Report from Malawi: Weathering a Second Wave—or Tsunami—of COVID-19
Institute for Global Health and Infectious Diseases
Key members of the UNC Project Malawi evaluation team who are diagnosing and treating fellow staff members with suspected and confirmed COVID-19 cases include (from left) laboratory technician Confidence Banda, Dr. Cecilia Kanyama, and Dr. Cornelius Munyanga. (Institute for Global Health and Infectious Diseases)
Dr. Mina Hosseinipour is a professor of medicine and scientific director for the Institute’s UNC Project-Malawi. UNC recently honored her with a 2021 Distinguished Teaching Award for Post-Baccalaureate Instruction.
Officials announced the first confirmed case of COVID-19 in Malawi on April 2, 2020. At UNC Project Malawi, we’d been working for a month to carefully review and prepare for the virus. We established COVID preventive procedures and clinical management guidelines and planning for staff and staff relatives. We enhanced our oxygen supply through concentrators and obtained more oxygen cylinders. We worked with Kamuzu Central Hospital (KCH) to assist in training and preparations for the onslaught.
And then we waited for the cases to come. A series of events came and went, activities that should have prompted community spread of COVID-19 but didn’t. The month of June brought election campaigning and by early July, we saw a significant increase in cases in the country. The KCH COVID unit filled with patients. This wave lasted approximately two months and then, nearly as suddenly and without appreciable mitigation measures, the cases seemed to go away. Many of us wondered why the incidence of COVID fell so rapidly and nearly completely — we had no admissions, the COVID units closed, we saw less than 1 percent positivity rate among tested individuals, and seemingly no increased admissions, deaths or otherwise in the communities. Malawi was spared, it seemed, and the country seemed to rejoice. Through October and November, things seemed to be back to our usual existence.
In early December, we could see the epidemic picking up in South Africa and we knew there was constant traffic between our two countries. Countries throughout the region were seeing an uptick. Many of us recognized the threat and issued warnings to maintain vigilance, but with so few cases to point to, it was difficult to convey the potential seriousness to communities and our staff.
In mid-December, a visitor to one of the Project-Malawi research studies fell ill while conducting activities at the site. One week later, we learned the visitor eventually had tested positive and was admitted for treatment. By this time, one staff member was already symptomatic and had infected their family members and other household contacts. Our outbreak investigation eventually yielded four positive staff members and numerous staff requiring quarantine. As we recessed for the Christmas and New Year’s holidays, we alerted staff of this serious event and the need to practice COVID prevention measures over the holidays.
The timing of the reintroduction of the virus (and likely the new South African variant) could not have been worse. The holidays bring church services, family gatherings, weddings, and travel to home villages. The result was not just a second wave; it was more like a tsunami of COVID cases. Over the course of a week, the COVID units reopened and filled to capacity. At KCH, the medical short stay and its associated holding tent (now re-erected) overflowed with people spilling into hallways, corridors, and floor space. The demand for oxygen sky-rocketed. We struggle each day to maintain oxygen cylinders even after adding an oxygen plant at KCH in the summer after the first wave.
Read more on the Institute for Global Health and Infectious Diseases website.