COVID-19 in pregnant women in South Africa; a retrospective review (preprint)

Objective: To describe the prevalence, profile and clinical outcomes of pregnant women with COVID-19 admitted to a tertiary facility in Gauteng, South Africa Design: Retrospective review Setting: An academic hospital in Johannesburg, South Africa Population: Two-hundred and four (204) pregnant women with COVID-19 admitted between 6 March and 30 August 2020 Methods: Patient data was captured on discharge or death from paper-based clinical files onto a digital database Main Outcome Measures: Rates of mortality and/or admission to ICU, symptomatic versus asymptomatic disease, maternal and fetal outcome and mode of delivery. Results: A final cohort of 204 pregnant women were included in the study. Thirty three (16.2%) women were critically ill, with 21 (10.3%) admitted to the ICU and 3 (1.5%) deaths related to COVID-19. Conclusions: COVID-19 related mortality in our cohort was higher than that seen internationally, likely due to differences in background maternal mortality rates and difficulty in accessing care.

COVID-19 In-Hospital Mortality in South Africa: The Intersection of Communicable and Non-Communicable Chronic Diseases in a High HIV Prevalence Setting (preprint)

Background: The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis (TB) are unclear, particularly in low- and middle-income countries in Africa. We investigated this interaction using a nationally representative hospital surveillance system for laboratory-confirmed COVID-19 hospital admissions in South Africa.Methods: Using DATCOV data, we describe the demographic characteristics, clinical features, and in-hospital mortality among individuals admitted to public and private hospitals with COVID-19 during 5 March to 11 August 2020. Multivariable logistic regression models were used to assess the role of HIV-status and underlying comorbidities on in-hospital COVID-19 mortality.Findings: Hospital admissions peaked at 1,560 admissions per day, in late July. Among the 41,877 individuals admitted with laboratory-confirmed COVID-19, 7,662 (18.3%) died. Comorbidities were documented in 27,555 (65.8%) individuals, most commonly observed were hypertension (36.8%), diabetes (29.6%), obesity (19.7%), and HIV (8.7%); TB was reported in 0.7% of individuals. Increased risk of in-hospital mortality was associated with HIV and TB, as well as other described risk factors for COVID-19, such as increasing age, male sex, non-White race (Black, mixed and Indian race), chronic underlying conditions particularly hypertension, diabetes and obesity. In addition, HIV-infected individuals with immunosuppression had increased risk of mortality (adjusted odds ratio 2.2; 95% confidence interval 1.6-3.1). Among HIV-infected individuals, the prevalence of other comorbidities associated with severe COVID-19 outcomes was 39.9%. The effect of multiple comorbidities on mortality was similar in HIV-infected and -uninfected individuals.Interpretation: These data provide a better understanding of the interaction of non-communicable diseases, chronic infectious diseases like HIV and TB and COVID-19. Increasing age and presence of chronic underlying comorbidities (particularly hypertension and diabetes) are important additional factors associated with COVID-19 mortality in a middle-income African setting and are common among HIV-infected individuals. HIV- and TB-infected individuals, particularly those with additional comorbidities, would benefit from COVID-19 prevention programmes, as well as early referral and treatment.Funding Statement: DATCOV is funded by the National Institute for Communicable Diseases (NICD) and the South African National Government. No additional funding was obtained towards the completion of this analysis and the development of this manuscript.Declaration of Interests: The authors declare that there are no conflicts of interest.Ethics Approval Statement: The Human Research Ethics Committee (Medical), University of the Witwatersrand, approved the project protocol as part of a national surveillance program (M160667). This activity was reviewed by the U.S. Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy. All personal identifying information was de-linked for our analysis and stored in a secure server.

Age significantly influences the sensitivity of SARS-CoV-2 rapid antibody assays (preprint)

BACKGROUND Point of care serological assays are a promising tool in COVID-19 diagnostics but do have limitations. This study evaluated the sensitivity of five rapid antibody assays and explored factors influencing their sensitivity to detect SARS-CoV-2-specific IgG and IgM antibodies. METHODS Finger-prick blood samples from 102 participants, within two to six weeks of PCR-confirmed COVID-19 diagnosis, were tested for IgG and IgM on five rapid serological assays. The assay sensitivities were compared, and patient factors evaluated in order to investigate potential associations with assay sensitivity. RESULTS Sensitivity ranged from 36% to 69% for IgG and 13% to 67% for IgM. Age was the only factor significantly influencing the likelihood of a detectable IgG or IgM response. Individuals aged 40 years and older had an increased likelihood of a detectable IgG or IgM antibody response by rapid antibody assay. CONCLUSION Rapid serological assays demonstrate significant variability when used in a real-world clinical context. There may be limitations in their use for COVID-19 diagnosis amongst the young.