, Iraq, Iran, Libya, and Oman. 15/30

Social distancing mandates have stayed relatively constant over the last week. Many countries in the region have started or are about to start the school year with a combined approach of in-person and online instruction. 16/30

Mobility is now about 12% less than the baseline in January. It remained stable during the past couple of weeks but now shows some signs of slight decline. The lowest levels of mobility are currently seen in Saudi Arabia. 17/30

Despite mask mandates in @WHOEMRO , mask use has declined to less than 40%. The highest mask use is observed in the Gulf countries, but it is less than 30% in Afghanistan, Yemen, Palestine, Sudan, Egypt, Libya, and Tunisia. 18/30

#COVID19 testing rates have increased in the region but are still below 45 per 100,000. The highest rates of testing are now in UAE. 19/30

Our projections to Jan 1 take into account the #COVID19 seasonality. The large increase in daily deaths expected in late November and December is driven by continued increases in mobility and declines in mask use, but most importantly by seasonality. 20/30

We estimate the impact of seasonality by examining the trends in the Northern and Southern Hemispheres. Argentina, Chile, southern Brazil, and South Africa had much larger epidemics than expected on the basis of mobility, testing, and mask use during their winter months. 21/30

The statistical association between #COVID19 transmission rates and pneumonia seasonality patterns is strong in our data and is the basis for our estimate of the magnitude of the seasonal increase that is expected. 22/30

Given considerable public discussion of the role of herd immunity in explaining peaks and subsequent declines in the daily death and case rate. 23/30

We have explored the implied total death rate for each country based on IFR and different assumptions about the level of cumulative infection that will be associated with herd immunity. 24/30

The natural experiment of the Charles de Gaulle aircraft carrier suggests that up to 70% of individuals can get infected in a situation of near-random mixing. 25/30

Various theories, including super-spreaders, nonrandom mixing in less dense populations, non-overlapping social networks, and some prior coronavirus immunity, have led to theories that herd immunity may take place at much lower levels of cumulative infection such as 35-65%. 26/30

Our IFR, based on the analysis of seroprevalence data and herd immunity at 35% cumulative infection, would suggest the @WHOEMRO will eventually see 423,249 deaths. 27/30

With herd immunity at 50% cumulative infection, the figure would be 604,641 deaths, and at 65% it would be 786,033 deaths. Scale-up of a vaccine or improved treatments could substantially reduce these figures. 28/30

These calculations only serve to suggest that the epidemic in the region is far from complete, and even in the optimistic scenario of herd immunity kicking in at 35% cumulative infection, may be less than 30% of the way through the epidemic. 29/30

Finally, in many countries where the infected population is high, such as Ecuador, there is evidence against the theory of herd immunity at a low level of infection. 30/30