ABSTRACT
Background: Africa's first COVID-19 case was identified in Egypt on 14 February 2020. Since then, almost all African countries have reported cases. The pandemic is transitioning to more widespread community transmission in most African countries, underscoring the need to further scale-up COVID-19 testing with a much wider geographic coverage. In Africa, the expected devastation caused by COVID-19 has been 'delayed' compared to some European countries and the USA. The reason behind this is not well understood. The aim of this Google survey was to collect speculations about the phenomena in Ethiopia, in particular. Methods: This web-based survey used Google Forms to collect data from 28 April to 13 May 2020. Participants from the general public with different expertise were invited via email to take part in the survey. Participants' voluntarism to fill in the form, and their age, sex and educational status, were recorded. In addition, they were asked whether they worried about COVID-19 and the role of lockdowns to minimize the transmission rate of the disease in Africa. Multiple suggestions about the possible reasons behind the relative low number of COVID-19 case and fatalities were recorded, and the collected data were summarized using a Microsoft Excel spreadsheet. Results: A total of 102 participants took part in the web-based survey. Respectively, 92.1% and 64.4% of the participants worried about COVID-19 in Africa and believed that lockdowns could contain the disease in Africa. As for the question why, Africa still has a low number of COVID-19 cases and fatalities compared to other continents, participants reported the following points as the main factors: poor COVID-19 screening practice in the continent (71.3%);God is saving Africa (33.7%);Africans are immune to the virus (18.8%);and poor connection to the rest of the world (18.8%). Conclusions: There is a big concern about COVID-19 in Africa. Timely and accurate epidemiological data is one of the most important tools to inform and drive the COVID-19 response on the continent. Until researchers know exactly what is going on with COVID-19 in Africa, its member states need to keep on measuring and testing.
ABSTRACT
This study aimed to assess the diagnostic test accuracy (DTA) of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) serological test methods and the kinetics of antibody positivity. Systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We included articles evaluating the diagnostic accuracy of serological tests and the kinetics of antibody positivity. MEDLINE through PubMed, Scopus, medRxiv and bioRxiv were sources of articles. Methodological qualities of included articles were appraised using QUADAS-2 while Metandi performs bivariate meta-analysis of DTA using a generalized linear mixed-model approach. Stata 14 and Review Manager 5.3 were used for data analysis. The summary sensitivity/specificity of chemiluminescence immunoassay (CLIA), enzyme-linked immunosorbent assay (ELISA) and lateral flow immunoassay (LFIA) were 92% (95% CI: 86%-95%)/99% (CI: 97%-99%), 86% (CI: 82%-89%)/99% (CI: 98%-100%) and 78% (CI: 71%-83%)/98% (95% CI: 96%-99%), respectively. Moreover, CLIA-based assays produced nearly 100% sensitivity within 11-15 days post-symptom onset (DPSO). Based on antibody type, the sensitivity of ELISA-total antibody, CLIA-IgM/G and CLIA-IgG gauged at 94%, 92% and 92%, respectively. The sensitivity of CLIA-RBD assay reached 96%, while LFIA-S demonstrated the lowest sensitivity, 71% (95% CI: 58%-80%). CLIA assays targeting antibodies against RBD considered the best DTA. The antibody positivity rate increased corresponding with DPSO, but there was some decrement when moving from acute phase to convalescent phase of infection. As immunoglobulin isotope-related DTA was heterogeneous, our data have insufficient evidence to recommend CLIA/ELISA for clinical decision-making, but likely to have comparative advantage over RT-qPCR in certain circumstances and geographic regions.