The potential public health consequences of COVID-19 on malaria in Africa

Sherrard-Smith, Ellie; Hogan, Alexandra B.; Hamlet, Arran; Watson, Oliver J; Whittaker, Charles; Winskill, Peter; Ali, Fatima; Mohammad, Audu B.; Uhomoibhi, Perpetua; Maikore, Ibrahim; Ogbulafor, Nnenna; Nikau, Jamilu; Kont, Mara D.; Challenger, Joseph D.; Verity, Robert; Lambert, Ben; Cairns, Matthew; Rao, Bhargavi; Baguelin, Marc; Whittles, Lilith K; Lees, John A.; Bhatia, Sangeeta; Knock, Edward; Okell, Lucy; Slater, Hannah; Ghani, Azra C; Walker, Patrick; Okoko, Okefu Oyale; Churcher, Thomas S

doi:10.1038/s41591-020-1025-y

Cited by 172 publications

(142 citation statements)

References 62 publications

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“…The numbers involved are staggering, and in the many millions ( Table 2). The response has had major detrimental effects on childhood vaccination programs, education, sexual and reproductive health services, food security, poverty, maternal and under five mortality, and infectious disease mortality (78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93). The effect on child and adolescent health will "set the stage for both individual prosperity and the future human capital of all societies (page 2)" (94).…”

Section: Reality Sinking In Iatrogenic Collateral Harms: Lockdown As mentioning

confidence: 99%

“…Some effects of the COVID-19 response that put sustainable development goals out of reach(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90)(91)(92)(93). development goal Effect of COVID-19 response: some detailsChildhood vaccinationPrograms stalled in 70 countries (Measles, Diphtheria, Cholera, Polio) Education School closures: 90% of students (1.57 Billion) kept out of school -Early primary grades are most vulnerable, with effects into adulthood: effects on outcomes of intelligence, teen pregnancy, illicit drug use, graduation rates, employment rates and earnings, arrest rates, hypertension, diabetes mellites, depression -Not just education affected: school closures have effects on food insecurity, loss of a place of safety, less physical activity, lost social interactions, lost support services for developmental difficulties, economic effects on families moderate and severe scenario, projected excess deaths (mostly from delayed net campaigns and treatment) 203,000 to 415,000 over 1 year (an increase of 52-107%, with most deaths in children <5 yo).…”

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confidence: 99%

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COVID-19: Rethinking the Lockdown Groupthink

Joffe

2021

Front. Public Health

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The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

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Section: Reality Sinking In Iatrogenic Collateral Harms: Lockdown As mentioning

confidence: 99%

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confidence: 99%

COVID-19: Rethinking the Lockdown Groupthink

Joffe

2021

Front. Public Health

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“…Antimalarial resistant P. falciparum, the most lethal human malaria parasite species, are spreading (Dondorp et al, 2009;Imwong et al, 2017;Woodrow and White, 2017) and no efficacious vaccine has been developed to date. The devasting impact on endemic communities due to malaria has the potential to worsen with climate change and disruption of malaria control measures from outbreaks of other infectious diseases such as SARS-CoV-2 and Ebola (Rogerson et al, 2020;Sherrard-Smith et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

The Dynamic Roles of the Inner Membrane Complex in the Multiple Stages of the Malaria Parasite

Ferreira

Heincke

Wichers

et al. 2021

Front. Cell. Infect. Microbiol.

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Apicomplexan parasites, such as human malaria parasites, have complex lifecycles encompassing multiple and diverse environmental niches. Invading, replicating, and escaping from different cell types, along with exploiting each intracellular niche, necessitate large and dynamic changes in parasite morphology and cellular architecture. The inner membrane complex (IMC) is a unique structural element that is intricately involved with these distinct morphological changes. The IMC is a double membrane organelle that forms de novo and is located beneath the plasma membrane of these single-celled organisms. In Plasmodium spp. parasites it has three major purposes: it confers stability and shape to the cell, functions as an important scaffolding compartment during the formation of daughter cells, and plays a major role in motility and invasion. Recent years have revealed greater insights into the architecture, protein composition and function of the IMC. Here, we discuss the multiple roles of the IMC in each parasite lifecycle stage as well as insights into its sub-compartmentalization, biogenesis, disassembly and regulation during stage conversion of P. falciparum.

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“…In 2019, cases were estimated at 229 million, resulting in 409,000 fatal outcomes, primarily in Sub-Saharan Africa as a result of Plasmodium falciparum infection (WHO, 2020). This situation is predicted to rapidly worsen as a result of the ongoing SARS-CoV-2 pandemic that has crippled malaria treatment and prevention measures (Sherrard-Smith et al ., 2020). Absent an effective vaccine, malaria control and elimination strategies are critically reliant on the continued clinical efficacy of first-line artemisinin-based combination therapies (ACTs).…”

Section: Introductionmentioning

confidence: 99%

P. falciparum K13 mutations present varying degrees of artemisinin resistance and reduced fitness in African parasites

Stokes

Rubiano

Dhingra

et al. 2021

Preprint

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The emergence of artemisinin (ART) resistance in Plasmodium falciparum parasites, driven by K13 mutations, has led to widespread antimalarial treatment failure in Southeast Asia. In Africa, our genotyping of 3,299 isolates confirms the emergence of the K13 R561H variant in Rwanda and reveals the continuing dominance of wild-type K13 across 11 countries. We show that this mutation, along with M579I and C580Y, confers varying degrees of in vitro ART resistance in African parasites. C580Y and M579I cause substantial fitness costs, which may counter-select against their dissemination in high-transmission settings. We also define the impact of multiple K13 mutations on ART resistance and fitness in multiple Southeast Asian strains. ART susceptibility is unaltered upon editing point mutations in ferrodoxin or mdr2, earlier resistance markers. These data point to the lack of an evident biological barrier to mutant K13 mediating ART resistance in Africa, while identifying their detrimental impact on parasite growth.

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The potential public health consequences of COVID-19 on malaria in Africa

Cited by 172 publications

References 62 publications

COVID-19: Rethinking the Lockdown Groupthink

COVID-19: Rethinking the Lockdown Groupthink

The Dynamic Roles of the Inner Membrane Complex in the Multiple Stages of the Malaria Parasite

P. falciparum K13 mutations present varying degrees of artemisinin resistance and reduced fitness in African parasites

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