Epidemiology of COVID-19 in Misrata, Libya: A Population-Based Surveillance Study

Background: The prevalence of SARS-COV2 in Libya is unclear; PCR is still under-performed. Although lockdown measures have been in place for weeks, there is no prevalence data to support the gradual lifting of such lockdowns. SARS-COV2 IgM/IgG is emerging as potential alternatives to PCR testing, and many counties and towns have undertaken such seroprevalence studies. Objective: Prevalence of SARS-COV2 in Misrata, Libya amongst the population as a whole. Materials and Methods: The study was prospective, cross-sectional, population-based, and age-stratified, to assess SARS-COV2 IgM/IgG in the population of Misrata. It was carried out between the 18th and 21st of April, 2020. Results: A representative sample of 897 participants was tested for SARS-COV2 IgM/IgG antibodies. 30 participants were positive for IgM or IgG indicating a prevalence of 3.4% (95% CI, 2.8% - 5.2%), with eight (0.9%) IgM positive and 22 (2.4%) IgG positive. Accordingly, 9075 (95% CI, 6586 - 14,170) people are estimated to have had a current or recent COVID-19 infection, symptomatic or asymptomatic. Conclusion and Recommendations: Serological testing as a diagnostic or surveillance tool may uncover a large proportion of asymptomatic individuals in the community, far outnumbering PCR. The authors highly recommend further precautionary public measures, as well as an ongoing surveillance programme to monitor the epidemiological trends of the disease in the city of Misrata and Libya in general.