Be aware of the similarities between malaria and Covid-19, experts warn

With South Africa’s intensive care units crammed full of Covid-19 patients, even as the second infection surge slowly wanes, a new warning about malaria’s starkly similar initial presenting symptoms was issued on Thursday.


Professor Lucille Blumberg, epidemiology deputy director at the National Institute of Communicable Diseases (NICD) and a veteran of disease-outbreak monitoring and prevention issued the warning at a webinar.


She said that, with recent heavy rains in traditional malaria regions, it is now peak malaria season, meaning more infected patients present with Covid-19-like symptoms. With Covid-19 so ubiquitous and top of mind for most healthcare workers, malaria could easily be misdiagnosed, leading to delays in appropriate treatment and progression to severe disease, increasing pressure on hospitals’ intensive care units.

“The symptoms overlap with Covid-19, so we need to always check whether patients live in or have travelled to a malaria area within the last month — and do malaria tests. These results are usually very quick compared to Covid-19 tests, which can take days, meaning the opportunity to treat uncomplicated malaria can be lost,” she said.

Blumberg said, if it is caught early on, malaria is highly responsive to first-line drugs. One symptom of well-progressed malaria that’s identical to Covid-19 is Acute Respiratory Distress Syndrome (Ards).


“Not all Ards is Covid-19 — so get that travel and residential history — but ideally, we need to be treating malaria long before it becomes difficult,” she warned clinicians.

Among malaria, complications are fluid in the lungs and shortness of breath, which can easily be misdiagnosed as Covid-19. Both conditions look the same on an X-ray.

“Not everything with fever or breathing fast is Covid. Also, fever, headaches and fatigue overlap in both diseases. If there is a loss in taste and smell, however, it’s more likely to be Covid,” Blumberg said.

She said it was “critical” for clinicians to get a travel history and residential address to establish if the patient had been in a malaria-endemic region — and then test for malaria.

This comes a month after the NICD warned that the current focus on Covid-19 has led to malaria being missed.

In December, the institute said that early symptoms of malaria and Covid-19 are similarly non-specific. These symptoms include fever, headache, fatigue, and muscle and joint pains. More severe signs and symptoms also shared between these infections include respiratory difficulties, including ARDS.  


“Unrecognised and untreated malaria can rapidly progress to severe illness with high mortality. It is mandatory to check for malaria in all persons presenting with fever and ’flu-like illness, if they are resident in, or have travelled within the last six weeks from, a malaria-risk area, regardless of suspected Covid-19 condition, pending Covid-19 tests or even a positive test,” the NICD alert said

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Chris Bateman
Chris Bateman is a freelance journalist

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