Preparedness is essential for malaria-endemic regions during the COVID-19 pandemic
The coronavirus disease 2019 (COVID-19) pandemic that first emerged in Wuhan in China's Hubei province has quickly spread to the rest of China and many other countries. Within 3 months, more than 125 000 people have been infected and the death toll had reached over 4600 worldwide on March 12, 2020. In an attempt to contain the virus, the Chinese Government has made unprecedented efforts and invested enormous resources and these containment efforts have stemmed the spread of the disease. As of March 12, 2020, malaria-endemic regions in Africa have reported a few imported COVID-19 cases including in Nigeria, Senegal, and the Democratic Republic of the Congo.
Africa needs to be prepared to deal with COVID-19, given the infectious potential of the disease and its capacity to undermine malaria control efforts. In addition to the shared vigilance that countries around the world should maintain, regions need to consider their local malaria epidemic and take additional measures for preparation. There are relevant lessons from the 2014–16 outbreak of Ebola virus disease in west Africa. The emergence of Ebola in malaria-endemic countries, including Guinea, Liberia, and Sierra Leone, led to a public health emergency and dealt a heavy blow to malaria control efforts. In Guinea alone, an estimated 74 000 fewer malaria cases than expected were seen at health facilities compared with years without Ebola because of decreases in the number of patients with malaria seeking appropriate health care and the volume of malaria treatments being dispensed.
Contributing factors to this situation were the close resemblance of early Ebola symptoms with malaria, leading to difficulties in early diagnosis, and the fear on the part of community members of contracting Ebola in the health-care facilities. As Ebola overwhelmed health-care infrastructure, insufficient resources for malaria control in these regions led to increased mortality and morbidity. In Guinea, the official number of reported deaths from malaria in 2014 was 1067 (WHO estimate 9428) compared with 108 reported in 2013, and there were 2446 deaths from Ebola virus disease in 2014.
More alarmingly, it was estimated that there were about 7000 additional malaria-associated deaths among children younger than 5 years in Guinea, Liberia, and Sierra Leone due to the Ebola outbreak. There is, therefore, a real and pressing danger for malaria-endemic regions when faced with the threat of a novel infectious disease outbreak.