Limited containment options of COVID-19 outbreak revealed by regional agent-based simulations for South Africa

Background: COVID-19 has spread from China across Europe and the United States and has become a global pandemic. In countries of the Global South, due to often weaker socioeconomic options and health care systems, effective local countermeasures remain debated.  Methods:  We combine large-scale socioeconomic and traffic survey data with detailed agent-based simulations of local transportation to analyze COVID-19 spreading in a regional model for the Nelson Mandela Bay Municipality in South Africa under a range of countermeasure scenarios. Results:  The simulations indicate that any realistic containment strategy, including those similar to the one ongoing in South Africa, may yield a manifold overload of available intensive care units. Only immediate and the most severe countermeasures, up to a complete lock-down that essentially inhibits all joint human activities, can contain the epidemic effectively.  Conclusions:  As South Africa exhibits rather favorable conditions compared to many other countries of the Global South, our findings constitute rough conservative estimates and may support identifying strategies towards containing COVID-19 as well as any major future pandemics in these countries.