COVID-19 community transmission and clustering in Addis Ababa; what does this entail to the country’s pandemic response?

Background: The early phase of the COVID 19 response in Ethiopia focuses primarily on containment of transmission linked to foreign travels and has significantly contributed to flatten the epidemic curve for about two months. From mid-May, the number of cases reported daily has seen a dramatic increase especially in the capital, Addis Ababa. Objective: To describe how community and cluster transmission grows exponentially and the trends and what the country should do differently to control the epidemic. Methods: Secondary data were abstracted from Ethiopian Public Health Institute, Emergency Operating Center and Incident Management reports, situation updates, from Health Minister’s daily epidemic updates, and detailed epidemiologic investigation reports. A narrative and descriptive analysis were used. Results: Primary case C1 had 67 contacts. Of these, five close contacts have become secondary cases. Of the 96 contact identified with the secondary cases, 16 become tertiary cases. From the 75 contacts identified with the tertiary cases, seven become quaternary cases and three quinary cases. One of the secondary cases was a super spreader, which infected 9 people. Most of these cases were clustered in one area of the city. Primary case C2 had 50 contacts. Of which four of his close family members have become positive for COVID-19. Except for the primary cases, all subsequent cases  asymptomatic. The number of positive cases identified in the community has been growing fast. End of April, 63% of the cumulative cases were among people who had travel history; while in mid-June 83% of the cumulative cases were identified in the community. From mid-May, the epidemic has shown exponential growth. Conclusions: Exponential growth of the COVID-19 outbreak has followed the occurrence of community and cluster transmissions and is likely to overwhelm the county’s emergency response facilities and the health care system in the near future. Tailored containment and mitigation strategies and responses that match the magnitude of the problem is needed. Comprehensive surveillance, increasing testing capacity; self/home isolation of cases and quarantining of contacts; implementation of non-pharmacological public health interventions; increasing awareness and community engagement, and ensuring compliance through low enforcement are important aspects to be strengthened.