Estimation of COVID-19 burden in Egypt

We read with interest the Correspondence by Ashleigh Tuite and colleagues.¹ We thank them for their interest in estimating the coronavirus disease 2019 (COVID-19) burden in Egypt. However, their model-based calculations used the number of patients known on March 6, and the numbers of patients and deaths are continuously changing. Attempting to reach a more up-to-date estimate of the expected number of patients in Egypt, we used other assumptions according to real-life data.

The rapid spread of COVID-19, which started in China, led to its characterisation as a pandemic by WHO on March 11.² On Feb 14, Egypt announced its first COVID-19 case.³ Thereafter, Egypt scaled up preventive measures, with a partial lockdown starting on March 25. RT-PCR was done in nasopharyngeal swabs from symptomatic patients and contacts of confirmed cases traced in the preceding 2 weeks. In patients with a high rate of suspicion, the test was repeated after 48 h. Screening at airports included body temperature and clinical assessment and the use of a rapid diagnostic test for anti-severe acute respiratory syndrome coronavirus 2 IgM and IgG. Deaths from influenza-like illness were also reviewed.

As of March 31, Egypt announced 710 COVID-19 cases and 46 related deaths (fatality rate 6·48%, 95% CI 4·78–8·55).⁴ We acknowledge that, in the absence of open screening, this could be an underestimation of the total number of patients and an overestimation of the fatality rate. To estimate the expected disease burden in Egypt, we used fatality rates in the USA and Germany, because they applied open screening, and in regional countries with conditions similar to those of Egypt (Algeria, Bahrain, Iran, Israel, Jordan, Saudi Arabia, Lebanon, Morocco, Palestine, Qatar, Tunisia, Turkey, and United Arab Emirates). On the basis of WHO's report on March 31,⁴ the fatality rate of all reported countries ranged from 0·7% to 11·8%. We deduced a factor by dividing our fatality rate by the global rate and those of the listed countries. This factor was then multiplied by our number of identified cases to estimate the expected total number (table ).

Table.

Estimated number of patients with COVID-19 in Egypt

	Number of patients with confirmed COVID-19*	Number of deaths related to COVID-19*	Fatality rate, % (95% CI)	Expected number of patients with COVID-19 in Egypt (95% CI)
Egypt	710	46	6·48% (4·78–8·55)	..
Germany	71 690	774	1·08% (1·01–1·16)	4261 (3377–5241)
USA	185 159	3773	2·04% (1·97–2·10)	2257 (1720–2886)
USA and Germany	256 849	4547	1·77% (1·72–1·82)	2598 (1974–3331)
Region†	68 936	3281	4·76% (4·60–4·92)	966 (738–1233)
Global	854 013	42 006	4·92% (4·87–4·96)	935 (697–1222)

COVID-19=coronavirus disease 2019.

^*As of March 31, 2020.

^†Includes Algeria, Bahrain, Iran, Israel, Jordan, Saudi Arabia, Lebanon, Morocco, Palestine, Qatar, Tunisia, Turkey, and the United Arab Emirates.

In conclusion, the expected total number of patients with COVID-19 in Egypt, as of March 31, could be in the range of 710–5241 patients. Notably, the exclusion of patients who have not acquired the infection from the reporting country could have decreased these numbers. Additionally, the listed countries do not share the same curves of spread or deaths, stages of the epidemic, or steps of interventions.