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Chibwana MG, Jere KC, Kamn'gona R, et al. High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi. medRxiv. 2020;doi: 10.1101/2020.07.30.20164970.
Chibwana, M. G., Jere, K. C., Kamn'gona, R., Mandolo, J., Katunga-Phiri, V., Tembo, D., Mitole, N., Musasa, S., Sichone, S., Lakudzala, A., Sibale, L., Matambo, P., Kadwala, I., Byrne, R. L., Mbewe, A., Henrion, M. Y. R., Morton, B., Phiri, C., Mallewa, J., Mwandumba, H. C., Adams, E. R., Gordon, S. B., & Jambo, K. C. (2020). High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi. medRxiv : the preprint server for health sciences, . https://doi.org/10.1101/2020.07.30.20164970
Chibwana, Marah G, et al. "High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi." medRxiv : the preprint server for health sciences vol. (2020). doi: https://doi.org/10.1101/2020.07.30.20164970
Chibwana MG, Jere KC, Kamn'gona R, Mandolo J, Katunga-Phiri V, Tembo D, Mitole N, Musasa S, Sichone S, Lakudzala A, Sibale L, Matambo P, Kadwala I, Byrne RL, Mbewe A, Henrion MYR, Morton B, Phiri C, Mallewa J, Mwandumba HC, Adams ER, Gordon SB, Jambo KC. High SARS-CoV-2 seroprevalence in health care workers but relatively low numbers of deaths in urban Malawi. medRxiv. 2020 Aug 05; doi: 10.1101/2020.07.30.20164970. PMID: 32766597; PMCID: PMC7402052.
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medRxiv. 2020 Aug 05; doi: 10.1101/2020.07.30.20164970.

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

medRxiv : the preprint server for health sciences

Marah G Chibwana, Khuzwayo C Jere, Raphael Kamn'gona, Jonathan Mandolo, Vincent Katunga-Phiri, Dumizulu Tembo, Ndaona Mitole, Samantha Musasa, Simon Sichone, Agness Lakudzala, Lusako Sibale, Prisca Matambo, Innocent Kadwala, Rachel L Byrne, Alice Mbewe, Marc Y R Henrion, Ben Morton, Chimota Phiri, Jane Mallewa, Henry C Mwandumba, Emily R Adams, Stephen B Gordon, Kondwani C Jambo

Affiliations

  1. Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
  2. Centre for Global Vaccine Research, Institute of Infection, Veterinary Ecological Sciences, University of Liverpool, Liverpool, UK.
  3. Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
  4. Liverpool School of Tropical Medicine, L3 5QA, Liverpool, United Kingdom.
  5. Ministry of Health, Queen Elizabeth Central Hospital, Blantyre, Malawi.

PMID: 32766597 PMCID: PMC7402052 DOI: 10.1101/2020.07.30.20164970

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 22

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.

Keywords: COVID-19; IgG; Malawi; SARS-CoV-2; Seroprevalence

Conflict of interest statement

Competing interests E.R.A. and R.L.B. worked with Mologic (UK) to independently validate the SARS-CoV-2 ELISA at the Liverpool School of Tropical Medicine (LSTM). All other authors report no potential

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