Outcome of Symptom-Based RT-PCR Testing for SARS-CoV-2: Experience from a Large Public Testing Centre in Nigeria

Background: Access to testing for SARS-CoV-2 in Nigeria is still highly restricted. Only patients who are symptomatic for SARS-CoV-2 are selected for testing. This pattern of testing will miss a large proportion of individuals with the infection who are asymptomatic and presymptomatic. This study reports the experience of a symptom-based study from a large testing centre in Nigeria. Methods: A cross-sectional study, reviewing data collected from respondents presenting at the Nigerian Institute of Medical Research (NIMR) modified drive-through center for COVID-19 test between the period March 31st and August 31st, 2020 were included in the analysis. Results: A total of 9891 participants were recruited into the study and 2465 participants (24.9%) had a positive PCR result for SARS-CoV-2. The majority of the respondents were above 18 years old, n = 9163 (93.4%). The average age of the respondents was 36.7 years (sd 13.8 years). The age of the participants has a significant effect on SARS-CoV-2 status (AOR = 1.009, CI, 1.005 to 1.012, p = 0.0001). There was a male preponderance, n = 5652 (57.6%). The odds of having a positive status for SARS-CoV-2 were 0.9 times lower for female participants. The majority of the respondents had a history of travel, n = 6788 (68.6%). Cough was the commonest symptom, n = 1062 (10.7%) followed by fever, n = 979 (9.9%). The mortality rate was 0.1%. Among the participants with comorbidity, 31 (51.7%) had positive results for SARS-CoV-2 while 29 (48.3%) had negative results. Conclusion: Symptom-based approach to testing for SARS-CoV-2 in Nigeria revealed a high positivity rate, while mortality from those tested in the study is low. Age and gender appear to play a significant role in the dynamics of the disease.

COVID-19 Spread Patterns Is Unrelated to Malaria Co-Infections in Lagos, Nigeria

Malaria and COVID-19, though caused by different organisms, share a significant number of symptoms like fever, headaches, difficulty in breathing and fatigue. Therefore, determining if a patient is positive for COVID-19 or Malaria based on symptoms alone, might be misleading, especially during pandemic response. It has been reported that an individual begins to manifest Malaria symptoms between 10 - 15 days after infection with malaria parasite, although some individuals may be asymptomatic. Some COVID-19 infected patients, like Malaria, are also asymptomatic but could contribute to transmission of SARS-CoV-2 virus. These similarities in symptoms have led to misconception about COVID-19 being real and misdiagnoses of both infections, especially in Nigeria. However, there are possibilities that Malaria and COVID-19 could co-exist in some individuals thereby leading to mismanagement and treatment of only one infection while neglecting the possibility of the patient being infected with both diseases. We aim to determine possible correlation between Malaria and COVID-19 in a Malaria endemic country like Nigeria. This study was carried out using the qPCR molecular testing approach, a gold standard for COVID-19 testing and rapid diagnostic test kits to detect Malaria parasites in 617 individuals residing in urban settings. We demonstrated that COVID-19 and Malaria infection amongst adults in urban settings are unrelated thereby focusing on symptoms alone may result in misdiagnosis. Our findings show that Malaria is not among the underlying medical conditions strongly associated with increased risk for severe COVID-19 illness amongst adults in urban settings.