High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi

Abstract

Background: In low-income countries, like Malawi, important public health measures including social distancing or a lockdown have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCWs) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi. Methods: We recruited 500 otherwise asymptomatic HCWs from Blantyre City (Malawi) from 22nd May 2020 to 19th June 2020 and serum samples were collected from all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. Results: A total of 84 participants tested positive for SARS-CoV-2 antibodies. The HCWs with positive SARS-CoV-2 antibody results came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 8.2 - 16.5]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was eight times the number of reported deaths. Conclusions: The high seroprevalence of SARS-CoV-2 antibodies among HCWs and the discrepancy in the predicted versus reported deaths suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.

Fear of COVID‐19 and stigmatization towards infected people among Jordanian people

“…18,19 Similarly, recovered patients from COVID-19 infection and healthcare practitioners in Malawi were reportedly denied access to public transportation, experienced insults in the streets, and faced evictions from their rented homes. 20 Media reports in Jordan revealed that recovered people, doctors and medical practitioners handling patients of COVID-19 faced significant social alienation, they were compelled to move from their rented houses and were sometimes assaulted in the ordinary course of their work. 21 Regarding the social stigma of COVID-19 patients, an incident occurred in India and China where a family allegedly abandoned their expectant kin because she tested positive for SARS-CoV-2 when she delivered a baby in a Maharashtra state hospital.…”

SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey

“…Chibwana and colleagues found that 12.3% of healthcare workers in Blantyre, Malawi tested positive for SARS-CoV-2 antibodies; 11 Uyoga and colleagues found a crude seroprevalence of 5.6% in Kenyan blood donors; 12 Olayanju and colleagues determined a 45.1% seroprevalence among asymptomatic healthcare workers in Ibadan, Nigeria; 13 and Mulenga and colleagues noted a SARS-CoV-2 prevalence of 10.6% in 6 of 117 districts in Zambia. 14 Significant underreporting of cases is likely the result of a high prevalence of minimally symptomatic disease in a younger demographic coupled with under-resourced systematic surveillance in the setting of legacies of distrust of authorities and foreign interventions (resulting in the avoidance of testing).…”

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 20201

“…Populationbased serological surveys, hundreds of which have been conducted worldwide, can help shed light on the extent of this underestimation of SARS-CoV-2 infections (5,6). As of March 18, 2021, only 16 studies published or available in preprint had been conducted in sub-Saharan Africa (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) H. Majiya et al, unpub. data,…”