Findings of two surveys on the Coronavirus pandemic done in Blantyre indicate that the country could have more cases than reported because large numbers of cases are either asymptomatic or only show mild signs.
The result, according to the surveys, is a discrepancy in the actual number of reported Covid-19 cases and deaths in the country as many who may have contracted and died from the global respiratory infection did not have their cases registered.
The first sero-prevalence survey, done at the Malawi-Liverpool Wellcome Trust, was conducted among healthcare workers to establish the cumulative incidence of severe acute respiratory syndrome coronavirus (Sars-CoV-2) infection in urban Malawi.
Reads the report of the first survey: “The crude estimates suggest that there should have been at least 138 deaths by 19th June 2020. However, four weeks following the sero-survey, only 17 Covid-confirmed deaths in Blantyre have been reported by the Public Health Institute of Malawi (4), which is approximately eight times below the predicted deaths.
“When the sero-prevalence is extrapolated to the entire Malawi, it predicts approximately 5 295 Covid-19 deaths, but only 51 deaths have been reported by 16th July 2020.
“These crude estimates highlight a discrepancy between the predicted deaths using infection fatality rates from elsewhere and the actual number of reported Covid-19 deaths in Malawi.”
By August 2, Malawi had cumulatively recorded 4 231 cases, including 123 deaths. Among the cases, 996 are imported infections and 3 235 are locally transmitted.
The deaths, on the other hand, show that about 109 were people above 40 years of age with 39 of them in the 50-59 age bracket.
According to the survey, the discrepancy between the reported mortality at the observed sero-prevalence estimate may also suggest that there are large numbers of underreported or misclassified deaths in Malawi.
On a positive note, the survey indicates that the impact of Sars-CoV-2 in Africa is potentially much less severe or is following a different trajectory than that experienced in China, Americas and Europe, where case fatality ratios were commonly above five.
Adds the survey: “This warrants further investigation. However, the reasons behind the discrepancy in the Covid-19 pandemic trajectory between sub-Saharan Africa and elsewhere might include population demography, climate and prior cross-reactive immunity.
“In Malawi, for example, the population is younger, and the elderly who mostly experience worse outcomes in other settings, are 5.1 percent of the population, largely residing in rural areas. If the prevalence of Sars-CoV-2 is very low in rural areas, this may explain the low number of deaths, and would strengthen the call to shield the elderly.”
According to the 2018 Population House Census, 51 percent of the Malawi population is aged below 18.
The survey has since suggested the need to develop locally parameterised mathematical models that would more accurately predict the trajectory of the epidemic in sub-Saharan Africa.
The model, according to the survey, will allow better evidence-based policy decision-making and public health response planning.
Another survey done at College of Medicine shows that there is high rate of active Covid 19 infection in Blantyre, indicating that of every 100 healthy people, 13 were actively infected and tested positive, higher than 11 percent for healthcare workers.
It reads: “In each setting where healthcare workers and community members tested, healthcare workers did not have higher rates of infection. Covid-19 infections in urban Malawi is not due to isolated outbreaks, but general spread in the community. Healthcare workers are more at risk than general population.”
The survey has since recommended the need to amend strategic response to address general community transmission in urban areas.
In an interview, Society of Medical Doctors president Victor Mithi said it was difficult to test almost everyone at any given point, hence, the discrepancies on the confirmed numbers and those on the ground.
He said: “The surveys are showing us that we have a lot of work to do, we need a lot of testing, and it also goes back to people in communities that once they have symptoms they should show up at hospitals for testing.
“At hospitals, we need more testing kits; when people get there, they shouldn’t take long before they get tested. Results have to be given within the expected range so that those found positive shouldn’t live recklessly because hospitals have delayed providing results.”
Mithi said it was more scary even for health workers as the surveys show that many of them are getting infected. He attributed the matter to a number of factors that include lack of adequate personal protective equipment.
But in a separate interview, Ministry of Health spokesperson Joshua Malango said test kits are now available.
He said: “What we are looking at now is a possibility of decentralising the sample collection points further, especially in hotspot districts.”
On his part, infectious disease specialist Titus Divala said the surveys confirm earlier fears that many people in the country may be infected with the pandemic and that the situation was becoming more scary.
He said: “The bad news from this is that local transmission is very high. However, the number of deaths is far smaller than expected. If the epidemic was to behave as it did in Europe or China, we would have registered a lot of deaths by now.
“What is needed is to invest in targeted, rather than blanket and disastrous interventions. Being different than elsewhere, our epidemic deserves local solutions: Local research, local modelling, local innovations, local social science, and local economics.”
Divala also stressed the need for Malawi to invest in larger studies to confirm current findings and to track rates of severe illness and death in hospital and the community, but also to identify where, when and how to target interventions
Officials from the Ministry of Health and Presidential Taskforce were not readily available for comment yesterday.
However, in daily updates on Saturday, co-chairperson of the Presidential Taskforce on Covid 19, Dr John Phuka reminded the public that Coronavirus is often more severe in older people but also those that have health conditions.
He said: “It is important to ensure that the chronic condition you live with is under control; this means ensuring you are regularly taking medication for diabetes (sugar disease), hypertension (high BP), HIV, TB and asthma.”
On March 20 2020, Covid-19 was declared a National Disaster in Malawi, and on April 2 2020, Malawi registered the first three cases of the pandemic.