Malaria or COVID-19? A case report highlighting a diagnostic challenge in Africa

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Abstract A 40 years old woman previously healthy was diagnosed and treated for malaria without any significant improvement. At the concern of an increase in shortness of breath, she consulted the nearby hospital where an additional diagnosis of COVID-19 infection was made. She died shortly after due to severe COVID-19 Pneumonia. In countries like Rwanda where 70% of malaria cases are treated at community level by community health workers, typical malaria signs and symptoms (fever, shivering, headache, fatigue, muscle aches, diarrhea, vomiting) are well known by lay providers and even by patients themselves. These overlap with common COVID-19 symptoms. It is very likely that unrecognized COVID-19 disease transmitters will lead to a much wider virus spread, especially by those patients for whom a concurrent malarial disease is easily confirmed using the widely available malaria rapid tests. There is a growing need to reinforce the ability of fragile health systems to discriminate between multiple common causes for common symptoms, especially for malaria and COVID-19 infection.

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