key: cord-0762507-wfebx7ur authors: Mehmood, Qasim; Tahir, Muhammad Junaid; Jabbar, Abdul; Siddiqi, Ahsun Rizwan; Ullah, Irfan title: Crimean–Congo hemorrhagic fever outbreak in Turkey amid the coronavirus disease 2019 (COVID-19) pandemic; a debacle for the healthcare system of Turkey date: 2021-07-26 journal: Infect Control Hosp Epidemiol DOI: 10.1017/ice.2021.343 sha: 5ac78e783eada00f911a880808338f0b3ef7e28d doc_id: 762507 cord_uid: wfebx7ur nan areas and the people working in livestock industries, agricultural fields, slaughterhouses, and veterinary farms. 3 COVID-19 was declared a global pandemic by the World Health Organisation (WHO) in March 2020. 6 The first human case of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection was detected in Turkey on March 11, 2020 , according to the Daily Sabah. As reported by the Health Ministry of Turkey on June 28, 2021, Turkey had had >5.4 million confirmed COVID-19 cases, along 49,634 deaths from the virus. A mass vaccination program against COVID-19 began in Turkey on January 14, 2021, after the emergency use of the Chinese Sinovac vaccine was approved by the authorities. More than 33,380,000 people of Turkey have now been vaccinated against SARS-CoV-2. 7 Total or partial lockdowns imposed in different regions of the world due to the COVID-19 pandemic have resulted in various epidemics of arboviruses in many countries like Brazil, 8 Kenya, 6 and Asia. 9 The continuous attention of public health authorities toward COVID-19 and the lack of vigilance toward other infectious agents has led to frequent outbreaks in various countries. Healthcare systems in different countries have been exhausted while dealing with the COVID-19 pandemic, which has led to various challenges for healthcare authorities. 6 The emergence of CCHF in Turkey amid the COVID-19 pandemic has presented various challenges. Recently it has been reported that COVID-19 and CCHF present with similar clinical symptoms and computed tomography (CT) findings. Thus, special care should be adopted while dealing with suspected individuals who present with these clinical symptoms. A typical COVID-19 patient presents with fever, weakness, dry cough, dyspnoea, and loss of smell and taste. Common presentations of CCHF include fever, myalgia, ecchymosis, and extensive hemorrhages. So, CCHF should be included in the differential diagnosis, especially in patients with evidence of ground-glass opacities on chest CT scans in endemic areas. 10 In Turkey, a female patient was infected with both SARS-CoV-2 and CCHF at the same time. She presented with high-grade fever, fatigue, and respiratory insufficiency, and a treatment process was started first for SARS-CoV-2 and then supportive treatment was given for CCHF. The patient was fortunate enough to recover from both. If extra attention was not given to her case, she would have been treated only for COVID-19 and CCHF would have been overlooked. 11 Training programs for physicians and healthcare workers (HCWs) are necessary to enhance their awareness regarding early diagnosis, management, and prevention against CCHF. 12 When all the available healthcare services in Turkey are engaged in dealing with COVID-19 patients, managing patients infected with CCHF is challenging. CCHF patients frequently need hospitalization in well-resourced intensive care units (ICUs), easy availability of blood and blood products, and proper modes of isolation. CCHF patients also need mechanical ventilation in severe cases, which presents challenges because patients with severe COVID-19 infection also require ventilatory support. 1 CCHFV can also be transmitted to HCWs dealing with CCHF patients due to inadequate use of N95 masks, improper hand hygiene, and inappropriate removal of gloves, gowns, and masks after handling blood or tissue products of infected patients. The WHO should collaborate with the Ministry of Agriculture and Forestry of Turkey to arrange programs to eradicate the tick population in areas where a high number of CCHF cases have been reported. Prevention measures against CCHF outbreaks in Turkey should focus on the education of individuals at increased risk of infection and the supply of personal protective equipment (PPE) to the at-risk population. Awareness campaigns regarding personal protective measures should be encouraged among the general public to avoid tick bites. People should be advised to wear light-colored clothing covering both arms and legs and to use insect repellents to minimize exposure to tick bites. Integration between clinicians and public health workers is required to control all aspects of the outbreak and to manage the growing health crisis in the country. Crimean-Congo hemorrhagic fever in Turkey: current status and future challenges Crimean-Congo hemorrhagic fever in Turkey Turkey records 13 Crimean-Congo hemorrhagic fever deaths year to date. Outbreak News Today website Zoonotic virus kills 13 since January in Turkey. Daily Sabah website Crimean-Congo hemorrhagic fever virus: advances in vaccine development Rift Valley fever and COVID-19 outbreak in Kenya: a double whammy COVID-19 in Brazil: the danger of overlapping crises COVID-19 and dengue: double punches for dengue-endemic countries in Asia COVID-19 and Crimean-Congo hemorrhagic fever: similarities and differences COVID-19 patient, beats both. Daily Sabah website Potential of Crimean-Congo hemorrhagic fever outbreak during Eid Ul-Adha Islamic festival and COVID-19 pandemic in Pakistan Acknowledgments.Financial support. No financial support was provided relevant to this article. All authors report no conflicts of interest relevant to this article.