First Few Cases Study to Investigate Clinical and Epidemiological Characteristics of COVID-19 in the Early Phase of the Response, Sierra Leone 2020

Abstract

Background: Sierra Leone reported its first case of COVID-19 on March 30, 2020. This report describes the clinical characteristics and the epidemiological features of the first few cases and contacts of COVID-19 in Sierra Leone. Methods: A prospective case-ascertained study was conducted to identify contacts of laboratory-confirmed COVID-19 cases. Demographic, socio-economic, and clinical presentations were collected. Specimen were collected on day 1, day 7, and days 14-21. Data was analyzed using R, Stata, and Microsoft Excel. Results: The study included 160 cases and 1,003 contacts (56% males, 66% age 15-49 years). Of the total, 101/160 (63.1%) were primary cases, 59/160 (36.9%) secondary cases. Common symptoms reported included cough (39/160, 24.4%), headache (35/160, 21.9%), and fatigue (29/160, 18.1%). However, 55% (88/160) of the cases were asymptomatic at enrollment, and 83% (49/59) of the secondary cases were exposed to asymptomatic primary cases. The secondary infection rate was 5.8%. Almost 97% of the secondary cases tested positive on day 1and 3.4% on day 7. Pre-existing medical conditions among cases included diabetes and obesity. Conclusions: We were able to identify clinical and epidemiological characteristics of 160 COVID-19 cases in the early phase of the pandemic in Sierra Leone. The findings of this study helped the Government of Sierra Leone develop and revise its policies and response strategies in order to reduce preventable COVID-19-related deaths. Early investigational protocols such as the first few cases study can be of great utility during outbreaks of relatively unknown diseases. What is already known on this topic A cluster of unusual pneumonia cases was reported in Wuhan, China, that was later identified to be caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2. However, limited knowledge exists on the epidemiological and clinical characteristics of SARS-CoV-2 and the outbreak dynamics at the time Sierra Leone detected its first case. What this study adds This study helped to understand the key clinical characteristics of COVID-19 cases and epidemiological features of COVID-19 diseases in Sierra Leone. Implications of the study in practice, or policy The findings of this study provided evidence for targeted and specific prevention and control measures to contain the spread of the disease in Sierra Leone.