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

Chibwana, Marah ORCID: 0000-0002-8940-3855, Jere, Khuzwayo, Kamng'ona, Raphael, Mandolo, Jonathan, Katunga-Phiri, Vincent, Tembo, Dumizulu, Mitole, Ndaona, Musasa, Samantha, Sichone, Simon, Lakudzala, Agness
et al (show 13 more authors) (2020) High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi.

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<ns3:p><ns3:bold>Background</ns3:bold>: 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.</ns3:p><ns3:p> <ns3:bold>Methods</ns3:bold>: We recruited 500 otherwise asymptomatic HCWs from Blantyre City (Malawi) from 22<ns3:sup>nd</ns3:sup> May 2020 to 19<ns3:sup>th</ns3:sup> June 2020 and serum samples were collected from all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum.</ns3:p><ns3:p> <ns3:bold>Results</ns3:bold>: 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.</ns3:p><ns3:p> <ns3:bold>Conclusions</ns3:bold>: 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.</ns3:p>

Item Type: Article
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User: Symplectic Admin
Date Deposited: 25 May 2021 09:56
Last Modified: 05 Oct 2022 20:59
DOI: 10.12688/wellcomeopenres.16188.1
Open Access URL: http://doi.org/10.12688/wellcomeopenres.16188.1
URI: https://livrepository.liverpool.ac.uk/id/eprint/3123974