excess mortality during the covid 19 pandemic in aden governorate yemen a geospatial CORD-Papers-2022-06-02 (Version 1)

Title: Excess mortality during the COVID-19 pandemic in Aden governorate Yemen: a geospatial and statistical analysis
Abstract: (ENGLISH) Background The burden of COVID-19 in low-income and conflict-affected countries is still unclear largely reflecting low testing rates. In parts of Yemen reports indicated a peak in hospital admissions and burials during May-June 2020. To estimate excess mortality during the epidemic period we quantified activity across all identifiable cemeteries within Aden governorate in Yemen (population approximately one million) by analysing very high-resolution satellite imagery and compared estimates to Civil Registry office records from the city. Methods After identifying active cemeteries through remote and ground information we applied geospatial analysis techniques to manually identify new grave plots and measure changes in burial surface area over a period from July 2016 to September 2020. After imputing missing grave counts using surface area data we used alternative approaches including simple interpolation and a generalised additive mixed growth model to predict both actual and counterfactual (no epidemic) burial rates by cemetery and across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and thereby compute excess burials. We also analysed death notifications to the Civil Registry office during April-July 2020 and in previous years. Results We collected 78 observations from 11 cemeteries of which 10 required imputation from burial surface area. Cemeteries ranged in starting size from 0 to 6866 graves. In all but one a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated {approx} 1500 excess burials up to 6 July and 2120 up to 19 September corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data which indicated a peak 1823 deaths in May alone. However both sources suggested the epidemic had waned by September 2020. Discussion To our knowledge this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial under-ascertained impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous mathematical modelling predictions though our method cannot distinguish direct from indirect virus deaths. Satellite imagery burial analysis appears a promising novel approach for monitoring epidemics and other crisis impacts particularly where ground data are difficult to collect.
Published: 2020-10-31
DOI: 10.1101/2020.10.27.20216366
DOI_URL: http://doi.org/10.1101/2020.10.27.20216366
Author Name: Koum Besson E S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/koum_besson_e_s
Author Name: Norris A
Author link: https://covid19-data.nist.gov/pid/rest/local/author/norris_a
Author Name: Bin Ghouth A S
Author link: https://covid19-data.nist.gov/pid/rest/local/author/bin_ghouth_a_s
Author Name: Freemantle T
Author link: https://covid19-data.nist.gov/pid/rest/local/author/freemantle_t
Author Name: Alhaffar M
Author link: https://covid19-data.nist.gov/pid/rest/local/author/alhaffar_m
Author Name: Vazquez Y
Author link: https://covid19-data.nist.gov/pid/rest/local/author/vazquez_y
Author Name: Reeve C
Author link: https://covid19-data.nist.gov/pid/rest/local/author/reeve_c
Author Name: Curran P J
Author link: https://covid19-data.nist.gov/pid/rest/local/author/curran_p_j
Author Name: Checchi F
Author link: https://covid19-data.nist.gov/pid/rest/local/author/checchi_f
sha: 4bde3004b7225532b7d2ad02732cc36ad65a9468
license: medrxiv
source_x: MedRxiv; WHO
source_x_url: https://www.who.int/
url: https://doi.org/10.1101/2020.10.27.20216366 http://medrxiv.org/cgi/content/short/2020.10.27.20216366v1?rss=1
has_full_text: TRUE
Keywords Extracted from Text Content: Yemen COVID-19 Al Baydha Yemen's SecureWatch dashed lines line SARS-CoV-2 persons COVID-19 Cemeteries VHR medRxiv preprint Figure S12 coronavirus WorldPop Figure S11 Touzi lines virus' medRxiv preprint Figure 3 surface area medRxiv surface Al-Radwan Figure S14 Orfeo ToolBox 27 no/very human https://www.maxar.com/products/securewatch cemeteries Figure 3 gazetteers Figure S13 lockdown Figure 4 governorate-wide bodies medRxiv preprint Table S5 cemetery-specific https://doi.org/10.1101/2020.10.27.20216366 doi Hadhramout [7] [8] [9] Al-Qateea decedents smooth under-or graves Taiz OpenStreetMap 25 Figure 5 ≈2.4 Yemen patients ACLED Sanaa. Smooth medRxiv preprint Table 3 medRxiv preprint Figure S14 medRxiv preprint ≈2.1 Figure S12 10/78 headstones Fergus McBean
