COVID-19 weekly epidemiological report Published on 6 July 2021 Epidemiological Week 26, 2021 (28 June to 4 July 2021)

Cumulative data (2 April 2020 to 4 July 2021) Confirmed Contacts Tests Vaccines administered Recoveries Admissions Deaths cases traced conducted First dose Second dose 37,057 33,404 2,538 1,215 39,892 274,356 385,242 43,165

Epidemiological Week 26, 2021 (28 June to 4 July 2021) 1,348 329 129 28 1,085 8,664 0 0

Highlights

• As of 4 July 2021, a total of 37,057 confirmed COVID-19 cases had been registered in Malawi. Of these cases, 1,348 were reported from 28 June to 4 July 2021 (Epi-week 26), representing a 69.6% increase in the number of new cases compared to Epi-week 25.

• In the past week, all districts except Likoma and Nkhata Bay reported new cases with the majority of the new cases recorded in Blantyre (520), followed by Lilongwe (195), Ntchisi (98), and Kasungu (92).

• A total of 8,664 samples were tested for COVID-19 in the past week (Epi-week 26). Cumulatively 274,356 tests have been conducted in the country. The positivity rate for the past week was 15.6%, an increase from 10.7% in the previous week.

• In the past week, there were 129 newly hospitalised cases, representing a 98.5% increase compared to Epi-week 25. Cumulatively 2,538 cases have been admitted since the first cases were registered on 2 April 2020.

• 28 new deaths were reported in the past week, a 75% increase compared to week 25. Cumulatively, 1,215 deaths have been reported, and the overall case-fatality ratio is 3.3% (1,215/37,057).

• In the past week, 329 recoveries were registered, bringing the total number of recoveries to 33,460 representing a recovery rate of 90.1%.

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

Overview of COVID-19 cases in Malawi

As of 4 July 2021, Malawi has registered a total of 37,057 confirmed COVID-19 cases (Figure 1) including 1,215 deaths. Of the cases, 1,348 cases were reported in the current reporting period (Epi week 26 of 2021) representing a 69.6% increase in the number of new cases compared to Epi-week 25. All districts except Likoma and Nkhata Bay registered new cases in the past week with the majority of the new cases recorded in Blantyre (520), followed by Lilongwe (195), Ntchisi (98), and Kasungu (92). (Table 1). The median age of all cases is 34 years with an interquartile range (IQR) of 24- 45 years and 60.2% are male. As shown in Figure 2, the highest proportion of all cases to date is in the 30-to-39-years (22.9%)) followed by 20-to-29-years (22.8%)) and 40-to-49-years (17.1%) age groups. has the highest recorded case fatality ratio (CFR) at 8.8% and Mangochi has the lowest at 1.5% (Figure 3), whilst the national CFR is at 3.3%. Nkhata Bay has recorded the highest recovery rate at 96.8% whilst Ntchisi has the lowest at 56.3% (Figure 4).

1400 1100 New cases 7-day moving average 1000 1200 900

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Number of cases of Number 400

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- 7 400 300 200 200 100 0 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2020 2020 2020 2020 2020 2020 2020 2020 2020 2021 2021 2021 2021 2021 2021 2021 Date case reported Figure 1: Number of COVID-19 cases and 7-day moving average by date of reporting in Malawi as of 4 July 2021

6000 Female Male Median age (IQR), years: 34 (24 to 45) 60.2% male 5000

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0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ Missing Age group (Years) malawimoh @health_malawi covid19.health.gov.mw/ +265 990 800 000 Dial *929# or SMS “Corona” to 929 or call 929 2 of 9

