NICD warning: Malaria cases can be misdiagnosed as Covid

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  • The NICD says malaria cases are being diagnosed as Covid-19.
  • Covid and malaria have similar onset symptoms.
  • People experiencing Covid-like symptoms should indicate if they have been to malaria risk zones.


The National Institute for Communicable Diseases (NICD) has issued a warning that malaria cases are being misdiagnosed as Covid-19.

South Africa is currently at the peak of the malaria season, especially in regions where the disease is endemic. Malaria-risk areas in SA are parts of Limpopo, KwaZulu-Natal and Mpumalanga. However, Gauteng has seen a slight increase in malaria cases, says the NICD’s principal medical scientist Dr Jaishree Raman.

“Covid has pulled resources from the malaria programmes, reducing active surveillance and case investigation, which is reducing the ability [to] classify cases accurately,” said Raman.

Raman was speaking at the NICD’s media briefing on Wednesday.

“Data cleaning and case classification is ongoing, so at the moment, we cannot say whether the uptick in cases is due to locally-acquired or imported malaria,” she said.

Why is misdiagnosis happening?

Raman explains that malaria and Covid-19 have similar non-specific early symptoms, including fever, chills, headaches, fatigue and muscle pain.

She said that when people experience these symptoms, they assume that it is Covid and may not immediately seek medical attention, thinking they have flu or Covid-19.

Raman also said that many healthcare providers are not considering malaria in fever patients who reside in or have travelled to a malaria-risk area. She warns that untreated malaria rapidly progresses to severe disease in immune-compromised people and can be fatal.

“Any individual presenting with fever or flu-like illness, if they reside in a malaria-risk area in Limpopo, KwaZulu-Natal and Mpumalanga or have travelled to a malaria-risk area, especially Mozambique, in the past six weeks, must be tested for malaria by blood smear microscopy or malaria rapid diagnostic test. If they test positive for malaria, the patient must be started on malaria treatment immediately,” the NICD said in a statement this week.

Taxi malaria 

The NICD says that "taxi malaria" should be considered in patients with unexplained fever who have not been in a malaria-endemic area. Raman explains that taxi malaria is transmitted by "hitch-hiking" mosquitoes from malaria-endemic locations and enter into a non-risk zone. 

Ramen advises those who travel to malaria-risk areas to practise non-pharmaceutical interventions such as wearing long sleeves, applying mosquito repellent, and using aircon and fans. She adds that such people should take malaria preventative medicine.

*For more Covid-19 research, science and news, click here.

READ | Covid-19 vaccine trials: High rate of side effects reported with placebos - researchers

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