Extracted Text Content in Record: First 5000 Characters:The burden of COVID-19 in low-income and conflict-affected countries is still unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May-June 2020. To estimate excess mortality during the epidemic period, we quantified activity across all identifiable cemeteries within Aden governorate in Yemen (population approximately one million) by analysing very high-resolution satellite imagery, and compared estimates to Civil Registry office records from the city. We collected 78 observations from 11 cemeteries, of which 10 required imputation from burial surface area. Cemeteries ranged in starting size from 0 to 6866 graves. In all but one a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated ≈ 1500 excess burials up to 6 July, and 2120 up to 19 September, corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data, which indicated a peak 1823 deaths in May alone. However, both sources suggested the epidemic had waned by September 2020. To our knowledge this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial, under-ascertained impact of COVID-19 in this urban Yemeni governorate, and are broadly in line with previous mathematical modelling predictions, though our method cannot distinguish direct from indirect virus deaths. Satellite imagery burial analysis appears a promising novel approach for monitoring epidemics and other crisis impacts, particularly where ground data are difficult to collect. On 10 April 2020, Yemen recorded its first laboratory-confirmed coronavirus disease case in the Southern governorate of Hadhramout. By the end of May, cases and deaths had been reported in the governorates of Aden, Taiz, Lahj and Sanaa. 1 The pandemic's impact on Yemen was expected to be severe, despite its comparatively young population. 2, 3 Transmission models parameterised based on China and Europe evidence initially predicted some 85,000 virus deaths, approaching the number reported killed during the country's ongoing armed conflict. [4] [5] [6] Additional risk factors of concern resulting from this five-year protracted crisis included disrupted health services (only half of pre-existing health facilities were fully functional as of early 2020), shortage of health workers, overcrowding due to internal displacement, food insecurity and shrinking humanitarian aid. 3, 5, [7] [8] [9] During May 2020, videos posted on social media showing large numbers of fresh graves suggested a spike in burial activity across several Yemeni governorates including Sana'a, Aden, Ibb and Al Baydha. [10] [11] [12] In the southern city of Aden, the use of mechanical excavators in place of human gravediggers suggested that demand exceeded routine capacity. 13, 14 The medical organisation Médecins sans Frontières also reported a peak in hospital admissions, with a high case-fatality ratio, in Aden during the same period. 10 Separately, a shortage of personal protective equipment forced several hospitals to close or reject patients exhibiting COVID-19 symptoms. 3, 12, 15 As of 9 October 2020, Yemen had reported 2049 confirmed SARS-CoV-2 infections with 593 deaths 16 , but the reliability of these official numbers is undermined by low testing capability. 17, 18 A high COVID-19 casefatality ratio (28.9%) is indicative of case under-ascertainment. 19, 20 The virus could thus be circulating undetected and unmitigated within communities, and the true mortality figures could be far higher than reported, as suggested elsewhere. [21] [22] [23] Moreover, in Yemen's protracted crisis an epidemic could result in increased population mortality both directly (from SARS-CoV-2 infection) and indirectly (due to reduced access to healthcare, lack of healthcare workers and/or medical supplies, and/or the socio-economic costs of the pandemic and related control measures, including worsened food security). Information on excess deaths can inform the ongoing response and provide evidence for additional resource mobilisation. 24 Moreover, it may be combined with transmission-dynamic modelling to infer the local state of progression of the epidemic. 21 In this study, we used a novel method based on analysis of satellite imagery to remotely estimate excess mortality during a COVID-19 epidemic in Aden, Yemen. Our study had the secondary aim of establishing the method for possible application elsewhere. Our analysis covered the entire Aden governorate (population ≈ 1 million: see below), consisting mainly of urban or peri-urban settlements. We systematically measured burial activity over (i) a baseline prepandemic period starting in Jan 2016 and (ii) the COVID-19 transmission period, starting 1 Apr 2020 (see below) until mid-September 2020. We sought to exhaustively quantify the num
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