Malawi COVID-19 epidemiological report, Epi Week 26 2021

Figure 2: Age and sex distribution of COVID-19 cases in Malawi as of 4 July 2021 Table 1: Number of weekly and cumulative COVID-19 cases, deaths, and recoveries in Malawi as of 4 July 2021 Confirmed Cases Deaths Recoveries Transmission Classification* Reporting Health District New Total New Total New Total Imported Local Blantyre 520 11,942 12 416 220 10,850 379 11,563 Lilongwe 195 8,360 0 289 23 7,679 256 8,104 Mzimba North 10 2,278 0 53 0 2,168 32 2,246 Zomba 84 1,720 2 65 0 1,518 59 1,661 Mangochi 21 1,030 1 15 13 954 226 804 Kasungu 92 974 5 31 21 695 35 939 Salima 28 909 3 16 1 847 77 832 Dowa 11 755 0 19 1 675 205 550 Mchinji 64 696 0 23 3 559 23 673 Mulanje 23 680 0 29 2 589 47 633 Nkhata Bay 0 652 0 12 0 631 60 592 Neno 4 604 1 9 0 582 7 597 Mzimba South 23 569 0 27 1 477 105 464 Karonga 3 556 0 22 0 507 37 519 Thyolo 15 502 0 19 18 406 70 432 Balaka 22 496 1 15 0 452 61 435 Dedza 8 472 0 9 4 446 67 405 Nkhotakota 16 416 0 13 2 372 55 361 Ntcheu 14 413 1 23 12 366 49 364 Machinga 38 387 0 9 0 302 95 292 Chiradzulu 8 374 1 23 0 337 30 344 Rumphi 20 338 0 24 0 293 20 318 Phalombe 4 335 0 7 0 321 4 331 Chikwawa 15 264 0 9 3 209 36 228 Chitipa 1 250 0 22 0 226 6 244 Mwanza 10 249 0 6 5 228 18 231 Ntchisi 98 238 1 4 0 134 2 236 Nsanje 1 187 0 4 0 172 38 149 Likoma 0 50 0 2 0 48 0 50 Mwanza PoE 0 361 0 0 0 361 361 0 Total 1,348 37,057 28 1,215 329 33,404 2,460 34,597 *Imported means that infection has been acquired from outside the country; Local transmission means that the source of infection is within the country; PoE, Point of Entry;

10.0%

8.0%

6.0%

4.0% Case Fatality Ratio Fatality Case 2.0%

0.0%

Health District Figure 3: Case Fatality Ratio by health district (02 April 2020 to 4 July 2021)

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

100% 90% 80% 70% 60% 50% 40%

30% Recovery rate Recovery 20% 10% 0%

Health District

Figure 4: Recovery rate by Health District (2 April 2020 to 4 July 2021)

Laboratory testing

During epi-week 26, a total of 8,664 tests were performed with a positivity rate was 15.6%, an increase from 10.7% in Epi-week 25 (Table 2 and Figure 5). Compared to epi week 25, the number of tests conducted in this reporting period has increased by 16.2%. Of the tests conducted in the past week, 4,436 (51.2%) were done using antigen-based rapid diagnostic tests (Table 2) whilst the rest were molecular tests using reverse transcription-polymerase chain reaction (RT-PCR) and GeneXpert. As of 4 July 2021, 274,356 SARS-CoV-2 tests were conducted across 16 testing sites using RT- PCR, 42 GeneXpert, and 211 antigen rapid diagnostic testing sites.

4000 40%

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0 0% Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 2020 2020 2020 2020 2020 2020 2020 2020 2020 2020 2021 2021 2021 2021 2021 2021

