Dynamic and features of SARS-CoV-2 infection in Gabon

Abstract

In a context where SARS-CoV-2 population-wide testing is implemented, clinical features and antibody response in those infected have never been documented in Africa. Yet, the information provided by analyzing data from population-wide testing is critical to understand the infection dynamics and devise control strategies. We described clinical features and assessed antibody response in people screened for SARS-CoV-2 infection. We analyzed data from a cohort of 3464 people that we molecularly screened for SARS-CoV-2 infection in our routine activity. We recorded people SARS-CoV-2 diagnosis, age, gender, blood types, white blood cells (WBC), symptoms, chronic disease status and time to SARS-CoV-2 RT-PCR conversion from positive to negative. We calculated the age-based distribution of SARS-CoV-2 infection, analyzed the proportion and the spectrum of COVID-19 severity. Furthermore, in a nested sub-study, we screened 83 COVID-19 patients and 319 contact-cases for anti-SARS-CoV-2 antibodies. Males and females accounted for respectively 51% and 49% of people screened. The studied population median and mean age were both 39 years. 592 out of 3464 people (17.2%) were diagnosed with SARS-CoV-2 infection with males and females representing, respectively, 53% and 47%. The median and mean ages of SARS-CoV-2 infected subjects were 37 and 38 years respectively. The lowest rate of infection (8%) was observed in the elderly (aged > 60). The rate of SARS-Cov-2 infection in both young (18-35 years old) and middle-aged adults (36-60 years old) was around 20%. The analysis of SARS-CoV-2 infection age distribution showed that middle-aged adults accounted for 54.7% of SARS-CoV-2 positive persons, followed respectively by young adults (33.7%), children (7.7%) and elderly (3.8%). 68% (N = 402) of SARS-CoV-2 infected persons were asymptomatic, 26.3% (N = 156) had influenza-like symptoms, 2.7% (N = 16) had influenza-like symptoms associated with anosmia and ageusia, 2% (N = 11) had dyspnea and 1% (N = 7) had respiratory failure, which resulted in death. Data also showed that 12% of SARS-CoV-2 infected subjects, had chronic diseases. Hypertension, diabetes, and asthma were the top concurrent chronic diseases representing respectively 58%, 25% and 12% of recorded chronic diseases. Half of SARS-CoV-2 RT-PCR positive patients were cured within 14 days following the initiation of the anti-COVID-19 treatment protocol. 78.3% of COVID-19 patients and 55% of SARS-CoV-2 RT-PCR confirmed negative contact-cases were positive for anti-SARS-CoV-2 antibodies. Patients with severe-to-critical illness have higher leukocytes, higher neutrophils and lower lymphocyte counts contrarily to asymptomatic patients and patients with mild-to-moderate illness. Neutrophilic leukopenia was more prevalent in asymptomatic patients and patients with mild-to-moderate disease for 4 weeks after diagnosis (27.1-42.1%). In Patients with severe-to-critical illness, neutrophilic leukocytosis or neutrophilia (35.6-50%) and lymphocytopenia (20-40%) were more frequent. More than 60% of participants were blood type O. It is also important to note that infection rate was slightly higher among A and B blood types compared with type O. In this African setting, young and middle-aged adults are most likely driving community transmission of COVID-19. The rate of critical disease is relatively low. The high rate of anti-SARS-CoV-2 antibodies observed in SARS-CoV-2 RT-PCR negative contact cases suggests that subclinical infection may have been overlooked in our setting.

Figure 1

Age distribution of SARS-CoV-2 RT-PCR test. Middle-age adults represented 54.72% of SARS-CoV-2 positive persons, young adults 33.74%, children 7.69% and elderly 3.85%.

Figure 2

Chronic diseases among SARS-CoV-2 positive subjects. (a) 12% of SARS-CoV-2 infected subjects, had chronic diseases. (b) Hypertension represented 58% of recorded chronic diseases, followed respectively by diabetes (25%) and asthma (12%). Other conditions (including thyroid and renal diseases) represented 5% of recorded chronic disease cases.

Figure 3

(a–l) Temporal changes in the count of leukocytes (a–d), lymphocytes (e–h) and neutrophils (i–l) in patients with different COVID-19 severity spectrums. Blood samples were collected and analyzed at diagnosis (Dx), week 1 (W1), week 2 (W2) and week 4 (W4).

Figure 4

(a–h) Temporal changes in the count of monocytes (a–d) and thrombocytes (e–h) in patients with different COVID-19 severity spectrums. Blood samples were collected and analyzed at diagnosis (Dx), week 1 (W1), week 2 (W2) and week 4 (W4).

Figure 5

Anti-SARS-CoV-2 antibodies among patients and contact-cases. 78.3% of COVID-19 patients and 55% of SARS-CoV-2 PCR negative contact-cases had anti-SARS-CoV-2 antibodies.