Malaria and Parasitic Neglected Tropical Diseases: Potential Syndemics with COVID-19?

Julie R Gutman, Naomi W Lucchi, Paul T Cantey, Laura C Steinhardt, Aaron M Samuels, Mary L Kamb, Bryan K Kapella, Peter D McElroy, Venkatachalam Udhayakumar, Kim A Lindblade, Julie R Gutman, Naomi W Lucchi, Paul T Cantey, Laura C Steinhardt, Aaron M Samuels, Mary L Kamb, Bryan K Kapella, Peter D McElroy, Venkatachalam Udhayakumar, Kim A Lindblade

Abstract

The COVID-19 pandemic, caused by SARS-CoV-2, have surpassed 5 million cases globally. Current models suggest that low- and middle-income countries (LMICs) will have a similar incidence but substantially lower mortality rate than high-income countries. However, malaria and neglected tropical diseases (NTDs) are prevalent in LMICs, and coinfections are likely. Both malaria and parasitic NTDs can alter immunologic responses to other infectious agents. Malaria can induce a cytokine storm and pro-coagulant state similar to that seen in severe COVID-19. Consequently, coinfections with malaria parasites and SARS-CoV-2 could result in substantially worse outcomes than mono-infections with either pathogen, and could shift the age pattern of severe COVID-19 to younger age-groups. Enhancing surveillance platforms could provide signals that indicate whether malaria, NTDs, and COVID-19 are syndemics (synergistic epidemics). Based on the prevalence of malaria and NTDs in specific localities, efforts to characterize COVID-19 in LMICs could be expanded by adding testing for malaria and NTDs. Such additional testing would allow the determination of the rates of coinfection and comparison of severity of outcomes by infection status, greatly improving the understanding of the epidemiology of COVID-19 in LMICs and potentially helping to mitigate its impact.

Conflict of interest statement

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Publication charges for this article were waived due to the ongoing pandemic of COVID-19.

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