On two cases of atypical respiratory distress in eastern Democratic Republic of the Congo months before the COVID 19 pandemic was declared: Could SARS Cov 2 have been already spreading? Case report

Background: Predictions have been made that Africa would be the most vulnerable continent to the novel coronavirus disease 2019 (COVID-19). Interestingly, the spread of the disease in Africa seems to be slower than in many parts of the World. Among possible hypotheses, some parts of Africa may have undergone a “silent” COVID-19 epidemic and acquired a herd immunity before the official declaration of the disease in December 2019.Case presentation: We report two cases (one 55-year-old man and one 25-year-old woman) of acute respiratory distress secondary to atypical pneumonia in Bukavu, in eastern Democratic Republic of the Congo (DRC) which occurred between September and December 2019, before the official beginning of the COVID-19 pandemic. One patient had returned from China and the other had close contacts with travellers from China in the 2 weeks prior to the onset of symptoms. In either case, the aetiology could not be accurately determined. However, the two cases presented a clinical picture (progressive dyspnoea, preceded by dry cough and fever) and laboratory changes (procalcitonin within the normal range, slight inflammation, and lymphopenia) compatible with a viral infection. The chest X-Rays series of the first patient showed lesions (reticulations, ground glass, and nodules ≤ 6 mm) similar to those found in COVID-19. In addition, unlike the 25-year-old female patient who had no comorbidity, the 55-year-old male patient who had hypertension as comorbidity, developed a more severe acute respiratory distress which progressed to death.Conclusion: These cases bring to the attention a number of facts which make us suspect that the COVID-19 epidemic may have already been present in the region months before the official beginning of the pandemic.