Controlling the first wave of the COVID–19 pandemic in Malawi: results from a panel study

  1. Jethro Banda
  2. Albert N. Dube
  3. Sarah Brumfield
  4. Amelia C. Crampin
  5. Georges Reniers
  6. Abena S. Amoah
  7. Stéphane Helleringer

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Abstract

Many African countries have experienced a first wave of the COVID–19 pandemic between June and August of 2020. According to case counts reported daily by epidemiological surveillance systems, infection rates remained low in most countries. This defied early models of the potential impact of COVID–19 on the continent, that projected large outbreaks and massive strain on health systems. Theories proposed to explain the apparently limited spread of the novel coronavirus in most African countries have emphasized 1) early actions by health authorities (e.g., border closures) and 2) biological or environmental determinants of the transmissibility of SARS-CoV-2 (e.g., warm weather, cross-immunity). In this paper, we explored additional factors that might contribute to the low recorded burden of COVID–19 in Malawi, a low-income country in Southeastern Africa. To do so, we used 4 rounds of panel data collected among a sample of adults during the first 6 months of the pandemic in the country. Our analyses of survey data on SARS-CoV-2 testing and COVID-related symptoms indicate that the size of the outbreak that occurred in June-August 2020 might be larger than recorded by surveillance systems that rely on RT-PCR testing. Our data also document the widespread adoption of physical distancing and mask use in response to the outbreak, whereas most measured patterns of social contacts remained stable during the course of the panel study. These findings will help better project, and respond to, future waves of the pandemic in Malawi and similar settings.

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    SciScore for 10.1101/2021.02.21.21251597: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: We sought oral informed consent from all participants before each round of data collection.
    IRB: Data collection procedures for the COVID–19 panel were approved by the institutional review boards of the National Health Sciences Research Committee in Malawi, the Johns Hopkins University School of Public Health and the London School of Hygiene and Tropical Medicine.
    RandomizationEach interviewer was randomly assigned a set of respondents at the beginning of the COVID–19 panel, and these sets were maintained in all 4 rounds of data collection.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableParticipants in the COVID–19 panel included men and women aged 18 years and older.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This finding about the completeness of case counts derived from RT-PCR testing is affected by potential limitations. Our self-reported measure of prior SARS-CoV-2 testing, in particular, might misrepresent testing coverage. Due to stigma surrounding COVID–19 (86), some respondents might have failed to report previous tests for SARS-CoV-2. This would have prompted a downward bias in our estimates of testing coverage. Despite including a description of the sample collection procedure in our survey question in round 4, some participants might have confused SARS-CoV-2 testing with other prevention measures, e.g., temperature checks, screening questionnaires. This would have led to bias in the opposite direction, possibly inflating estimates of the proportion of participants tested for SARS-CoV-2. We also did not investigate repeat testing for SARS-CoV-2 among panel participants, nor did we assess whether testing coverage varied over time. Based on these data, and also owing to the selectivity of our study sample (see below), we could not produce an estimate of the true number of infections with SARS-CoV-2 in Malawi. Nonetheless, our findings corroborate results from a serosurvey conducted in Blantyre (87) and several similar surveys conducted in other African settings (12,88,89). In these studies, the high prevalence of IgG antibodies against SARS-CoV-2 implied a number of cases (much) larger than recorded by surveillance systems relying on RT-PCR testing. Whereas our data indica...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2021.02.21.21251597v1 on medRxiv