key: cord-0913604-hl6wxd4y
authors: Ribeiro, Victoria Stadler Tasca; Telles, João Paulo; Tuon, Felipe Francisco
title: Arboviral diseases and COVID‐19 in Brazil: Concerns regarding climatic, sanitation and endemic scenario
date: 2020-05-28
journal: J Med Virol
DOI: 10.1002/jmv.26079
sha: 4d68de615a0062fd8222f649a65c49f63a433871
doc_id: 913604
cord_uid: hl6wxd4y

Brazil is witnessing a massive increase of COVID‐19 cases and may face some difficulties, not only regarding to other respiratory pathogens, but also to other relevant issues parallelly occurring, for instance, the beggining of autumn and winter seasons, which provides a longer period with high transmissibility of respiratory viroses. Additionally, Brazil is localized in a geographical tropical area with relevant arboviral diseases, where Dengue fever presented highest incidence during March‐June, mainly at Southeast and Midwest regions, where probably it will occur overlapping curves of arboviruses and COVID‐19, which will overload our public health system. The main affected áreas by COVID‐19 in Brazil were the same that presented 66% of the Dengue fever cases in Brazil. Moreover, it is importante to highlight the difficulty found to distinguish Dengue fever and COVID‐19 and its implications, which present similar laboratorial and clinical characteristics. Besides that, it has been pointed out false‐positive results in serological tests for Dengue fever, which later were confirmed as COVID‐19. These issues demand urgent attention,once they culminate in serious and devastating impacts in the Brazilian health system, public health, and social conditions. This article is protected by copyright. All rights reserved.

To the Editor, Coronavirus disease-19 (COVID-19) has emerged in Latin America in a different scenario from North America, Asia, and Europe. COVID-19 was officially first described in Brazil in São Paulo, on February 26 th 1 . Since then, progressively, Brazil has been witnessing a massive and concerning increase on the COVID-19 incidence curve, which threatens the Brazilian's health, economic and social conditions in many ways. We read with interest the recent commentary paper by Blasco et al. 2 , which points out the occurrence of other respiratory coinfections, considering the different periods of the year (seasons), and the possibility of a viral interference phenomenon.

Nevertheless, here we discuss and raise awareness of some difficulties that Brazil may face during the COVID-19 pandemic, not only regarding to other respiratory pathogens, but also to other relevant issues parallelly occurring in Brazil: (I) Brazil is in the middle of the autumn season (March 21 st to June 20 th ) and winter season will end only on September 22 nd . This climatic scenario provides a longer period with high transmissibility of respiratory viruses (for instance, Influenza A H1N1 and H3N2, Influenza B), parallelly.

Besides, (II) Brazil is localized in a geographical tropical area with relevant arboviral diseases. In 2019 Dengue fever presented highest incidence during March-June, mainly at Southeast and Midwest regions. Number of cases and incidence per 100.000 habitants during 2019 of dengue fever were 1.544,987 and 735, respectively, while chikungunya and zika fever presented 132,205 and 10,768 cases 3 . In Brazil, probably it will occur overlapping curves of arboviruses and COVID-19, which will overload our public health system 4 .

In addition to that, (III) regarding Intensive Care Units (ICU), there are only 2,2 ICU beds per 10,000 habitants and disparities exist between different Brazilian regions and public versus private health systems according last surveillance in 2020 5 . Public health system has 1,4 ICU beds per 10,000 habitants, while private health system 4,9 ICU beds per 10,000 habitants. The North Brazilian accounts for 4,3% of the total ICU beds in Brazil, while Southeast accounts for more than 50%.

After SARS-CoV-2 infection, ICU occupation rate increased progressively. São Paulo, the state most affected by COVID-19 in Southeast region, presents 74% of ICU occupation, while São Paulo City, the capital of the state, 90% (until May 24 th , 2020) 6 Another point that should be highlighted is the (V) difficulty found to distinguish Dengue fever and COVID-19 and its implications, which present similar laboratorial and clinical characteristics. Besides that, it has been pointed out falsepositive results in serological tests for Dengue fever, which later were confirmed as COVID-19 12 . A major concern must be raised for the high incidence of arboviruses in peripherical areas and low-income communities in Brazil (i.e. slums), concomitant to COVID-19 dissemination, once sanitation and hygiene measures and medical access are scarce.

It is important to raise awareness about the possible different COVID-19 impacts in Brazilian health system when considering concomitant endemics such as caused by arboviruses and the respiratory diseases that a high transmissibility of other respiratory viruses are linked to. These issues demand urgent attention, once infection cases and deaths caused by COVID-19 remain underdiagnosed due to a lack of resources 13 , and arboviruses epidemic is a reality, which may culminate in a higher SARS-CoV-2 dissemination in Brazil with serious and devastating impacts in the health system, public health, and social conditions.

COVID-19 in Latin America: The implications of the first confirmed case in Brazil. Travel Medicine and Infectious Disease

Co-detection of respiratory pathogens in patients hospitalized with Coronavirus viral disease-2019 pneumonia

Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue, chikungunya e Zika), Semanas Epidemiológicas 01 a 52

COVID-19 and dengue fever: A dangerous combination for the health system in Brazil. Travel Medicine and Infectious Disease

AMIB apresenta dados atualizados sobre leitos de UTI no Brasil

Ministry of Health, Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue

Covert COVID-19 and false-positive dengue serology in Singapore. The Lancet Infectious Diseases

Substantial Undocumented Infection Facilitates the Rapid Dissemination of Novel Coronavirus (SARS-CoV-2)

None.

F. F. Tuon is a CNPq researcher. The other authors declared no competing interests.