Examining the Evolution and Drivers of COVID-19 Transmission Waves in Ghana, 2020 – 2022

Background Ghana reported the first COVID-19 cases on 12 March 2020. Response actions were rolled out along seven thematic pillars to limit the importation, detect and contain the virus, effectively manage cases, ensure effective coordination and maintain essential services. A whole-of-government and whole-of-society approach was adopted for the response. The government instituted restriction measures at various stages of the response to contain the pandemic or limit the impact of the pandemic on the health, social and economic wellbeing of the citizens. Four distinct transmission waves were recorded within the first 2 years of the pandemic. The study examined the key drivers of the major waves. Methods A descriptive analysis of the pandemic from March 2020 to March 2022 was conducted using data reported through the country’s COVID-19 surveillance platforms. All RT-PCR confirmed cases reported from the 16 administrative regions over the two-year period were analysed. The effective reproduction number was computed using a model developed by Cori and colleagues. Results A total of 160,761 cases with 99.1% (159,227) recoveries or discharges were reported as of 12 March 2022. The Greater Accra Region reported 56.3% of the confirmed cases. Within the period, 1,445 deaths (CFR= 0.9%) were reported. Approximately 2.3 million tests (76,774 per million population) tests were conducted with a cumulative test positivity rate of 6.8%. COVID-19 vaccination was enrolled a year after the first cases were reported and 21.3% of the target population was fully vaccinated as of 12 March 2022. Ghana recorded four major COVID-19 transmission waves characterized mainly by variants of concern and sub-optimal adherence to the public health and social measures. Conclusion Scaling up and enhancing community acceptance of COVID-19 vaccination as well optimizing the current surveillance and response systems are essential is sustaining the current gains and limiting the emergence of new variants of concern. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement There was no financial support from any entity for this piece of work ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ghana Health Service I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Dataset used for this manuscript is public available. All extracted data and analysis can be made available on request