**8. Conclusions**

Malaria and COVID-19 may have similar aspects and seem to have a strong potential for mutual influence. They have already caused millions of deaths, and the regions where malaria is endemic regions are at risk of suffering from the consequences of COVID-19 due to mutual side effects, such as less access to treatment for patients with malaria due to the fear of access to healthcare centers leading to worse outcomes and diagnostic delays. Moreover, the similar and generic symptoms make it harder to achieve an immediate diagnosis. Healthcare systems and professionals will face a grea<sup>t</sup> challenge in case of a syndemic [56,57]. The role of young health professionals, well-motivated and trained in primary care, will also be essential [58] in countries with a high burden of malaria.

In patients with symptoms such as fever, fatigue, and headache, both malaria and COVID-19 tests should always be performed. According to recent WHO recommendations [59], in the case of challenges due to the COVID-19 pandemic (e.g., supply chain disruption for RDTs, health worker absenteeism, shortage of personal protective equipment) a malaria diagnosis should be considered for all fever cases in endemic countries. On the other hand, patients with COVID-19-related symptoms that negative for malaria must undergo isolation to exclude COVID-19 until repetition of the virological sample, thus reducing the potential risk of transmission.

Even though a COVID-19 outbreak may not occur in the malaria-endemic regions, the WHO has called for ministries of health and national malaria control programs to ensure that malaria control efforts are not disrupted while facing the COVID-19 response [59,60]. Preparedness is the key to tackling any public health crisis, and malaria-endemic countries need to be prepared for the challenges COVID-19 could pose. Finally, from a global perspective, it is necessary to increase and join efforts in order to develop an effective vaccine and it make available for everyone, as this would be the most effective preventive measure for both diseases.

**Author Contributions:** F.D.G. and C.M. conceived the idea; Methodology, F.D.G. and C.M.; Validation, F.D.G., C.M., P.L., D.P., G.P.; Formal writing—original draft preparation, F.D.G., C.M., Writing—review and editing, C.M., G.P., All authors reviewed the literature, drafted and critically revised the manuscript, and approved the final version before submission. All authors have read and agreed to the published version of the manuscript

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