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

Figure 5: COVID-19 daily testing trend in Malawi (2 April 2020 to 4 July 2021) Table 2: Laboratory testing for COVID-19 in Malawi (April 2020 to 4 July 2021) Samples tested Positive Negative Name of the testing site Past week Past week Total Past week Total Total PCR AgRDT PCR AgRDT PCR AgRDT PCR AgRDT PCR AgRDT QECH 1,553 0 51,311 250 0 7,032 0 1,303 0 44,090 0 KCH 837 129 42,442 102 7 6,403 11 735 122 35,655 336 NHRL 468 0 28,926 8 0 1,301 0 460 0 27,625 0 Blantyre DREAM 343 0 25,967 28 0 2,913 11 315 0 22,998 43 Mzuzu 97 25 15,085 3 5 1,706 600 94 20 8,622 4,124 Zomba 203 453 10,849 17 63 1,157 616 186 390 4,168 4,908 99 256 7,369 24 32 169 400 75 224 1,097 5,703 KUHES 70 0 6,587 27 0 1,121 0 43 0 5,423 0 Mwanza 3 429 6,425 0 41 271 235 3 388 3,037 2,882 0 347 6,287 0 75 0 743 0 272 0 5,544 PIH 2 67 4,698 0 21 479 313 2 46 2,615 1,286 Kasungu 0 242 3,827 0 90 36 888 0 152 165 2,738 Mchinji 54 180 3,719 5 57 70 603 49 123 429 2,617 Mangochi 36 67 3,707 6 10 34 693 30 57 355 2,625 Mzimba South 0 278 3,706 0 19 116 353 0 259 1,350 1,885 Balaka DREAM 3 0 3,445 1 0 413 0 2 0 3,026 0 Nkhotakota 0 131 3,445 0 15 19 296 0 116 156 2,974 MLW 184 0 3,129 49 0 458 0 135 0 2,667 3 Mwaiwathu Private Hosp 0 180 2,983 0 34 0 407 0 146 0 2,576 Karonga 0 42 2,887 0 3 175 368 0 39 746 1,596 Dowa 30 42 2,852 5 6 70 500 25 36 236 2,046 Balaka 0 58 2,816 0 20 19 249 0 38 144 2,401 Nkhata Bay 0 2 2,562 0 0 115 399 0 2 368 1,680 Salima 9 96 2,473 0 28 36 303 9 68 418 1,716 Mulanje 0 164 2,440 0 22 30 608 0 142 108 1,694 Dedza 0 38 2,404 0 8 18 519 0 30 118 1,749 Chiradzulu 0 63 2,248 0 18 21 413 0 45 78 1,736 Neno 0 16 2,215 0 4 35 527 0 12 143 1,510 Machinga 0 180 1,897 0 35 6 268 0 145 22 1,601 Ntcheu 0 52 1,687 0 10 13 271 0 42 167 1,236 Phalombe 0 36 1,659 0 4 9 327 0 32 110 1,213 Ntchisi 0 357 1,541 0 98 7 229 0 259 36 1,269 Rumphi 0 130 1,495 0 20 28 272 0 110 119 1,076 Nsanje 0 1 1,214 0 1 73 95 0 0 230 816 Thyolo 0 48 1,200 0 10 68 116 0 38 242 765 Chikwawa 0 211 1,063 0 15 9 166 0 196 78 810 Karonga MEIRU 0 0 971 0 0 27 0 0 0 937 0 Kamuzu Barracks 0 0 948 0 0 54 5 0 0 136 753 Chitipa 0 9 734 0 1 55 173 0 8 158 348 Nkhoma Mission 0 35 498 0 2 9 29 0 33 33 427 UNC Project Lilongwe 0 0 458 0 0 122 0 0 0 336 0 MUST 0 0 439 0 0 25 0 0 0 414 0 Ndirande Health Centre 232 0 392 25 0 42 0 207 0 350 0 Blantyre Adventist Hosp 0 46 355 0 12 0 60 0 34 0 295 Likoma 0 0 289 0 0 4 44 0 0 94 147 Malamulo Adventist 3 4 240 1 3 12 64 2 1 29 135 Chitawira Private 0 0 235 0 0 0 51 0 0 0 184 Lilongwe Lighthouse 0 20 161 0 5 10 18 0 15 58 75 Blantyre Lighthouse 2 2 53 2 1 6 3 0 1 32 12 Wezi Medical Center 0 0 42 0 0 18 0 0 0 24 0 Total 4,228 4,436 274,356 553 795 24,814 12,243 3,675 3,641 169,442 67,518 Grand total (PCR & AgRDT) 8,664 274,356 1,348 37,057 7,316 236,960 PCR: Reverse Transcription-Polymerase Chain Reaction (also includes those tested using GeneXpert); AgRDT: Antigen-based Rapid Diagnostic Test; NHRL; National Health Reference laboratory: KUHES; Kamuzu University of Health Sciences: MLW; Malawi Liverpool Wellcome Trust: QECH; Queen Elizabeth Central Hospital: KCH; Kamuzu Central Hospital: PIH; Partners in Hope: MUST; Malawi University of Science and Technology

