{"doi":"10.1101/2020.07.30.20164970","title":"High SARS-CoV-2 seroprevalence in Health Care Workers but relatively low numbers of deaths in urban Malawi","abstract":"BACKGROUND: In low-income countries, like Malawi, important public health measures including social distancing or a lockdown have been challenging to implement owing to socioeconomic constraints, leading to predictions that the COVID-19 pandemic would progress rapidly. However, due to limited capacity to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, there are no reliable estimates of the true burden of infection and death. We, therefore, conducted a SARS-CoV-2 serosurvey amongst health care workers (HCWs) in Blantyre city to estimate the cumulative incidence of SARS-CoV-2 infection in urban Malawi. METHODS: June 2020 and serum samples were collected from all participants. A commercial ELISA was used to measure SARS-CoV-2 IgG antibodies in serum. RESULTS: A total of 84 participants tested positive for SARS-CoV-2 antibodies. The HCWs with positive SARS-CoV-2 antibody results came from different parts of the city. The adjusted seroprevalence of SARS-CoV-2 antibodies was 12.3% [CI 8.2 - 16.5]. Using age-stratified infection fatality estimates reported from elsewhere, we found that at the observed adjusted seroprevalence, the number of predicted deaths was eight times the number of reported deaths. CONCLUSIONS: The high seroprevalence of SARS-CoV-2 antibodies among HCWs and the discrepancy in the predicted versus reported deaths suggests that there was early exposure but slow progression of COVID-19 epidemic in urban Malawi. This highlights the urgent need for development of locally parameterised mathematical models to more accurately predict the trajectory of the epidemic in sub-Saharan Africa for better evidence-based policy decisions and public health response planning.","journal":"medRxiv","year":2020,"id":118388,"datarank":6.097117684698583,"base_score":4.553876891600541,"endowment":4.553876891600541,"self_citation_contribution":0.6830815337400812,"citation_network_contribution":5.414036150958502,"self_endowment_contribution":0.6830815337400812,"citer_contribution":5.414036150958502,"corpus_percentile":null,"corpus_rank":null,"citation_count":94,"citer_count":92,"citers_with_citation_signal":76,"citers_with_endowment":76,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9644,"is_data_producer":true,"deposit_databanks":{"figshare":["10.6084/m9.figshare.12745214.v2"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":324148,"name":"Khuzwayo C. Jere","orcid":"0000-0003-3376-8529","position":1,"is_corresponding":false},{"id":324965,"name":"Raphael Kamng’ona","orcid":null,"position":2,"is_corresponding":false},{"id":324149,"name":"Jonathan Mandolo","orcid":"0000-0003-0143-7469","position":3,"is_corresponding":false},{"id":324150,"name":"Vincent Katunga-Phiri","orcid":"0000-0001-9173-3426","position":4,"is_corresponding":false},{"id":324966,"name":"Dumizulu Tembo","orcid":null,"position":5,"is_corresponding":false},{"id":324967,"name":"Ndaona Mitole","orcid":null,"position":6,"is_corresponding":false},{"id":324968,"name":"Samantha Musasa","orcid":null,"position":7,"is_corresponding":false},{"id":324151,"name":"Simon Sichone","orcid":"0000-0003-3520-7901","position":8,"is_corresponding":false},{"id":324969,"name":"Agness Lakudzala","orcid":null,"position":9,"is_corresponding":false},{"id":324152,"name":"Lusako Sibale","orcid":"0000-0001-5378-3561","position":10,"is_corresponding":false},{"id":324153,"name":"Prisca Benedicto-Matambo","orcid":"0000-0002-6215-270X","position":11,"is_corresponding":false},{"id":324970,"name":"Innocent Kadwala","orcid":null,"position":12,"is_corresponding":false},{"id":324154,"name":"Rachel L. Byrne","orcid":"0000-0001-5398-3125","position":13,"is_corresponding":false},{"id":324971,"name":"Alice Mbewe","orcid":null,"position":14,"is_corresponding":false},{"id":324156,"name":"Ben Morton","orcid":"0000-0002-6164-2854","position":15,"is_corresponding":false},{"id":324972,"name":"Chimota Phiri","orcid":null,"position":16,"is_corresponding":false},{"id":324973,"name":"Jane Mallewa","orcid":null,"position":17,"is_corresponding":false},{"id":324157,"name":"Henry C. Mwandumba","orcid":"0000-0003-4470-3608","position":18,"is_corresponding":false},{"id":274623,"name":"Emily R. Adams","orcid":"0000-0002-0816-2835","position":19,"is_corresponding":false},{"id":324158,"name":"Stephen B. Gordon","orcid":"0000-0001-6576-1116","position":20,"is_corresponding":false},{"id":324159,"name":"Kondwani Jambo","orcid":"0000-0002-3195-2210","position":21,"is_corresponding":false},{"id":324147,"name":"Marah G. Chibwana","orcid":"0000-0002-8940-3855","position":0,"is_corresponding":true}],"reference_count":13,"raw_metadata":null,"created_at":"2026-07-18T23:13:58.531532Z","pmid":"32766597","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}