key: cord-0922273-txajtv11
authors: Hasan, Mohammad Mehedi; Costa, Ana Carla dos Santos; Xenophontos, Eleni; Mohanan, Parvathy; Bassey, Esther Edet; Ahmad, Shoaib; Essar, Mohammad Yasir
title: Lassa fever and COVID‐19 in Africa: A double crisis on the fragile health system
date: 2021-07-06
journal: J Med Virol
DOI: 10.1002/jmv.27169
sha: ce15cb602a3db6f1df124929ad6bf6f2edbaa86c
doc_id: 922273
cord_uid: txajtv11

Lassa fever is an acute zoonotic disease endemic in the African continent. The COVID-19 pandemic has aggravated this situation, as it has increased the fragility of African health systems and redirected resources from other diseases to fight the pandemic. Associated with this, the similarity of symptoms between lassa fever and COVID-19 led to the misdiagnosis of both diseases and the lack of epidemiological control of these on the continent. Multidisciplinary measures involving the multiple spheres of society are indispensable to deal with the challenges of the endemic lassa fever during COVID-19 pandemic and in a post-COVID era. This article is protected by copyright. All rights reserved.

COVID-19 in Nigeria is at 56,256 affirmed cases with 1082 deaths across the country, though LF comes to 1078 affirmed cases with 225 deaths. 9 The yearly hike of human cases is more often than not watched amid the dry season (December-April) taking after the generation cycle of the vector within the monsoon season (May-June). This repetitive transient pattern related to LF implies that the pandemic started shortly after LF peaked in Nigeria, resulting in a double crisis of COVID-19 and LF. Amid epidemiological Week 9 of 2020, when the first affirmed case of COVID-19 was recorded in Nigeria, there was an increase in the number of affirmed LF cases. The expanded number of cases from the 2019 LF plague brought about the early rise of LF in 2020. 9 In 2007, almost 6% of febrile adults and 3.5% of intensely febrile sick children in endemic ranges have affirmed infections. Indeed, with steady care and treatment with ribavirin, case fatalities were still as high as 24%-33% in tertiary clinic settings in recent times whereas almost 13.5% of survivors have sensorineural hearing loss. Also, LF accounts for almost 22% of hospital maternal mortality in endemic ranges.

Unfortunately, LF control was quite ignored in Nigeria. This disappointment permitted the episodes to gain in recurrence and seriousness with numerous deaths, which also included healthcare workers. 10 The extent of cases shifted from 37% to 82% within the first quarter, 8%-30% within the second quarter, 6%-22% within the third quarter, and 11%-33% within the fourth quarter. The extent of cases within the to begin with quarter was less than 50% in 6 of the Ogun (1). 12 The situation is complicated due to the similarity within the clinical picture of COVID-19 and LF, making the misdiagnosis at the onset of both illnesses with a critical chance with an expanded probability of coinfection. The underdiagnosis due to the overlap of symptoms between COVID-19 and other infectious diseases, such as Dengue, Typhoid were also identified in other low-income countries, such as Pakistan and India. 13, 14 The official declaration of COVID-19 as a pandemic had further demonstrated the urgency of taking action globally. Yet in the case of Nigeria, resources directed for containing the COVID-19 pandemic had to be compromised for fighting diseases with higher rate fatality ratio, such as LF. 15 Therefore, healthcare professionals, policymakers and researchers assisted by international institutions should pay special attention to monitoring both diseases.

Given that the host of LFV is a rodent found in houses and surrounding fields and that there's no prophylaxis for LF; prevention can only be achieved through educating people living in endemic areas on ways to protect themselves from LF. 16 Good "community hygiene" should be encouraged by providing of rodent-proof containers and means for maintaining clean households and forming dump away from houses. 10 When it comes to the healthcare sector, early differential diagnosis should take place by testing febrile patients with COVID-19 PCR testing to confirm the cases and proceed to the appropriate treatment. To ensure preparedness of health institutions in control of LF and COVID-19, it is important to follow the written protocol of managing infectious diseases for achieving optimal safety precautions for the management and control of infectious diseases. 17 

Lassa fever diagnostics: past, present, and future

Lassa fever: epidemiology, clinical features, diagnosis, management and prevention

Vaccine platforms for the prevention of Lassa fever

Dengue and COVID-19: a double burden to Brazil

Chikungunya and COVID-19 in Brazil: the danger of an overlapping crises

COVID-19 And Zika: an emerging dilemma for Brazil

The spread of Yellow fever amidst the COVID-19 pandemic in Africa and the ongoing efforts to mitigate it

Statista. Nigeria: cumulative coronavirus cases, by state 2021

Coepidemics: have measures against COVID-19 helped to reduce Lassa fever cases in Nigeria? New Microbes New Infect

Preparedness of Nigerian Health Institutions toward managing Lassa fever epidemic and COVID-19 pandemic

WHO. Lassa fever -Nigeria. 2020

A skeleton in the closet: the implications of COVID-19 on XDR strain of typhoid in Pakistan

Dengue amidst COVID-19 in India: the mystery of plummeting cases

Is the COVID-19 pandemic masking the deadlier Lassa fever epidemic in Nigeria?

Risk maps of lassa fever in West Africa

Preparedness of Nigerian health institutions toward managing lassa fever epidemic and COVID-19 pandemic

Acting now to strengthen Africa's health systems