key: cord-263968-v9sncm4l
authors: Ahmed, Anwar E.
title: Incidence of coronavirus disease (COVID-19) and countries affected by malarial infections
date: 2020-04-22
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2020.101693
sha: 
doc_id: 263968
cord_uid: v9sncm4l

nan

Travel Medicine and Infectious Disease journal homepage: www.elsevier.com/locate/tmaid

Dear Editor,

The city of Wuhan in China -toward the end of 2019 -experienced emergence of a new coronavirus disease (COVID-19), formally named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1] . Unlike other animal-to-human coronavirus diseases, this virus shows potential to spread more rapidly in certain areas or countries within the short period of a few weeks. A low incidence of novel coronavirus disease (COVID-19) has been reported from countries with a high incidence of malarial infections. The author investigates whether the rapid spread of COVID-19 is related to the incidence of malaria cases in countries affected by COVID-19. The study utilized publicly available data on COVID-19 cases by countries reporting [2] . For each country affected by COVID-19, the incidence of malaria cases per 1000 population at risk in 2015 has been retrieved [3] .

As of March 22, 2020, results indicate world regions that are malaria free or recorded limited malarial infections reported a large number of COVID-19 cases ( The Poisson regression is used to assess whether the malarial incidence rate (per 1000 population at risk) is a predictor for increased cases of COVID-19. The model shows that as the malarial incidence rate (per 1000 population at risk) increased by 1, the COVID-19 incidence rate tends to decrease by 8.82%. A ROC curve analysis (Fig. 3) indicated that the incidence of COVID-19 was a good classifier (AUC = 0.8115) for countries that were malaria free or recorded limited malarial infections (5 or less per 1000 population at risk).

As of March 22, 2020, malarial drugs have not yet been approved by the FDA as treatments for COVID-19. However, the use of malarial drugs such as chloroquine and hydroxychloroquine shown great promise in treating COVID-19, specifically in China [5] and in France [6] , as well as in a number of ongoing clinical trials across the world. Fig. 3 . The incidence of COVID-19 as a predictor for malaria-free or limited malaria infections.

Another study in France investigated the effectiveness of both hydroxychloroquine and azithromycin with COVID-19, 97.5% of 80 patients improved clinically at Day 5, except two elderly patients (2.5%) [7] .

In conclusion, the spread and clinical management of the current coronavirus outbreaks may require guidelines that incorporate the use of anti-malarial drugs. Future studies are needed to investigate whether a) the use of anti-malarial drugs, b) the environmental factors, and c) different strains of COVID-19 reduce the incidence of COVID-19 infection in countries affected by malaria.

None.

The study may not require IRB/ethics committee approval due to utilization of publicly reported data.

The contents, views or opinions expressed in this publication or presentation are those of the authors and do not necessarily reflect official policy or position of Uniformed Services University of the Health Sciences, the Henry M Jackson Foundation for the Advancement of Military Medicine, the Department of Defense (DoD), or Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. Government.

The author has no conflict of interest to disclosure.

Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses

An interactive web-based dashboard to track COVID-19 in real time

Malaria Published online at OurWorldInData.org

Chloroquine is a potent inhibitor of SARS coronavirus infection and spread

Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro

Chloroquine and hydroxychloroquine as available weapons to fight COVID-19

Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a sixday follow up: a pilot observational study

Ahmed Henry M Jackson Foundation for the Advancement of Military Medicine

E-mail addresses: anwar