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

Anscombe, Catherine, Lissauer, Samantha, Thole, Herbert, Rylance, Jamie ORCID:, Dula, Dingase, Menyere, Mavis, Kutambe, Belson, van der Veer, Charlotte, Phiri, Tamara, Banda, Ndaziona P., Mndolo, Kwazizira S., Mponda, Kelvin, Phiri, Chimota, Mallewa, Jane, Nyirenda, Mulinda, Katha, Grace, Mwandumba, Henry ORCID:, Gordon, Stephen ORCID:, Jambo, Kondwani ORCID:, Cornick, Jennifer, Feasey, Nicholas ORCID:, Barnes, Kayla G., Morton, Ben ORCID: and Ashton, Philip M. (2023) 'A comparison of four epidemic waves of COVID-19 in Malawi; an observational cohort study'. BMC Infectious Diseases, Vol 23, Issue 1, e79.

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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: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WC Communicable Diseases > WC 20 Research (General)
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 21 Feb 2023 15:50
Last Modified: 21 Feb 2023 15:50


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