Table 1.

Possible contributors to low counts of COVID-19 cases in Ethiopia, based on a focus group discussion on April 25, 2020

Potential contributing factors	Explanatory interpretation
Reliance on self and institutional reporting	Testing-related factors
Insufficient disclosure
Insufficient contract tracing
Prolonged incubation period and asymptomatic viral shedding
Low testing capacity
Narrow case definition
Challenges with specimen collection and transportation
Insufficient training and experience
Standardization of testing for local use
Low adjuvant investigations using tests other than RT-PCR
Low sensitivity of RT-PCR in early stages of infection
High prevalence of other infectious diseases provides protection	Differences in host-agent factors
Cross-immunity with other viruses
Genetic diversity of both virus and host
Environmental factors (temperature, humidity, altitude)
Age distribution
Urban to rural ratio
Social determinants (culture, diet, pets)
Hygiene hypothesis (including immunizations)
Travel and movement patterns
General naiveté for modern medicine
Timing and early implementation of interventions	Early implementation of public health measures
Quarantine
Isolation
Banning of mass gatherings
Border closures
School closures
Health education campaigns
Ethiopia is in its 8th week of monitoring	The epidemic trajectory
Ethiopia is in the pre-growth phase of infections