A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study

Anscombe, C. et al. (2023) A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study. BMC Infectious Diseases, 23, 79. (doi: 10.1186/s12879-022-07941-y) (PMID:36750921) (PMCID:PMC9902830)

Abstract

Background: Compared to the abundance of clinical and genomic information available on patients hospitalised with COVID-19 disease from high-income countries, there is a paucity of data from low-income countries. Our aim was to explore the relationship between viral lineage and patient outcome. Methods: We enrolled a prospective observational cohort of adult patients hospitalised with PCR-confirmed COVID-19 disease between July 2020 and March 2022 from Blantyre, Malawi, covering four waves of SARS-CoV-2 infections. Clinical and diagnostic data were collected using an adapted ISARIC clinical characterization protocol for COVID-19. SARS-CoV-2 isolates were sequenced using the MinION™ in Blantyre. Results: We enrolled 314 patients, good quality sequencing data was available for 55 patients. The sequencing data showed that 8 of 11 participants recruited in wave one had B.1 infections, 6/6 in wave two had Beta, 25/26 in wave three had Delta and 11/12 in wave four had Omicron. Patients infected during the Delta and Omicron waves reported fewer underlying chronic conditions and a shorter time to presentation. Significantly fewer patients required oxygen (22.7% [17/75] vs. 58.6% [140/239], p < 0.001) and steroids (38.7% [29/75] vs. 70.3% [167/239], p < 0.001) in the Omicron wave compared with the other waves. Multivariable logistic-regression demonstrated a trend toward increased mortality in the Delta wave (OR 4.99 [95% CI 1.0–25.0 p = 0.05) compared to the first wave of infection. Conclusions: Our data show that each wave of patients hospitalised with SARS-CoV-2 was infected with a distinct viral variant. The clinical data suggests that patients with severe COVID-19 disease were more likely to die during the Delta wave.

• Item Type: Articles
• Additional Information: This work was supported by the UK Foreign, Commonwealth and Development Office and Wellcome grants for SARS-CoV-2 diagnostics [220757/Z/20/Z] and the MLW Core Grant [206545/Z/17/Z]. KGB is supported by an NIH-Fogarty fellowship [TW010853].
• Keywords: COVID, SARS-CoV-2, ISARIC, delta, mortality, LMIC, Malawi, Africa.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Barnes, Dr Kayla
• Authors: Anscombe, C., Lissauer, S., Thole, H., Rylance, J., Dula, D., Menyere, M., Kutambe, B., van der Veer, C., Phiri, T., Banda, N. P., Mndolo, K. S., Mponda, K., Phiri, C., Mallewa, J., Nyirenda, M., Katha, G., Mwandumba, H., Gordon, S. B., Jambo, K. C., Cornick, J., Feasey, N., Barnes, K. G., Morton, B., and Ashton, P. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Virus Research
• Journal Name: BMC Infectious Diseases
• Publisher: BioMed Central
• ISSN: 1471-2334
• ISSN (Online): 1471-2334
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in BMC Infectious Diseases 23: 79
• Publisher Policy: Reproduced under a Creative Commons License