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

Hospitalizations and deaths

In epi-week 26, a total of 129 newly hospitalised cases, representing a 98.5% increase compared to Epi-week 25. (Figure 6). Cumulatively 2,538 cases have been admitted since the first cases were registered on 2 April 2020. A total of 28 new deaths were reported in the past week representing a 75% increase compared to week 25. Cumulatively, 1,215 deaths have been reported, and the overall case-fatality ratio is 3.3% (Figure 6). Figure 7 presents the age and sex distribution of the COVID-19 deaths in Malawi whose median age is 60 years and 67.5% are male.

400 Admissions Deaths 350

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0 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 1 3 5 7 9 11 13 15 17 19 21 23 25 2020 2021 Epidemiologic weeks Figure 6: Weekly number of new COVID-19 admissions and deaths in Malawi as of 4 July 2021

200 Female Male 180 Median age (IQR), years: 60 (49 to 70) 160 67.5% male CFR: 3.3% 140

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0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+ Missing Age group, years

Figure 7: Age and sex distribution of COVID-19 deaths in Malawi as of 4 July 2021

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

COVID-19 vaccination

Due to stock-outs of the vaccine, there were no doses administered in the past week. Cumulatively, 385,242 first dose and 43,165 are second dose vaccines have been administered since the official launch of vaccination on 11 March 2021 (Figure 8).

90,000 Second dose 80,000 First dose 70,000 60,000 50,000 40,000 30,000

20,000 Number of vaccines administered vaccines of Number 10,000 0 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Epi weeks Figure 8: COVID-19 vaccines administered per epi-week as of 4 July 2021

Summary of Prevention and Response Activities

Coordination To facilitate coordination and maintain focused efforts towards combating COVID-19, routine and ad-hoc meetings are held as follows: • Presidential Task Force on COVID-19 meets weekly • Health Cluster meetings every two weeks • Weekly Laboratory, RCCE, IPC, Supplies & Logistics, and Case Management technical committees • The surveillance technical committee is meeting three times a week • Public Health Emergency Operation Centre (PHEOC) is meeting three times a week The following activities are being conducted to ensure an efficient and coordinated response • Public Health Emergency Operation Centre is running 24/7 and Incident Management System is operational • Integrating different data sources to the EOC dashboard (CCPF, HTSS) • Revising and finalising threshold alert levels of response • COVID-19 response plan was reviewed • Planning review of health cluster TORS and functions • Harmonization of data sources for Incident Management System data management • Updating EOC terms of reference and handbook Surveillance, Case Detection, and Rapid Response • Daily collection of data and production of daily situation reports • Production of weekly epidemiological reports • Monitoring health care workers infection rates • Conducted training of trainers of the 3rd Edition IDSR guidelines and planning for roll-out • Training of District Rapid Response Teams taking place • Ongoing and Planned Surveys o Syndrommic Surveillance for COVID-19 – ongoing o Population-based seroprevalence survey – data collection finished in 5 of 12 districts

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

• Routine monitoring of the epidemic to flag resurgences in the country and assessing risks from various countries

Laboratory • Conducted training of trainers on AgRDT testing • GeneXpert platforms at Mwanza, Mchinji, and Dedza borders now functional • GeneXpert cartridges are now in stock • Capacity building for genotyping still underway • Conducted baseline assessment for sample repository capacity in the country

Infection Prevention and Control (IPC) • Piloting of IPC comprehensive assessment tools in Zomba Central Hospital, Thyolo District Hospital and Mulanje Mission Hospital • IPC training for junior staff with particular emphasis on cleaning and health care waste management for Blantyre DHO, Mwanza, Daeyang Hospital, Mzuzu central and Nkhatabay • IPC compliance monitoring by regulatory bodies and selected Health Associations

