Covid Research and Public Health Policy

During the first years of the COVID-19 pandemic, infection and fatality rates were underreported and undercounted in fragile and conflict-affected states, particularly those with closed and authoritarian regimes. This had a range of knock-on effects, including a lack of ability to assess the global impact of the pandemic and challenges in providing adequate prevention and treatment supplies through international health and aid agencies. Following a hunch led Emma to create a new methodology for modeling infection rates in these states, which informed public health policy in real time during the pandemic. 

Emma led Syria in Context’s project reporting on Covid-19 in Syria but quickly became uncomfortable with the lack of reliable formal data about infection rates and fatalities in the country. A lack of accurate information meant she was unable to provide adequate public health or policy advice, a concern shared by others working on the response. She began an independent multidisciplinary investigation into the actual rates of Covid-19 in Damascus during Syria's first wave of infection in 2020 for Syria in Context [COVID-19 Spreads out of Control in Damascus, August 6, 2020] during which time the regime was hiding the real toll of the virus. This work resulted in a collaboration with Imperial College, London, that grew from informal findings [Coronavirus Update Number 19, August 19, 2020], to a pre-print published through Imperial College's WHO collaboration and later a peer-reviewed publication in Nature Communications [Leveraging community mortality indicators to infer COVID-19 mortality and transmission dynamics in Damascus, Syria] in April 2021. 

The initial findings independently reached by Syria in Context in August 2020 stood up to replication by tens of researchers and academics, including in Syria (including retrospective research that drew on official data, which later became available). This work was covered by a range of global media outlets, including PBS Newshour, Al-Jazeera, and The National, and it informed policy and donor support for Syria. 

This work also provided the basis for a framework for a multidisciplinary approach to epidemiological modeling of Covid-19 rates in closed states that was used elsewhere during the pandemic including Yemen, Sudan, India, and elsewhere. This modeling informed high-level policy analysis and government decision-making during the pandemic, such as in the January 28, 2021, UK Government SAGE meeting [Discussion document: Key International COVID-19 Science Issues for SAGE] where all of the cited papers on underreported Covid-19 rates drew on the methodology devised through this work.