LAUSR

The unprecedented global coronavirus disease (COVID-19) pandemic caused by SARS-CoV-2 has rapidly spread to all continents (WHO, 2020a). Whilst spread to Africa has been slow, there are now increasing numbers of COVID-19 being reported from African countries who are preparing themselves (Kapata et al., 2020) for an exponential rise in numbers of cases. As of 26th April 2020, there have been 2,804,796 confirmed COVIDD-19 cases reported to the WHO with 193,710 deaths. In Africa there have been 20,316 cases with 839 deaths reported from 49 countries (WHO, 2020b). In comparison, the WHO malaria report indicates that there were an estimated 228 million cases and 405,000 deaths due to malaria globally in 2018, majority of which were from the Africa region (WHO, 2020c). COVID-19 currently imposes an additional burden to the already overstretched, resource strapped health services which are grappling to bring under control the high burden of existing infectious and non-infectious diseases, including TB, HIV, and malaria. Proactive screening for COVID-19 is ongoing in high malaria endemic African countries. A case of COVID-19 is deemed ‘confirmed’ based on a positive laboratory test result for SARS-Cov-2 virus infection regardless of symptoms (WHO, 2020b). Health care workers and community members alike are faced with an important challenge of quickly identifying symptoms and taking appropriate steps for laboratory investigation in line with the case definition based on surveillance or clinical characterisation (WHO, 2020a). Key steps to identifying a COVID-19 case ultimately involves symptomatic or high risk patients presenting to health providers with complaints of any of the following symptoms or travel history: fever, cough, shortness of breath, fatigue, headache and others of acute onset or history of travel to affected areas or contact with an infected person. Thus, current screening approaches for COVID-19 are likely to miss approximately 50% of the infected cases even in countries with good health systems and available diagnostic capacities (Gostic et al., 2020). Malaria shares some of the highly recognisable symptoms with COVID-19 such as: fever, difficulty in breathing, fatigue and headaches of acute onset. Thus, a malaria case may be misclassified as COVID19 if symptoms alone are used to define a case during this emergency period and vice versa. Malaria symptoms appear within 10-15 days after an infective bite; multi-organ failure is common in severe cases among adults while respiratory distress is also expected in children with malaria, mimicking what is