Malaria deaths could double this year if prevention is interrupted by COVID-19

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Malaria-related deaths in sub-Saharan Africa in 2020 could be more than double those of 2019 if malaria-prevention activities are interrupted due to COVID-19, suggests a modelling study.

The malaria burden is heavily concentrated in sub-Saharan Africa, where COVID-19 cases are also rising. In response to the COVID-19 pandemic, countries in this region are implementing non-pharmaceutical measures to slow the transmission of the causative SARS-CoV-2 virus. The distribution of long-lasting insecticidal mosquito nets has had a major role in the control of malaria in sub-Saharan Africa, and many countries have net-distribution campaigns planned for 2020. However, it is unknown how COVID-19-related disruptions of these campaigns would impact the malaria disease burden.

Thomas Churcher and colleagues at the MRC Centre for Global Infectious Disease Analysis, Imperial College London, used COVID-19- and malaria-transmission models to estimate the impact of disrupting malaria-prevention initiatives and other essential health services under four different COVID-19 epidemic scenarios. They found that if malaria-prevention measures are stopped completely, the 2020 malaria burden could be more than double that of 2019. The authors showed that in Nigeria alone, reducing the malaria case management for six months and delaying the distribution of nets could result in an average of 81,000 additional deaths.

The authors note that managing these negative effects is possible. They argue that malaria-prevention activities – especially the distribution of mosquito nets – should be prioritised, along with access to antimalarial treatments, plus social distancing and the use of other non-pharmaceutical interventions to prevent the transmission of SARS-CoV-2.

Abstract
The burden of malaria is heavily concentrated in sub-Saharan Africa (SSA) where cases and deaths associated with COVID-19 are rising1. In response, countries are implementing societal measures aimed at curtailing transmission of SARS-CoV-22,3. Despite these measures, the COVID-19 epidemic could still result in millions of deaths as local health facilities become overwhelmed4. Advances in malaria control this century have been largely due to distribution of long-lasting insecticidal nets (LLINs)5, with many SSA countries having planned campaigns for 2020. In the present study, we use COVID-19 and malaria transmission models to estimate the impact of disruption of malaria prevention activities and other core health services under four different COVID-19 epidemic scenarios. If activities are halted, the malaria burden in 2020 could be more than double that of 2019. In Nigeria alone, reducing case management for 6 months and delaying LLIN campaigns could result in 81,000 (44,000–119,000) additional deaths. Mitigating these negative impacts is achievable, and LLIN distributions in particular should be prioritized alongside access to antimalarial treatments to prevent substantial malaria epidemics.

Authors
Ellie Sherrard-Smith, Alexandra B Hogan, Arran Hamlet, Oliver J Watson, Charlie Whittaker, Peter Winskill, Fatima Ali, Audu B Mohammad, Perpetua Uhomoibhi, Ibrahim Maikore, Nnenna Ogbulafor, Jamilu Nikau, Mara D Kont, Joseph D Challenger, Robert Verity, Ben Lambert, Matthew Cairns, Bhargavi Rao, Marc Baguelin, Lilith K Whittles, John A Lees, Sangeeta Bhatia, Edward S Knock, Lucy Okell, Hannah C Slater, Azra C Ghani, Patrick GT Walker, Okefu Oyale Okoko, Thomas S Churcher

 

Nature Medicine abstract

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