Abstract
Background: We set out to estimate the community-level exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Ghana. Methods: Phased seroprevalence studies of 2729 participants at selected locations across Ghana were conducted. Phase I (August 2020) sampled 1305 individuals at major markets/lorry stations, shopping malls, hospitals and research institutions involved in coronavirus disease 2019 (COVID-19) work. The study utilized a lateral flow rapid diagnostic test (RDT) which detected IgM and IgG antibodies against SARS-CoV-2 nucleocapsid protein. Results: During Phase I, 252/1305 (19%) tested positive for IgM or IgG or both. Exposure was significantly higher at markets/lorry stations (26.9%) compared to malls (9.4%), with 41–60-year group demonstrating highest seropositivity (27.2%). Exposure was higher in participants with no formal education (26.2%) than those with tertiary education (13.1%); and higher in informally employed workers (24.0%) than those in the formal sector (15.0%). Results from phases II and III, in October and December 2020 respectively, implied either reduced transmissions or loss of antibody expression in some participants. The Upper East region showed the lowest seropositivity (2%). Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Reflective of second wave hospitalisation trends, the 21-40 age group demonstrated modal seropositivity (24.9) in Phase IV whilst 40-60 years and 60+ previously demonstrated highest prevalence. Conclusions: Overall, the data indicates higher COVID-19 seroprevalence than officially acknowledged, likely implying a considerably lower-case fatality rate than the current national figure of 0.84%. The data also suggests that COVID-19 is predominantly asymptomatic COVID-19 in Ghana. The observed trends mimic clinical trends of infection and imply that the methodology used was appropriate.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was first reported in Wuhan, China, in late 20191
There are more than 280 Conformité Européenne-in vitro diagnostics (CE-IVD)-marked COVID-19 antibody detection rapid diagnostic test (RDT) kits listed with the Foundation for Innovative Diagnostics (FIND)[13]
During Phase III, 200 individuals were screened from Navrongo and Bolgatanga in the Upper East Region (C1), which had the lowest reported COVID-19 cases in Ghana at the time the study began
Summary
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) was first reported in Wuhan, China, in late 20191. By April 20th, 2021 there were 141,058,320 coronavirus disease 2019 (COVID-19) SARS-CoV-2 reported infections with 3,015,314 associated deaths (case fatality ratio (CFR): of 2.1%) globally. RT-PCR sensitivity may be affected by viral load, virus replication rate, ribonucleic acid (RNA) isolation method, and the source or timing of swab collection relative to disease stage[10] This could lead to false negativity of about 20%11, indicating that actual infections may be higher than reported per test. Phase IV, in February 2021, showed doubled seropositivity in the upper income bracket (26.2%) since August 2020, reflective of Ghana’s second wave of symptomatic COVID-19 cases. This suggested that high transmission rates had overcome the initial socioeconomic stratification of exposure risk. Keywords African COVID-19, SARS-CoV-2, Seroepidemiology, Community seroprevalence, serology, Ghana
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