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First 100 Persons with COVID-19 — Zambia, March 18–April 28, 2020

Our take —

This case series provides a characterization of the first 100 cases of confirmed COVID-19 in Zambia, a lower-middle income country in sub-Saharan Africa, and includes a description of the national response in the early days of the pandemic. While this study documented known risk factors for disease (male sex), cases were generally young and only 20% had underlying comorbidities. Of those with comorbidities, HIV infection and hypertension were the most common. This study profiles Zambia’s experience in the early stages of the COVID-19 epidemic; however, updated data on the progress of their detection and containment strategies are warranted.

Study design

Case Series

Study population and setting

This case series details the likely source of infection, natural history, and clinical outcomes from the first 100 individuals with laboratory-confirmed SARS-CoV-2 infection in Zambia from March 18 to April 28, 2020. During this time frame, the Ministry of Health conducted 6,165 SARS-CoV-2 tests, initially only in individuals with suspected COVID-19, per the March 20, 2020 World Health Organization definition, and starting April 13, 2020 followed a national mandate, more broadly in all hospitalized patients, outpatients with fever, cough, or shortness of breath, any death in an individual with respiratory symptoms, and biweekly in healthcare workers in facilities that had treated any patients with COVID-19. Other measures to capture suspected cases included community-based and port-of-entry screening, a national public hotline, and contact tracing. From March 20 onwards, authorities in Zambia closed all schools, colleges, and universities, restricted foreign travel, and restricted mass gatherings to limit the spread of COVID-19.

Summary of Main Findings

Of the 6,165 tests, 100 (1.6%) were positive. Most positive tests (77%) were from Lusaka, and were identified through point-of-entry testing (35%) or contact tracing (30%). The majority of cases were males (61%) and in those 30 to 44 years of age (32%). At the time of testing, most cases were asymptomatic (79%); among those with symptoms, fever, cough, sore throat, headache and fatigue were the most common. Patients recovered a median of 12 days (interquartile range 1-42 days) from symptom onset (or date of testing for asymptomatic patients). Although few patients (20%) had comorbidities, those who did were most likely to have HIV (35%) or hypertension (35%). All three patients who died (3 out of 100 cases) had at least one underlying health condition and two of them received intensive care services.

Study Strengths

This study provides detailed epidemiologic and clinical data on the first 100 cases of COVID-19 in Zambia.

Limitations

This case series does not offer insight into how COVID-19 may have acted and/or spread in Zambia after these first 100 cases, particularly how its dynamics may have changed as the virus spread beyond the capital city (Lusaka). Additionally, these data are not necessarily representative of other countries in the region.

Value added

This is one of the first characterizations of how one country in sub-Saharan Africa (Zambia) tracked and managed the first 100 cases over the first 41 days of the COVID-19 pandemic within its borders.

This review was posted on: 20 November 2020