Case management • Finalised 3rd edition of case management manual and training modules were drafted o Planning on the dissemination and training of the guidelines • Health facility readiness for third wave and action plan was developed and incorporated into the revised response plan • Guardians’ policy was reviewed • Death audit training is in progress Risk communication and community engagement (RCCE) • Airing of Public Services Announcements (on both National and Community) to encourage the public to receive the second dose of COVID-19 vaccine • Conducted a message development session to address emerging issues on COVID-19 and to increase uptake of the vaccine • Organised CSO engagement meetings to lobby for their support in demand creation for vaccine • Continuous media and community engagements • Monitoring feedback on different platforms and addressing them through the daily press statements • Drafting COVID-19 daily updates to include key messages that also addresses the emerging issues. • The public can access the COVID-19 information by dialling 929, *929# for USSD services or by sending “hi” through WhatsApp to 0990 800 000, Facebook – Ministry of Health – Malawi, Twitter @health_malawi and website https://covid19.health.gov.mw

COVID-19 vaccine update • The second dose vaccination was launched on 4 June 2021 • Vaccination is open to all the eligible above the age of 18 years • Community engagement and demand creation activities have been enhanced in all districts • Weekly meetings of the COVID-19 vaccine National Task Force • Revising the vaccine development plan to beyond the 20% population

Case definitions

The case definitions are based on the current information available and may be revised as new information accumulates. 1. Suspect case a. A patient with a severe acute respiratory infection (FEVER1 AND at least one sign/symptom of respiratory disease (e.g., cough, shortness breath includes other severe COVID symptoms), AND with

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Malawi COVID-19 epidemiological report, Epi Week 26 2021

no other aetiology that fully explains the clinical presentation presenting to a health facility who may or may not require hospitalization.

OR

b. Patients with acute respiratory illness (at least one sign/symptom of respiratory disease (e.g., sore throat, cough, difficulties in breathing, fever)) or other COVID-19 related symptoms (headache, fatigue, general body pains, loss of smell and taste, diarrhoea), AND with no other aetiology that fully explains the clinical presentation2 AND at least one of the following: i. history of residence in an area reporting community transmission3 within Malawi or travel to or residence in a country, area, or territory reporting local transmission of COVID-19 during the 14 days before symptom onset

OR

ii. is a health care worker or any person who has been working in an environment where COVID- 19 cases are being managed c. A person, with or without acute respiratory illness, having been in contact4 with a confirmed or probable COVID-19 case, in the 2 days prior to14 days after onset of symptoms of the confirmed or probable case 2. Probable case a. A suspect case for whom testing for COVID-19 is inconclusive. Inconclusive being the result of the test reported by the laboratory

OR

b. A suspect case for whom testing could not be performed for any reason5

3. Confirmed case A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms

4. COVID-19 death COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case unless there is a clear alternative cause of death that cannot be related to COVID disease (e.g., trauma). There should be no period of complete recovery between illness and death.

Conclusion

Malawi is experiencing a resurgence of COVID-19 as it continues to register an increase in the number of new cases, new deaths, admission, and positivity rate. Additionally, a shift from imported infection to locally acquired infections highlights increased community transmission.

2 Clinicians should also be alert to the possibility of atypical presentations in patients who are immunocompromised 3 Community transmission within Malawi, areas updated according to the positivity rate determined from tests conducted. Refer to updated list 4 Contact is defined as: • Providing direct care for COVID-19 patients, working with health care workers infected with coronavirus, visiting patients, or staying in the same close environment of a COVID-19 patient. • Working together in close proximity or sharing the same classroom environment with a COVID-19 patient • Traveling together in close proximity with a COVID-19 patient in any kind of conveyance • Living in the same household as a COVID-19 patient • Having attended a joint event of which patients with COVID-19 have been identified (meetings of different kinds where contact between participants is very likely) within a 14‐day period after the onset of symptoms in the case under consideration 5 Sample for Laboratory confirmation will be collected from Suspect Case including DECEASED suspect cases or unexplained sudden death and persons that have been in contact with a confirmed case of COVID-19 and fit screening criteria for testing malawimoh @health_malawi covid19.health.gov.mw/ +265 990 800 000 Dial *929# or SMS “Corona” to 929 or call 929 9 of 9