key: cord-0792725-wrfm1wy0
authors: Rana, Muhammad Suleman; Alam, Muhammad Masroor; Ikram, Aamer; Zaidi, Syed Sohail Zahoor; Salman, Muhammad; Khurshed, Adnan
title: Co‐circulation of COVID‐19 and dengue: A perspective from Pakistan
date: 2020-09-29
journal: J Med Virol
DOI: 10.1002/jmv.26567
sha: b8985b24579db4beb5325a604d792cd3efc88207
doc_id: 792725
cord_uid: wrfm1wy0

COVID‐19 was first reported in Wuhan, China in December 2019, and has now become a serious public health threat for 213 countries across the globe. As of September 3, 2020 the global toll of confirmed COVID‐19 cases surpassed 26 million including 0.8 million deaths[1]. This article is protected by copyright. All rights reserved.

In Pakistan the total number of COVID-19 cases rose to 297,014 including 6,328 deaths as of September 3, 2020 [1] . Unfortunately, the endemicity of dengue in Pakistan has been sustained for decades with the history of repeated dengue epidemics. According to the Ministry of National Health Services, Regulations and Coordination, a total of 1,32,977 confirmed dengue cases including 588 deaths have been documented between 2010 to 2019 [2] . During 2019, dengue epidemic in Pakistan, 52,485 confirmed dengue cases including 91 deaths [3] have been reported as compared to 3,204 cases and 2 deaths in 2018 [2] . It is estimated that the actual number of dengue cases can be much higher as the majority of infected individuals remain asymptomatic. Surprisingly, during the Month of March 2020, more than 416 confirmed dengue cases have been detected indicating an earlier onset compared to the post-monsoon peak season [4] . A total of 384 dengue cases were reported from Sindh province of Pakistan including 354 (92%) from Karachi city which is considered as an epicenter of dengue outbreaks for the last 30 years [5] . During the Month of July, 2020, more than 70 confirmed dengue cases were reported from Lahore city of Punjab province, considered as another major hotspot for dengue epidemics since 2010 [6] . During the Month of August, 3 confirmed dengue cases were reported from Peshawar city of Khyber Pakhtunkhwa province and 123 confirmed cases from Baluchistan province (NIH unpublished data). It is speculated that the number of confirmed dengue cases may rise This article is protected by copyright. All rights reserved.

tremendously due to lack of surveillance and diversion of entire efforts towards fight against COVID-19. Dengue cases in Pakistan start to appear at the beginning of monsoon season and peak between September and October each year. This year, however, dengue cases co-appeared with the COVID-19 infections and may lead to a serious public health crisis calling for cautiously assessment of the resource allocations and practice timely interventions to reduce the virus spread and restrict further transmission. Notably, dengue and COVID-19 present similar characteristics and could not be differentiated clinically.

Pakistan and results of the study showed that the rate of mortality is comparatively higher in COVID-19 patients co-infected with dengue compared to only COVID-19 patients and the significant difference in the hematological and biochemical markers between the co-infected and mono-infected COVID-19 patients was noted. Severe thrombocytopenia was observed in the co-infected patients as compared to the mono-infected COVID-19 patients. The high percentage of bilirubin, ALT, creatinine, prothrombin time, urea and CPK was noted in the coinfected group [7] . The co-infection of COVID-19 and dengue has already been reported from other countries such as Brazil, France and India [8] [9] [10] [11] . For the country like Pakistan with weakened health care system, infectious diseases have always remained a significant challenge augmented by the emerging and re-This article is protected by copyright. All rights reserved.

emerging pathogens after every few years. Community-driven interventions have always remained a high priority to combat challenges like COVID-19 and dengue to complement traditional surveillance and response approaches. Finally, the health authorities should prioritize nation-wide measures to control COVID-19 and dengue epidemics in the country by implementing intensified surveillance to assess drivers of COVID-19 and dengue spread, rapid and accessible diagnostic screening and coordinated efforts for real-time data-driven decisions.

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Prevention and control of escalating dengue epidemics in Pakistan

PAKISTAN CONFIRMS 416 DENGUE CASES IN 2020! Available at

PCPD reports 28 more dengue cases in Karachi:Available at

As Punjab records 70 dengue cases in 30 days, state may not be prepared for another outbreak

Emergence of co-infection of COVID-19 and dengue: A serious public health threat

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All authors declared that there are no conflict of interests.