MALARIA AND COVID-19 DIAGNOSTIC DILEMMA FOR MALARIA ENDEMIC COUNTRIES
Monday, 10 August | By Ahmed Manjang
As the COVID-19 pandemic spreads rapidly around the globe, there is an urgent need to aggressively tackle the novel coronavirus while ensuring that other killer diseases, such as malaria, HIV, TB and metabolic illnesses such as diabetes and high blood pressure are not neglected. In countries where malaria is endemic, this unprecedented pandemic will continue to impose an additional burden to the already overstretched, resources strapped healthcareservices.
The WHO Global Malaria Programme is leading a cross-partner effort to mitigate the negative impact of the coronavirus in malaria-affected countries and, where possible, contribute towards a successful COVID-19 response (1). Proactive screening of COVID-19 is ongoing in high malaria endemic sub-Saharan African countries. A positive COVID-19 case is deemed confirmed based on the positive laboratory test results of SARS-CoV-2 virus infection regardless of symptoms. Essential steps to identifying a COVID-19 case ultimately involves symptoms or high-risk patients presenting symptoms or travel history, cough, fever, fatigue, shortness of breath, headache and others of acute onset of history of travel to endemic areas or contact with an infected person. Thus, established screening methods for COVID-19 miss approximately 50% of the infected cases, even in countries with robust healthcare systems and available diagnostic companies.
Malaria share some of the highly recognisable symptoms with COVID-19 such as; fever, difficulty in breathing, fatigues and headache of acute onset. Thus, base on symptoms alone, a malaria case may be misclassified as COVID-19 an incidentduring this emergency period and verse versa. Symptoms of malaria appear within 10-15 days after an infective mosquito bite, and respiratory distress is also expected in children while multi-organ failure is common in severe cases among adults, mimicking what usually reported in patients with COVID-19. Like COVID-19, Travel history is another critical consideration that should be noted, when screening for a suspected case of malaria as well as a means of curbing, transmissions. Another notable similaritybetween COVID-19 and malaria individuals may be asymptomatic for a long time while transmitting the infections through their respective modes. The entire world is at a very high risk of COVID-19 while only 50% of the world bearing the brunt of the high risk of both COVID-19 and malaria cases and deaths. Although the instances of COVID-19 remain relative moderate in sub-Saharan Africa than other regions of the world, concern remains high that the situation may prove challenging with time considering the fragile healthcare systems in these areas. Thus, malaria and COVID-19 converges symptomatically and geographically. The gold standard way to definitively identify the underlaying infectious aetiology is through laboratory investigation. Therefore the availability of appropriate diagnostic capacity is essential for accurate surveillance and clinical management of cases.
Right now, it is expected that a high index of suspicion is skewed towards COVID-19 given the jitteriness of communities, health centres, countries, regional and global level. Also, another challenge is the people with fever may preferentially be tested for COVID-19 and sent home if tested negative. Conversely, febrile patients may get screened for malaria when they may have COVID-19 infection. The other possibility is that patients may have malaria and COVID-19 superinfection and diagnosis and treatment of one may lead to missing the other. A single case of COVID-19 has the potential to transmit to up to 3.58 susceptible people. Untreated malaria, on the other hand, has the potential to cause further community infections which in turn continue to be a significant source of illness and death worldwide. Undiagnosed COVID-19 and malaria parasite infection poses an immediate health challenge to the individual and public health consequences for the community. Furthermore, there is widespread fear that limited mobility and extended lockdowns will interrupt the supply chain of essential malaria drugs and test kits. Up to date, there is no definite treatment regimen for COVID-19
Countries, especially poorer nations like The Gambia, are struggling to meet the testing demand ofCOVID-19. In contrast, malaria tests are readily available at each point of care, including at the community level. There is an urgent need, therefore for enhancing sensitisation on the potential of COVID-19 and malaria co-infections.
Further guidance to clinicians on the significance of testing other aetiologies of illness more so in this period when there is much emphasis to early detection and isolation of COVID-19 in a bid to contain further spread to the disease. Since malaria tests are readily available, WHO recommends that health workers perform a rapid test for malaria as they screen for COVID-19 (1). Testing for malaria and COVID-19 at the same time is an excellent opportunity to respond to two potential infectious diseases promptly and reduce unnecessary morbidity and death. By quickly ruling out malaria, the healthcare provider can concentrate on the exact cause of illness and give appropriate and timely management of patients.
1. Chanda-Kapata P, Kapata N, Zumla A. COVID-19 and malaria: A symptom screening challenge for malaria-endemic countries. Int J Infect Dis [Internet]. 2020 May;94:151–3. Available from: https://linkinghub.elsevier.com/retrieve/pii/S120197122030223X
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